Helping individuals cope with illness through personal interaction and empathy is the most basic level of support that all caregivers should provide. Oncologists and other medical professionals responsible for the care of women with breast cancer need to incorporate planning for psychosocial management as an integral part of treatment. Social and emotional support focuses on adjustment to diagnosis, apprehension regarding treatment, and existential concerns. Providing such basic emotional support is the responsibility of those treating women with breast cancer, and it can be enhanced by teams having good communication skills and the ability to recognize significant distress, but it can also be provided individually by peers or clergy, or in group settings such as a support group (Spira, 1998). Providers can take several of the following steps to help individuals cope with “normal” levels of distress (NCCN Distress Management Guidelines, 2003):

• clarify diagnosis, treatment options and side effects and ensure that the patient understands the disease and her treatment options,

• acknowledge that distress is normal and expected and inform patients that points of transition can increase distress,

• build trust,

• mobilize resources and direct patient to appropriate educational materials and local resources,

• consider medication to manage symptoms (e.g., analgesics, hypnotics, anxiolytics), and

• ensure continuity of care.

Continued monitoring and re-evaluation are needed to determine if distress symptoms have exceeded “normal” expected levels and if a referral to more specialized psychosocial services is indicated. Signs and symptoms that should signal that a patient needs more help in coping include: excessive worries, excessive fears or sadness, anger or feeling out of control, preoccupation with illness, poor sleep or appetite, unclear thinking, despair, severe family problems, or spiritual crisis (NCCN Distress Management Guidelines, 2003). Figure 4-1 outlines the NCCN symptoms of “expected” distress and the “interventions” that will be helpful and are provided by the primary team.

Psychological and emotional support is often given in conjunction with providing education about breast cancer, its diagnosis and treatment, and