There is nothing glamorous about breast cancer, not when one spots a lump or abnormal skin on or around the breast, and definitely not when one reads about the seemingly invincible Hollywood powerhouse Angelina Jolie undergoing double mastectomy. But remarkably in some patients, breast cancer spurs positivity.

Through a series of studies, experts at Bengaluru's National Institute of Mental Health and Neurosciences (NIMHANS) delved into the domain of psycho-oncology to throw light on the need to understand the impact of cancer on one's perspective to life, self, spirituality, and relationships.

"Despite being the most common form of cancer in women, the number of survivors is expected to increase worldwide due to improvements in methods of early screening and treatment. Post the treatment, the challenge is to adapt to the changes in body image, sexuality and one's relationships, and deal with fears of recurrence," Mahendra P. Sharma, Professor of Clinical Psychology at NIMHANS, told Media.

However, a section of survivors, having overcome the battle with cancer, can experience positive changes commonly known as post-traumatic growth (PTG), said Sharma, on the occasion of World Health Day, that revolved around "Depression: Let's talk" this year.

"The most common theme among survivors is the increased appreciation for life and to live it to the fullest, to look after one's needs and make oneself a priority. Another recurring theme revealed that the survivors felt stronger mentally and were confident that if one could survive cancer, one could survive anything in life," he said.

Sharma and colleagues focused on 15 Indian women from urban communities of southern and eastern India. All of them were married and had undergone mastectomy/lumpectomy and were undergoing hormonal therapy.

Marriage is fraught with concerns for women who survive breast cancer, the analysis showed.

"Those who have had surgeries are particularly anxious about spousal acceptance issues. They are insecure as to whether their relationship will be the same, also whether their sex life will be impacted. But we also saw enhanced ability to empathise, to be generous and seeing others (including spouse) for their positives," Sharma explained.

The breast cancer survivorship trajectory also threw up interesting results in terms of spirituality, which helped a section of survivors find strength while they wrestled with questions of life and death.

In India, within the last five years, as of 2012, the estimated incidence rate was 145,000, morbidity rate was 70,000 and the prevalence rate was 397,000.

"Surviving cancer led them to contemplate what their life is meant for. Many felt drawn to a higher power while others believed in the thought 'what is going to happen will happen'," said Sharma.

The outcomes of the psycho-oncological study stress on the need to actively identify coping process through the early parts of treatment and the survivor's attitude towards the illness, Sharma pointed out.

"These processes can contribute to identifying and setting in process PTG as an attempt to rebuild the survivor's shattered assumptions about the world," notes the study co-authored by M.S. Barthakur, S.K. Chaturvedi and S.K. Manjunath.

Surgical oncologist and breast and endocrine surgeon Diptendra Kumar Sarkar said discussions around psycho-oncology are extremely appropriate and important.
 

"Try to understand the situation of a 40-year-old woman who has undergone breast removal. She has lost her hair due to chemotherapy. The challenge is not to make them disease-free... the challenge lies in making them free of the stigma," Sarkar, chief of the breast services and research unit, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, told.

"It is not the disease which kills... it's the mind. So the mental part and psycho-oncology are much more important than the treatment itself. If you can't get rid of the stigma, then the treatment is a waste," Sarkar said, referring to grassroot initiatives such as those initiated by the Disha organisation, founded by paediatrician Agnimita Giri Sarkar with the sole idea of reaching out to the population and removing the stigma associated with cancer.