Advice and Support for Daughters of Breast Cancer Patients

NEW YORK—Daughters of women with breast cancer face a broad range of medical, practical, and emotional issues, from their roles as advocates and caregivers to their own risk of developing the disease. A teleconference organized by Cancer Care, Inc., addressed these issues for an audience of more than 400 in the United States and Canada.

The 1-hour teleconference, titled “A Shared Purpose: Helping Daughters Whose Mothers Have Advanced Breast Cancer,” was moderated by Carolyn Messner, ACSW, Cancer Care’s director of education and training.

Cancer Care Teleconferences: An Ongoing Series

“A Shared Purpose: Helping Daughters Whose Mothers Have Advanced Breast Cancer” was part of an ongoing series of Cancer Care, Inc. teleconferences. It was presented through an educational grant from Novartis Pharmaceuticals, and will be repeated next May. Participants were provided booklets on bone metastases and the needs of caregivers.

Future teleconferences will cover such topics as advanced melanoma, ovarian and lung cancers, pain, fatigue, and grief.

Cancer Care is a national nonprofit organization providing help for people with cancer, their families, and professional care-givers. A staff of 45 counselors with MSW degrees provides counseling, answers questions, gives referrals, and conducts educational programs on specific subjects of value for cancer patients and their families.

Cancer Care can be reached through its toll-free number, 1-800-813-HOPE (in New York City, 212-302-2400). It also maintains a website in both English and Spanish. Log on at http://www.cancercareinc.org. Among the site’s offerings are audio versions of past teleconferences that can be downloaded on to a home computer.

It featured Karen Antman, MD, director of the Herbert Irving Comprehensive Cancer Center and chief of the Division of Medical Oncology, Columbia-Presbyterian Hospital, New York, and Patricia Spicer, CSW, coordinator of the breast cancer program at Cancer Care.

Dr. Antman stressed that “every person with breast cancer is different, and it’s important to talk with your own doctor or your mother’s doctor.” She reviewed the standard treatments for breast cancer and newer treatments with hormones and biologics, as well as the option of participating in a clinical trial. She cautioned daughters, however, against pinning hopes on experimental treatments hyped by the media, such as angiostatins, which may be years away from standard clinical use, if indeed they prove to be effective at all.

What Symptoms to Expect

Dr. Antman also advised the daughters on what symptoms to expect from the cancer and its treatment and how they are managed. In addition to medications to counteract nausea, she said, breast cancer patients may benefit from nutritional support and agents to prevent infection, strengthen bones, and relieve pain.

She mentioned the use of G-CSF (Neupogen) to counter neutropenia and lower the risk of infection, and bis-phosphonates to strengthen bones weakened by metastases.

Dr. Antman was emphatic that total pain control should be the goal, and that narcotic pain medication rarely represents an addiction risk in cancer patients.

“Patients do best when their pain is entirely relieved and they can go about their normal activities,” she said. “People who are in pain don’t eat very well, don’t sleep very well, and that gets in the way of their recovery.”

Once a mother is diagnosed with breast cancer, her daughter becomes a woman with a family history of breast cancer, Dr. Antman observed. Whether that represents an increased risk, however, depends on the mother’s age at diagnosis, whether other close relatives developed breast cancer at an early age, and whether the family is Jewish, which, she explained, is a group in which hereditary risk for breast cancer is more common.

Dr. Antman urged daughters to discuss with their health care provider whether earlier or more frequent screening is recommended and whether use of prophylactic tamoxifen (Nolvadex) should be considered [See article on the STAR trial on page 4.}

Furthermore, decisions about birth control and hormone replacement postmenopause should be made with the mother’s diagnosis in mind. Finally, she said, daughters of breast cancer patients should consider adopting a healthy life-style, including maintaining ideal weight and eating a diet high in vegetables.

Psychosocial Impact

In her presentation, Patricia Spicer, CSW, focused on psychosocial issues the daughter of a breast cancer patient might face. Many daughters become the primary caregiver when their mother develops breast cancer, she observed.

In addition to the day-to-day burden of caring for their mother, daughters may experience fear for themselves and their own children, anger when faced with a possibly demanding patient, and guilt or other conflicted feelings that may have predated the diagnosis or may develop in the course of giving care.

Ms. Spicer urged daughters to take care of themselves as well as their mothers. Taking time off, soliciting and accepting the help of others, seeking counseling, and joining a support group are among the strategies she suggested.