Dialogues

Oct 23, 2024, 10:41

Beyond the Cancer Diagnosis: Dialogue with Maryam Lustberg, by Adrian Pogacian

In the latest episode of ‘Beyond the Cancer Diagnosis’, Adrian Pogacian speaks with Dr. Maryam Lustberg about the persistent challenges of breast cancer, discussing why it remains aggressive despite technological advances and highlighting the psychosocial impact on patients during Breast Cancer Awareness Month.

Maryam Lustberg MD MPH is a breast medical oncologist and currently serves as Chief of Breast Oncology and Director of the Breast Center at Yale Canc er Center in New Haven Connecticut. She is the co-chair of Symptom Intervention for Alliance Clinical Trials and is immediate Past President of MASCC, an international organization devoted to improving cancer supportive care throughout the globe.

Clinically she treats men and women with all stages of breast cancer with a focus on personalizing all aspects of cancer care incorporating latest advances in therapeutics as well as optimization of symptom management strategies and delivery of holistic person centered care. Her research is centered on biomarkers of therapeutic response and cancer treatment related toxicities.

Adrian Pogacian, MS Psychology, clinical psychologist with executive education in Psycho-oncology, holding a degree in Global Health Diplomacy from Geneva Graduate Institute. Currently, researcher and associate lecturer with focus on Impact of Cancer Diagnosis on Couples and Families, Communication in Cancer Care and Posttraumatic Growth. His expertise is on Coping with Cancer and managing Fear of Recurrence.

Additionally, Founder of INCKA Psycho-oncology Center, Host of Beyond the Cancer Diagnosis Interview Series as well as Writer and Host Content in Psycho-oncology at OncoDaily.com, co-author of the first Romanian Multimodal Care Guideline in Pediatric Onco-hematology, active contributor to the International Psycho-oncology Society, presently IPOS Fear of Cancer Recurrence SIG member and IPOS Early Career Professionals in Psycho-Oncology Committee founder member.

The challenges of breast cancer in an age of many technologies

Adrian Pogacian: Dr. Maryam Lustberg, October is Breast Cancer Awareness Month and, unfortunately, the 2024 statistics fail to look in positive outcome. Hence, I am asking you as a doctor, why do you think that Breast Cancer it’s still so aggressive?

Maryam Lustberg: There is still a lot we do not fully understand about the biology of breast cancer and although treatments continue to improve, they still have significant gaps. For example, there are a subset of triple negative tumors that fail to respond to our current chemotherapy and immunotherapy combinations. Another gap is that a third or more of hormone receptor positive tumors with high-risk features can have late recurrences years from diagnosis. Additionally, there are persistent inequities in care and access to screening as well clinical care that also significantly impact disparities in outcomes.

Adrian Pogacian: You are renowned for your patient-focused care, therefore I would like to ask you what are the psychological aspects to consider in Breast Cancer?

Maryam Lustberg: No one individual is the same and there are so many factors that impact cancer care needs at the personal level. Our non-cancer health history, prior experiences with health care systems and our social support networks play a tremendous role in how individuals experiences the diagnosis of breast cancer as well as the subsequent treatments they receive.

The diagnosis of breast cancer can be frightening and life changing. Depending on what else is going on our lives and what types of past experiences or traumas we have had, the psychological aspects of hearing about the diagnosis can feel very differently across individuals.

Adrian Pogacian: Additionally, what is the psychosocial impact of Breast Cancer? It is well known that body image and sexuality are sensitive issues for women who have been diagnosed with this type of cancer.

Maryam Lustberg: Multiple impacts can be felt form a breast cancer diagnosis from existential questions and feeling one’s mortality to direct effects on many physical and emotional domains. Given the nature of breast cancer treatments, body image and sexual health can definitely be impacted. Early abrupt menopause is common as a consequence of many of our therapies and can be quite disruptive to emotional and physical wellbeing.

Although we do have options to help through a variety of interventions, including pharmacologic and non-pharmacologic, it can be a lot to go through. I think as a community acknowledging the hardness of these challenges is important. Many patients still feel they are the ones struggling. Normalizing discussion of all these issues is crucial.

Adrian Pogacian: Consequently, what are the coping strategies that you recommend for the patients and how hard is for them to learn these coping mechanisms?

Maryam Lustberg: I think a therapeutic relationship with the oncology team is quite important. Patients need to feel comfortable sharing their fears and concerns openly. Looking for the right fit for your team is one of the most important things I would recommend.

