Mental Health Considerations in MBC: 5 Things to Know

Metastatic breast cancer (MBC), one of the most prevalent forms of metastatic cancer globally, remains incurable, with a median survival time of 3 years. Although advances in treatment have increased survival in patients with MBC, managing ongoing treatments while living with MBC can lead to significant emotional distress and challenges in coping. Patients with MBC frequently experience feelings of depression and anxiety related to their diagnosis, significantly affecting their mental health. 
Here are five things to know about MBC and mental health. 
Depression and anxiety rank among the most common mental health disorders worldwide, and individuals with MBC face an exacerbated risk. According to a comprehensive meta-analysis encompassing 71 studies, the global prevalence of depression in women with breast cancer is 30.2%, which is markedly higher than the 3.8% prevalence rate observed in the general population. 
A systematic review and meta-analysis of 282,203 patients with breast cancer demonstrated that depression is correlated with a 30% elevation in mortality risk. Moreover, the concurrence of depression and anxiety exhibited the highest all-cause mortality rate, with depression alone being a close second. Another extensive systematic review incorporating 51 eligible cohort studies and involving 2,611,907 participants established that clinically diagnosed depression and anxiety are associated with diminished survival times and increased cancer-specific mortality. These findings underscore the critical importance of addressing depression and anxiety in patients with breast cancer, given their substantial impact on both general and cancer-specific mortality rates.
There is a significant correlation between sexual health and mental health, and patients diagnosed with MBC face additional challenges in maintaining good sexual health. Body image issues, which are frequently linked to mental health, are common among patients with MBC, often due to treatment side effects or postsurgical body changes. An analysis of data from the Women’s Health Initiative Life and Longevity After Cancer Study revealed that 20% of 4567 female cancer survivors, aged 68-99 years, reported body image concerns (ie, attractiveness).
Sexual dysfunction has a well-documented impact on the mental health of MBC patients, yet sexual issues often remain unaddressed by healthcare providers, especially for female cancer survivors. The BEROSE study, a single-center observational study involving 318 women with various stages of breast cancer (30% of whom had MBC), found that 65% of participants reported never receiving information about sexual health during their cancer care. A systematic review of 29 studies examining provider communication found that around 10% of patients were queried about their sexual concerns. Notably, this review revealed that sexual health discussions were more likely to occur with men — a significant finding given that MBC is predominantly diagnosed in women. 
Patients also report barriers to seeking and accessing sexual health support, including embarrassment about discussing sexual concerns, perceived discomfort from healthcare providers, and systemic limitations within healthcare. These findings underscore the need for enhanced communication and education regarding sexual health as an integral component of cancer treatment.
A meta-analysis of 28 randomized clinical trials with a total of 3053 participants with various cancers found that mindfulness-based interventions (MBIs) significantly alleviated short-term anxiety symptoms (up to 6 months after MBI vs usual care). Focusing on breast cancer, a systematic review of seven studies involving 532 female patients demonstrated notable improvements in anxiety and depression scores through mindfulness-based stress reduction. It is important to acknowledge that the sole study in the review including MBC patients was a feasibility study, constrained by its small sample size and lack of demographic diversity. Therefore, more research on the application of MBIs specifically within the MBC population is necessary. 
Given the evidence supporting mindfulness strategies to improve psychological symptoms, current ASCO guidelines advocate for offering MBIs to patients with cancer both during and after active treatment. 
The mental health advantages of physical exercise are well established, so it is not surprising that patients with MBC may experience similar benefits. A comprehensive meta-analysis of 14,554 patients with breast cancer demonstrated that physical activity interventions were associated with improved health-related quality of life (QOL). In the context of MBC, the PREFERABLE-EFFECT study, a multinational, randomized controlled trial involving 357 MBC patients, randomly assigned participants to either an exercise group or a control group. The exercise group engaged in a 9-month multimodal exercise regimen, whereas the control group received standard medical care supplemented with written advice on physical activity but no structured exercise program. The findings from the study revealed that the exercise group experienced reduced physical fatigue and enhanced health-related QOL. Additionally, this group showed notable improvements in physical fitness, social functioning, pain, and dyspnea. 
Given the profound impact that an MBC diagnosis has on mental health, there is a critical need to develop targeted mental health strategies to enhance the well-being of patients. One of the challenges of this endeavor is the difficulty of quantitatively assessing mental health outcomes. To address this, an international expert group has established a core outcome set of standardized measures specifically focused on health-related QOL for MBC patients. This set aims to enhance measurement consistency and mitigate reporting biases in outcome evaluations to improve the standardization of clinical research. 
In addition, the REBECCA study, a randomized clinical trial involving 309 female breast cancer patients, investigated the effects of nurse navigation compared with standard care. Participants in the nurse navigation group experienced significantly reduced symptoms of depression and improved health-related QOL after 6 months, compared with the control group receiving standard care. Moreover, a secondary analysis (N = 38) of a randomized controlled trial examined the impact of virtual-reality nature experiences on MBC patients. This study found that after 1 week, participants reported significant reductions in fatigue and depression, along with improvements in overall QOL. 
MBC presents significant challenges because of its profound impact on mental health. The high prevalence of depression and anxiety among patients with MBC correlates with diminished survival rates and underscores the urgent need for effective mental health interventions. Emerging evidence suggests that targeted strategies such as MBIs and physical exercise can significantly enhance the QOL and psychological well-being of MBC patients. Furthermore, innovative research efforts, including interventions like nurse navigation and virtual-reality experiences, hold promise for advancing mental health care in this population.