NEW YORK--Caring for a mother with advanced breast cancer can be a lot to deal with for a daughter. She has the tricky task of reversing roles with her mother. She may have a family of her own to care for--and there is the fear that she is at risk for cancer herself.
Patricia Spicer, CSW, coordinator of Cancer Care, Inc.s Breast Cancer Program, and Karen Antman, MD, director, Herbert Irving Comprehensive Cancer Center, and chief of medical oncology, Columbia Presbyterian Medical Center, offered support to these daughters during a Cancer Care teleconference.
Ms. Spicer said that one of the most difficult roles an adult child is asked to assume is that of caregiver to a parent. "It is important to recognize that many mothers and daughters have unresolved issues between them," she said, "and, unfortunately, cancer and the rigors of treatment do not usually turn the patient or family member into saints."
Mothers who are ill can become demanding, irritable, and angry, and their daughters can get angry, too. The daughter may feel that nothing she does is good enough--but feeling angry will also make her feel guilty, Ms Spicer said. "It is important to accept your feelings, whether they are positive or negative," she said. "If you try to suppress them, the anger may turn to rage, and the fear may turn to terror." She encouraged daughters to seek help by joining a caregivers support group or getting counseling.
Even though a mother may be irritable, "Mom still needs to feel that shes important in your life," Ms. Spicer said. "That means hugging her when you come in the door or simply holding her hand or kissing her to reassure her that shes still important to you." A mother should also be allowed to cry and to talk about death, and it is also okay for the daughter to cry with her, she said.
Ms. Spicer warned daughters against putting pressure on their mother to eat. "Sometimes we confuse love with food. If she is losing weight or does not want to eat, talk to the doctor," she said.
And daughters must also take care of themselves. Ms. Spicer urged them to take vacations and to ask for help when they need it. "When someone asks you what they can do, tell them. Ask them to come in for a couple of hours so you can out and shop or just sit in the park and get away from life with cancer."
Dr. Antman took on the question of a daughters cancer risk. The daughter is at significant risk, she said, if her mother was very young when she developed breast cancer, even more so if other close relatives had breast or ovarian cancer before age 45. But if the mother had cancer at age 65 or over, the daughters risk is probably not significantly increased.
High-risk women should consider genetic testing and counseling, Dr. Antman said, as they may have a BRCA1 or BRCA2 gene mutation. These genes account for about 5% of breast cancer cases.
Some experts feel that mammography screening for high-risk women should begin before the age at which the youngest family case occurred, or by age 40. Dr. Antman noted that MRI, which avoids radiation exposure, is being studied for screening of women under 40 who have a strong family history of breast cancer.
Regarding prevention, she recommends eating ample vegetables and using olive oil(Drug information on olive oil) on salads. Women who use a nonfat salad oil may actually be dispensing with something that could be protective, she said. She advised avoiding alcohol(Drug information on alcohol) and margarine, and not gaining more than a few pounds over ones weight at age 18, since estrogen is stored in fat cells. She also advised women whose mothers have had breast cancer to carefully discuss the use of birth control or hormone replacement with their physicians and not to use them for more than 5 years.