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Beyond Physical Treatment: The Importance of Mental Health Care and Other Considerations for People Living with Metastatic Breast Cancer 

December 5, 2024    Posted by: Eli Lilly and Company

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Anxious. Sad. Lonely. Strong. Driven. Relentless.

People who receive a metastatic breast cancer (MBC) diagnosis may feel a wave of varying emotions that ebb and flow throughout their cancer experience. Also known as advanced or stage IV breast cancer, MBC is treatable but remains incurable.

Understanding the MBC Patient Experience

To better understand the unmet needs and lived experiences of people living with MBC, Lilly created a three-part survey series, fielded in 2018, 2020 and 2024. Participants included women with MBC, specifically those in their 40’s and 50’s diagnosed with hormone receptor-positive (HR+), human epidermal receptor 2-negative (HER2-) breast cancer. The surveys also included MBC patient caregivers and health care providers (HCPs). Questions focused on the disease’s impact on mental health, relationships and daily life, patient/doctor relationships, treatment preferences (e.g., oral versus injectable treatments) and more.

Because the survey captured perspectives from a broad audience of women with MBC and their support networks and care teams over the course of six years, the results provide holistic and meaningful insights about the MBC patient experience, which are captured across three key domains: impact on daily life, mental health burden and challenges for Black and Hispanic women.

Impact on Daily Life

Any cancer diagnosis has significant implications on a person’s mental health, career, finances, friendships and family. Based on these survey results – MBC’s impact is substantial.

Many participants reported spending about half their time managing the disease. Even with evolving MBC treatment options, time spent managing MBC has only increased since 2018. Patients discussed the disease’s impact on their time, including efforts to schedule and travel to appointments, the mental toll of how their disease is affecting loved ones and worry associated with finances and career challenges. Half of survey participants living with MBC say that more treatment options would be very or extremely impactful on their decision to start a new treatment, specifically the flexibility and convenience of oral medications over injections that require significant time, travel and office visits.

Mental Health Burden

Those living with the disease and their loved ones experience onset or worsening of mental health conditions, particularly anxiety and depression. In fact, more than half of friends and family reported feeling anxiety across all three years of the study — and almost 50% experienced depression in 2024.

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Given the pervasive mental health impact of MBC, HCPs are becoming increasingly cognizant of the need for a holistic approach to a patient’s mental and physical health. Oncologists and nurses both reported an increase in the need for patient mental health support (by 15% and 23%, respectively).

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While many patients are able to find mental health support through advocacy and support groups (over 50%), many organizations have emphasized the need for widespread support and solutions that integrate mental health care at diagnosis and during and after treatment. In a 2023 study published by Future Healthcare Journal, authors working in oncology and psychiatry were brought together to advocate for better clinical integration to positively impact the outcomes and care of cancer patients and their mental health needs. The study noted that the prevalence of depression and anxiety among cancer patients is up to 20% and 10% respectively, regardless of the treatment phase or point in the disease trajectory.1

Challenges for Black and Hispanic Women

Each of the surveys carefully examined the MBC experience across diverse groups, and results consistently show that MBC continues to impact a number of demographic groups uniquely.

While all people living with MBC spend a significant amount of time on managing their condition, the time burden is even greater for Black patients who, in 2024, reported spending 61% of their time managing their disease as compared to 50% for other demographic groups.

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Careers, finances, and family are highly affected by MBC, with Black women reporting a higher financial impact compared to other groups: 84% reported experiencing financial repercussions from their condition. While full-time employment is on the decline overall for participants, both Black and Hispanic women are more likely to be employed full-time compared to white women (30%, 33% and 15%, respectively), further burdening their daily lives. Hispanic women are also more likely to have younger children, adding an additional layer of complexity and responsibilities, such as having to find and pay for childcare when traveling to and attending doctor appointments.

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Exercise, career development, and travel were identified as ambitions and activities that patients miss the most. Hispanic women reported MBC’s higher impact on their life compared to other groups, with 63% sharing they missed out on important events with loved ones and 23% needed to change their job.

Looking Ahead

It’s clear that the impact of an MBC diagnosis is far-reaching as it affects a patient's whole self – their mental health, daily life as well as the loved ones around them. Lilly is dedicated to helping advance solutions for many of the challenges the survey identifies, including through researching and developing new treatment options and partnering with organizations that are focused on patient support and other aspects of wellbeing.

People living with MBC deserve treatment plans that allow more time and attention to the important things in life, like spending precious time with loved ones, pursuing interests, hobbies and career goals, and preserving mental health through a challenging health experience.


References

1 Fernando, A., Tokell, M., Ishak, Y., Love, J., Klammer, M., & Koh, M. (2023, July). Mental health needs in cancer - a call for change. Future Healthcare Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540791/