Coping with Advanced Breast Cancer: A Roller Coaster of Emotions


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Liz Farrell, LICSW, a clinical social worker with Dana-Farber's Breast Oncology program, talks about the various ways to cope with advanced breast cancer and how to handle fear, anxiety, anger, grief, and feelings of isolation. This presentation was given at the Metastatic Breast Cancer Forum held at Dana-Farber on Oct. 5, 2013. The program was sponsored by EMBRACE (Ending Metastatic Breast Cancer for Everyone).

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  • My name is Liz Farrell and I am one of the clinical social workers in the Breast Oncology group. As all of you know, there are many different emotions that go along with a metastatic breast cancer diagnosis and it can often feel like a roller coaster. In my work with patients there are some common themes that emerge and I’m hoping we can talk a little bit about some basic coping strategies for some of these challenges.
  • Living with metastatic breast cancer can sometimes feel very isolating, particularly because of the lack of understanding about what metastatic breast cancer is in the greater community and amongst family and friends. This can feel very frustrating and isolating and it’s important to find ways to connect with other people who understand what metastatic breast cancer is and can share this experience. One way is by attending conferences like this one today where you can see how many other people are also living with this illness. Another way is to get some individual support either from a social worker here at DFCI or from a therapist in the community. Lastly, there are support groups available. There are a number of active support groups for metastatic breast cancer in the community and we are also going to be working towards re-starting a metastatic breast cancer support group at DFCI in the new year.
  • Feelings of anxiety when you’re living with metastatic breast cancer are normal. It’s important to have some coping strategies that help you deal with some of the times during this journey that are particularly anxiety provoking. For example, I often talk with people about the importance of having some “go to” techniques that can help you to manage increased anxiety around scan times and result appointments. These are times when it can be helpful to use things like mindfulness and meditation to help calm yourself. If you’re someone who finds exercising to be a helpful way to de-stress then having a plan for increasing exercise around these times can be useful. Anxiety comes from feeling out of control and sometimes finding ways to take back some control can really help to decrease anxiety. Some ways that people living with the many unknowns of metastatic breast cancer take control is by planning for the future. It can be helpful to plan for the future by getting affairs in order when you’re doing well. This can be difficult for friends and family members to understand but it can be helpful to know that you’ve planned for the worst while still continuing to hope for the best.
  • Fear about the unknown is common and can sometimes be very overwhelming. It’s important to allow yourself to feel these feelings rather than pushing them away and then think about some ways to cope with this. I often hear from patients that they’re afraid of what will happen when they progress and how they will be able to adjust to a new tx and all of the side effects that may go along with that. It’s important to be able to talk about the things that you’re afraid of so that you can work through these emtions rather than getting stuck in them. If you keep sweeping your fears under the rug, you eventually trip on them. If you pick each one up individually and face it, you can keep moving forward.
  • It’s normal to feel angry at different points on this journey. It’s important to accept your anger and to really try and explore the cause of it. Often times anger is a cover for saddness. It is often easier to be angry than to be sad. Sometimes when people are so angry for so long, it’s really about avoiding another emotion so it’s important to explore your anger and it’s sometimes helpful to talk through your anger with a supportive listener such as a friend, relative or therapist.
  • Elisabeth Kubler-Ross’s stages of grief and discussion about continued cycling through these stages at different point in this journey
  • It can be challenging to take care of the long-term relationships in your life when you’re coping with advanced cancer. This can be relationships with a close friend, family member or partner. Sometimes when you’re living with metastatic breast cancer it can be hard to focus on other aspects of your life. This sometimes can create tension in your long term relationships and it’s important to find ways to nurture these relationships so that they do not become strained as a result of your diagnosis. One way to do this is to keep communication open with the other person and to make sure they know that they can talk with you about how hard it might be for them to cope with your diagnosis and to maintain a sense of nromalcy in your relationship. Encourage them to find their own support to cope with the impact your diagnosis might be having on them. Try and understand what this is like for the other person. Creative intimacy is another way to help nurture your relationships. This can mean several different things depending on the nature of your relationship. One thing that can sometimes really be helpful when trying to maintain important relationships is to find times that are “cancer free.” Maybe there’s an agreement that there are certain times when cancer discussions are off limits and this can give both of you a break for a while and an opportunity to talk about other things that are important to you. Things might not be the way that they were, but there can be other ways in which they are better. Sometimes the best thing for the relationship is to acknowledge to the other person that you miss the way things were and that you want to find ways of still creating connection.
  • Experiment, have fun with it.
  • Changing needs with changes in developmental age
  • This is a tough one – many patients talk about feeling invisible, particularly in the breast cancer community and during breast cancer awareness month.
  • Coping with Advanced Breast Cancer: A Roller Coaster of Emotions

    1. 1. Liz Farrell, LICSW Susan F. Smith Center for Women’s Cancers Dana-Farber Cancer Institute
    2. 2. Feeling Isolated Coping Strategy  Seek support either individually or in a group setting
    3. 3. Anxiety Coping strategies        Meditation Mindfulness Exercise Journaling Regaining a sense of control Education Spirituality
    4. 4. Fear Coping Strategies • Identify the fear • Face the fear • Talk with your team about your fears
    5. 5. Anger Coping Strategies • Accept your anger • Explore your anger • Find a supportive listener
    6. 6. Stages of Grief  Denial  Anger  Bargaining  Depression  Acceptance
    7. 7. Managing long term relationships Coping Strategies • Keep open communication • Seek support • Try to understand what it’s like for the other person • Creative intimacy
    8. 8. Appearance Coping Strategies • Take time for yourself • Find ways to make yourself feel more comfortable with changes in your appearance • Consider participating in a “Look Good, Feel Better” workshop through the American Cancer Society (
    9. 9. Finding purpose and building structure Coping Strategies • Create a structure for your day even if you’re no longer working • Find something creative to do • Set short and long term goals • Try something new
    10. 10. Managing information with children Coping Strategies • Open communication • Regular check-ins • Sharing information with teachers, counselors, coaches • Stop in to the Blum Resource Center for kidpacks and a copy of “Cancer in the Family”
    11. 11. Feeling Invisible Coping Strategies • Join an established group for metastatic breast cancer patients • Join an online forum ( • Establish an informal support group in your community • Educate people about metastatic breast cancer
    12. 12. Caregiver concerns Coping Strategies • Encourage good self-care • Help caregivers find their own support
    13. 13.  “It is not hard to live through a day if you can live through a moment. What creates despair is the imagination, which pretends there is a future and insists on predicting millions of moments, thousands of days, and so drains you that you cannot live the moment at hand.” --André Dubus