“Endocrine therapies: balancing benefits and side effects. The point of view of the psychologist”: this is the title of the speech by Dr. Emanuela Mencaglia, psycho-oncologist in Humanitas, during Mamazone 2017, the seventh edition of “Patiente diplomata”, a day dedicated to women with and without breast cancer, organized by Humanitas last 14 October.

“There is no evidence in the literature to confirm that endocrine therapies influence mood, because oncological disease in itself strongly influences the personal emotional sphere. It is therefore very difficult at such an important time – such as a diagnosis or an operation – to distinguish whether the presence of anxiety and depression is linked to the drugs or to the complexity of the situation that the patient is experiencing,” said Dr. Mencaglia.


The role of personal factors

“The data available in the literature shows how important personality factors, such as age, education and being a couple or single, play a role.

Endocrine therapies lead most young patients to an early menopause, a condition that cannot be underestimated from an emotional point of view, and the age of early onset, in this sense, is a fundamental element. A young patient who had no premenopausal symptoms and who, from one day to the next, enters menopause, will have a lot of trouble in the first period, not only from a physical point of view, but also from a mental point of view, because menopause is commonly understood as a synonym for aging, coinciding with the loss of fertility. Young patients often have difficulty in dealing with this transition and it is necessary to discuss it. Some have good resources and are able to cope with this change independently, not without pain and not without having passed through so-called “personal grief”; other women instead need more comfort and see the ‘enlightened’ road to understanding how to proceed. Even for women already in menopause it is not easy; it is like repeating a passage that has already happened.

As far as the level of information is concerned, it should be noted that knowledge and awareness help at a later stage, but reaching them requires effort and commitment. Knowledge seems to initially increase symptoms of anxiety and depression. Informed patients are those who apparently find it most difficult to manage the information in their possession and the individual personality structure may or may not help to overcome the impasse of being aware, although this remains crucial to awareness, which becomes necessary to deal with the disease, the therapies and any side effects.

Having a husband or a companion seems to be favorable not only for psychological support, but also from a practical point of view: it helps, for example, when travelling for visits or in economic stability. Being in a couple is a fundamental part of the social network and in general in sick conditions a solid social and relational network improves the quality of life,” said the specialist.


Side effects, the importance of listening and talking to your doctor

“An early menopause dramatically affects libido and thus sexuality, which is a very sensitive aspect of a woman’s life.

During menopause joint pain can occur, making movement more difficult and annoying: the presence of pain is a known factor that can worsen depressive symptoms, because it affects daily activities and thus affects the quality of life.

Although you have the side effects we have been talking about, you should continue to follow the prescribed endocrine treatment, remembering to report any side effects to your doctor or oncologist because sometimes it only takes a few small steps to be better.

Finally, it is important to underline how fundamental it is to know oneself and reflect on oneself. We need to understand where our symptoms come from: does anxiety and depression really come from drugs? Have we really never had a dark time, when we struggled to be with others, or when we had difficulty rejoicing in things? We must remember that we are what we have experienced, the past is back in our thoughts and it is important to retrace the stages of our lives, wondering if there have ever been episodes of anxiety or depression or if we have experienced complicated situations in the past that triggered these problems.

Knowing this information is very important, both for the patient and for the doctors who follow him, because it is easier to rehearse certain types of sensations if they have already experienced them in the past and it is also easier to intervene for the best, with psychological support and, where necessary, with a drug by contacting a psychiatrist specialist so that with his work he can indicate which is the best drug for the symptom that is felt. Several patients with an antidepressant chosen ad hoc and taken in a careful manner, and always followed in the time of intake by the specialist, have really improved their quality of life,” concluded Dr. Mencaglia.


Watch the full speech of Dr. Emanuela Mencaglia, click here.