Dear Editor,
Breast cancer is the most common cancer among Iranian women (1), and in recent years, the number of cases among Iranian women has increased 5.2 times, reaching 14,743 cases in 2019 (2). Breast cancer survivors face many challenges that go beyond physical health and encompass emotional, psychological, and social dimensions (3). Patients with breast cancer experience longer-lasting psychosocial effects that impact their quality of life, including fatigue (4, 5), pain (4, 5), sleep disturbances (4), cardiovascular diseases (6), and sexual dysfunction (7), which may contribute to feelings of abandonment, isolation, distress, and ultimately depression and anxiety (5). Studies show that 37.6% of patients suffer from moderate to severe anxiety, and 35.9% experience mild to severe depression (8). The result of a meta-analysis reported the prevalence of depression among breast cancer survivors as 30.2% in the world (9) and 48.83% in Iran (10). This level of depression is higher than prevalence of post-partum depression, depression in infertile couples, and depression among adolescents (10). Mood disorder (depression (11), anxiety(12) and panic(13)), fear (Fear of recurrence (14), fear of cancer spread, fear of death (15)), issues related to self-concept and quality of life (body image (16), sexual and quality of life disorders (17)), are common among breast cancer survivors.
Globally, breast cancer survivors frequently face significant psychological distress following diagnosis and treatment (18). Women in Iranian society, due to cultural reasons, are under significant pressure after diagnosis and treatment. As a result, patients with breast cancer suffer not only from the physical side effects of the disease and its treatment but also from stress and emotional problems. The lack of support from the community and their families, negative attitudes from those around them, and sexual dysfunction further exacerbate their depression. This issue may be influenced by the cultural context of society and religious beliefs about women's responsibilities (10).
Psychological support programs for breast cancer survivors play a vital role in improving quality of life, reducing anxiety and depression, and adapting to changes after treatment (19). However, after survival, attention is often focused solely on the physical aspects related to the disease, while psychological interventions for managing stress, anxiety, and depression have been overlooked. These programs should be implemented sustainably throughout the survival period and aimed at enhancing the quality of life for the survivor, their spouse, and their family using various approaches. To improve the quality of life during the critical post-survival period, it is recommended to implement multidimensional care programs. These programs should aim to physically follow up on patients and manage their concomitant physical and psychological conditions. This requires providing accessible interventions, such as a psychoeducational program (20), individual and group counseling (21), social support (22), mindfulness training (23), family-centered (24) and spiritual programs (25). Addressing the stigma associated with cancer, increasing resilience, and adopting appropriate coping strategies are proposed as means to reduce psychological distress and enhance the quality of life for women. The sense of hope, purpose, belonging, and spiritual attachment inherent in Iranian culture can serve as a powerful psychological buffer against mental health challenges for breast cancer survivors and should be integrated into their comprehensive care management (26, 27). Offering these programs in a family-centered and culturally sensitive manner at home can improve outcomes for this group of women by reducing disease-related complications.