Ashley Johnson, a nurse practitioner at the Vanderbilt Breast Center, talks about the psychological effects of being diagnosed with breast cancer. She also addresses the unique emotional challenges women face and the continuing challenges after treatment.
Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I'm Rosemary Cope with Work/Life Connections. My guest today is Ashley Johnson, who is a Nurse Practitioner at the Vanderbilt Breast Center. Ashley is a graduate of the University of Memphis and completed her Master's in Nursing at Vanderbilt. Many people vividly remember how they felt when they were told they had breast cancer. Whatever your initial feelings, you may go on to experience several different emotions over time. Ashley, would you talk about the psychological effects of being diagnosed with cancer?
Ashley Johnson: Yes, ma'am. Thank you so much for having me. As a Nurse Practitioner here at The Breast Center, I see new patients when they come for evaluation of an abnormal mammogram or a lump, and I am often the one that calls them with the results of a breast biopsy that would show breast cancer. So, in many cases, even if somebody is expecting this news, I often see that they are stunned. You know, they are in shock initially. They are trying to hear the new information and assimilate what that means for them and their family. I think each person responds to the diagnosis differently. Many women go through stages of denial, shock. Some people are very angry. You know, they feel like this is not fair, wonder why me, why now. Patients can experience increased stress, depression, anxiety, grief. The diagnosis can be extremely stressful. I think all of those are very reasonable, common things that people experience. I think one of the other strong things that women feel is just a sense of fear, you know, fearful of the unknown, fearful of what does this mean for my family, fear of death. I think people experience loss, you know, fear of losing a part of their body, loss of their job, loss of relationships that they have, but I would also say that not all the emotions that people experience are negative. I think that sometimes after somebody has accepted their diagnosis, if they have developed a good treatment plan, they can maybe recognize social support systems that they have. You know, I think some people can feel a sense of hope, a sense of fighting, you know, and they can feel strong bonds with other survivors or even with their treatment team. So, I think you see a wide, wide range of different effects.
Rosemary Cope: Well, that's great information. You know, I hadn't thought about the somewhat positive part of that, that sense of determination to fight or that sense of hope or that sense of support from other people who are experiencing similar things and that, that is hopeful.
Ashley Johnson: It is. I think we have a really unique center and I think whenever patients come to us, specifically, or any other center, hopefully in many cases now people are diagnosed early stage, and breast cancer, in many cases, is treatable and curable, and when you can hear all that information and recognize the plan and know what's ahead, I think that's when people feel the most hopeful.
Rosemary Cope: Do women with breast cancer face unique, emotional challenges, as opposed to people with other types of cancer?
Ashley Johnson: I think certainly so. You know, breast cancer is diagnosed in women of really all ages, I think most commonly, you know, postmenopausal women, but it can be very young women, you know, as well. So, you know, you think about younger women sometimes are raising children and working full-time and you know, they are in a caregiver role, but even all age women, you know, can be caring for children or aging parents, whether retired or working. So, I think a lot of the challenges that we see might be related to kind of the phase of life. I also think sometimes the emotional challenges, it might relate to the stage of the cancer and the treatment that you are faced with, that some women, you know, caught early stage, they might be facing treatment for a few months versus someone at a later stage or metastatic. You know, they could be facing lifelong treatment and their emotions may vary widely, depending on what is faced. I think breast cancer patients really do face emotional challenges with their body image that, you know, for all women, and so much in our culture, your breast is so much a part of you and your sexuality. So, I think they can really, really struggle with integrating that, and then, with all cancer, there is always a fear of financial need and emotional challenges associated with the finances of treatment.
Rosemary Cope: Are there continuing emotional challenges even after treatment, maybe something that we wouldn't think about? Oh, the treatment is over. Everything is fine. But there are some other things to consider, aren't there?
Ashley Johnson: Absolutely. I think a lot of times women initially are just so shocked and they are just going from appointment from appointment trying to get over this, or get through this, that finally when the dust settles and they are clear, you know, "cleared," so to say, that is almost like more of an emotional time, that then they have this strong fear of recurrence. You know, many women may have had to make transitions at home or with work and now they are trying to redefine what is their new normal. You know, what does that look like? You know, they are transitioning from a time of active treatment to being a survivor and what does that mean with lifestyle choices? People might reevaluate - what is the best diet for me now? You know, do I want to start exercising? Do I want to change something in my life? You know, many women might use this as kind of a wake-up call, that they think - am I really in the career that I have always wanted? You know, what am I doing with my family? Am I meeting the goals I have always thought that I wanted to meet? But it can be a really, really welcome time to transition into survivorship, but there are struggles associated with it, too, and I think whether you've been through treatment for six months or 60 years, there is always the fear of recurrence, and so, for all women, I think, you know, every headache you ever have or, you know, stomach upset, or anything that you go through, your first thought it always going to be - is this my breast cancer again? And so, you have to work, kind of work through that. But I think there's a lot of resources. We have a great survivorship clinic and there's many, many more that can help transition from active treatment into survivorship and ongoing care.
Rosemary Cope: Whatever stage of treatment I might find myself, what are some of those resources that you've just mentioned that might be available?
Ashley Johnson: There is a wealth of resources, whether it is internally, locally, or nationally. Within Vanderbilt, you know, obviously we have The Breast Center, where I am. We have a survivorship clinic that I mentioned. We have so many other support systems for a lot of the side effects related to breast cancer, meaning, we have a lymphedema clinic. We have physical therapists. We have a Psych/Oncology department that can help with a lot of mental health needs. We have The Center for Integrative Health that can meet with you and think about long-term things like nutrition or acupuncture, you know, many, many other resources. We have chronic pain and symptom management clinic that can be a resource or certainly the Dayani Center for health and fitness. So, there's a plethora of things internally. I also think within Nashville, there's a lot of resources with Gilda's Club is one I would mention that is excellent. You know, there are locations in Franklin and Nashville. They can help breast cancer survivors and all cancer survivors and their family members. That's a great one. I also just think, you know, just general websites like The American Cancer Society, Susan G. Komen, cancercare.org. There are so many places that you can search and maybe get some initial information and then get plugged in with support groups, more educational classes and seminars. Certainly, I think there's other resources, and even asking your provider, you know, what have been their favorite resources to refer patients to.