Additionally, if you do have support systems whether family or friends, speak up about what you specifically need because they often don’t know and are guessing how to be helpful. You might need to be listened to without solutions being given or maybe you need groceries or dinner prepared on day of treatment. Telling them what you need helps you and helps them.

There are a few simple things you can do for yourself throughout the day. These include simple deep breaths, short meditations, walks in nature, paying attention to small beautiful details of daily living that we often ignore. All of these can help ground you and are very effective coping strategies in times of stress and anxiety.

Therapy sessions with a trusted counselor that you can connect with are also very soothing and helpful while coping with cancer treatments. These can be virtual or in person.

Adrian Pogacian: A crisis situation such as a Breast Cancer diagnosis can disrupt the family structure and affect the quality of life and well-being of all family members, because it is the first line of support for the adaptation of the patient to the diagnosis, treatment and all the oncological trajectory that she/he has to go through. From your experience, how difficult is for the other family members (especially children) to get over this hard life experience?

Maryam Lustberg: Children may experience a variety of emotions when dealing with a parent’s cancer treatment, including fear, sadness, and confusion. Acknowledging their feelings and providing them with the support they need to cope is essential. The strategies should be tailored to the age of the child as well their unique needs.

Some strategies include be open with age-appropriate honest information sharing about the diagnosis and treatments; keep lines of communication open; and stick to routines as much as possible since these are particularly to younger children. Additional helps is also available for parents by way of cancer program social workers and therapist to help navigate how to support their children during this time of crisis.

Some children may also benefit from developing a therapeutic relationship with a counselor that specializes in the care of children with parents undergoing cancer treatment. Although the experience can be difficult, I have seen multiple times that children are quite resilient and can do very well particularly when a few of the above strategies are utilized.

Adrian Pogacian: How about couples? Does the partner show sadness or hope? Have you seen cases of broken relationship after such a diagnosis?

Maryam Lustberg: Just as the experience is quite individual for the person diagnosed, how a partner experiences the diagnosis can be quite variable. A range of emotions can be felt including fear, anger, and sadness as well as hope for overcoming this challenge as a couple.

Many partners feel a tremendous responsibility to keep their emotions under the surface and be the careful inspectors of the health care processes that their partners undergo. This can feel quite stressful and anxiety producing depending on what other factors are active in their personal lives. Some couples feel closer. Others do not and the experience of going through a life-threatening diagnosis uncovers other major issues in the relationship.

Studies conducted to date do not show increased rates of divorces in those couples with a breast cancer history. (Fugmann et al Frontiers, 2022). Take home message is that every couple is unique just as every patient is. Additional support services for caregivers may be of benefit particularly when there is ongoing treatment in advanced cases of breast cancer.

Adrian Pogacian: As regards the last question, how important are awareness, prevention and psycho-oncological education with focus to Breast Cancer?

Maryam Lustberg: Pyscho-oncology support is part of breast cancer care. The sooner we all recognize that good care requires holistic care of the individual and their families which included mental, physical and spiritual support, the better our care will be. There is so much fragmentation in how care is delivered and I hope one day we can bring all these dimensions of care together. One way is through education and acknowledgment of what we are missing when we fail to do this more comprehensive approach.

Previous editions of “Beyond The Cancer Diagnosis”

Edition 1: Beyond The Cancer Diagnosis: Psycho-Oncological Aspects Of Kate Middleton’s Diagnosis

Edition 2: Beyond The Cancer Diagnosis with Sonia Amin Thomas – Survivorship

Edition 3: Beyond The Cancer Diagnosis: Dialogue with Wendy Lam, Hosted By Adrian Pogacian

Edition 4: Beyond The Cancer Diagnosis: Dialogue with Camille Moses, Hosted By Adrian Pogacian

Edition 5: Beyond The Cancer Diagnosis: Dialogue with Tihana Gašpert, Hosted By Adrian Pogacian

Edition 6: Beyond The Cancer Diagnosis: Dialogue with Amanda Balakirsky, Hosted By Adrian Pogacian

Edition 7: Beyond The Cancer Diagnosis: Dialogue with Dr. William Breitbart, Hosted By Adrian Pogacian

Edition 8: Beyond The Cancer Diagnosis: Dialogue with Dr. Alberto Costa, Hosted by Adrian Pogacian

Edition 9: Beyond the Cancer Diagnosis: Dialogue with Prof. Sophie Lebel, Hosted by Adrian Pogacian

Edition 10: Beyond the Cancer Diagnosis: Dialogue with Darren Haywood, hosted by Adrian Pogacian

Edition 11: Beyond the Cancer Diagnosis: Dialogue with Sarah, Hosted by Adrian Pogacian