Adverse Childhood Experiences and Cancer — information for lymphedema therapists

By Kathleen Helen Lisson, CLT

One of the most heartbreaking sentences I hear when a fellow lymphedema therapist reaches out asking for advice on how to help a client with lymphedema is ‘the patient has no one to help them with putting on garments or using their lymphedema pump.’

Often, we try to come up with donning / doffing aids and workarounds to help the client with the physical actions needed to complete self-care. We need to also realize that not being able to get their compression on and off is a symptom of a larger problem. The elephant in the room is — this client has no support system. They are under additional stress trying to care for a chronic illness without a caregiver or loved ones nearby willing or able or trustworthy enough to help. Can understanding WHY our clients do not have strong relationships help us to understand their situation more fully and anticipate future problems before they occur?

Many people with a cancer history have a history of stressful events that have made them feel unsafe, including Adverse Childhood Experiences.

Heshmati et al. state that “the psychosocial treatment of patients with cancer may require consideration of the effects of such early adversity on the healing and recovery process” (2023). These researchers investigated trauma in 133 women diagnosed with breast cancer “who had experienced physical, sexual, or emotional abuse or neglect” and found that “childhood trauma was common in breast cancer patients, with 42% of female patients reporting childhood trauma, and that these early experiences continued to exert negative effects on social connection during the illness trajectory”(2023).

The researchers conclude that “assessment of childhood adversity may be recommended as part of routine oncology care, and trauma-informed treatment approaches may improve the healing process in patients with breast cancer and a history of childhood maltreatment” (2023).

Why are our patients’ history of Adverse Life Experiences important? Pino et al. state that “individuals with Adverse Childhood Experiences (ACEs) are inclined to have more physical and mental health problems in adulthood. ACEs influence children directly or indirectly, through their living ecosystems, and include child abuse/neglect, poor parent/child relationships, conflict, low socioeconomic status or extreme poverty, and other challenges during their sensitive developmental stages” (2022).

What are the effects of ACEs on the body? Pino et al. state that:

• “Hypothalamic–pituitary–adrenocortical (HPA) axis are independently or jointly activated in response to psychosocial stress”
• “Activation of the HPA axis promotes the production of cortisol” and
• “Larger emotional reactivity to daily-life stressors is linked with an amplified inflammatory response”(2022).

Bahri et al. conducted a systematic review and meta-analysis and found that a “history of stressful life events could be associated with a moderate increase in the risk of breast cancer” (2019).

Why might this happen? These reasons are going to sound familiar! Bahri et al. state that two possible reasons could be:

• “Stress caused by such events can affect hypothalamic–pituitary–adrenal axis and cause disorders in the endocrine system, and therefore the amount of cortisol is increased and anti-neoplastic activity is inhibited” and,
• “High anxiety that is followed by stressful events, increase the breast cancer risk by suppressing the immunity system” (2019).

Stress can affect the immune system, and Bahri et al. state that “one of the most important responses of the immune system is increasing the circulating level of cytokines especially IL-6, TNF-α, and IL-1β.” Why is that important? Because “circulating levels of IL 6 and IL8 in breast cancer women are much higher than in normal people and are also related to the stage and mortality rate of breast cancer” (2019).

There are two take-away points:

• One — many of our clients are suffering physically from the effects of adverse childhood experiences
• Two — these experiences or major stressors suffered as an adult may also have robbed them of the family or loved ones’ support they need to participate in self-care for their chronic illness

Being a victim of childhood trauma may make it more difficult for them to trust others or become involved in their community. They may also not want to be ‘a bother’ or a complainer. Why? An article on PsychCentral states that “if you experienced trauma in childhood, you may have trouble with emotional closeness, maintaining relationships, and feeling safe with other people as an adult” (Lovering, 2022).

Let’s dig deeper into the research. Which childhood experiences are most harmful when it comes to developing cancer? Hu et al. conducted a systematic review and meta-analysis found that people exposed to sexual abuse, physical abuse and exposure to intimate partner violence as children are more likely to develop cancer as adults (2021).

As medical professionals helping people with a cancer history, it is important for us to:

• Understand the research connecting cancer to childhood and adult trauma
• Understand that our clients without family support may especially benefit from trauma-informed stress-reduction strategies.
• Support clients who want to learn stress-reduction strategies.
• Share information about ACEs with clients who are interested to learn more about childhood trauma.

The article ‘The Link Between Childhood Trauma and Feeling Lonely’ offers tips on reducing loneliness after childhood trauma, including finding a therapist, practicing self-love and taking small social steps (Lovering, 2022). Read more about the link between loneliness and childhood trauma here: https://psychcentral.com/pro/loneliness-rooted-in-relational-trauma

The book Mindful Strategies for Adult Clients with Adverse Childhood Experiences outlines trauma-informed, evidence-based methods for stress reduction that may help people with ACEs increase resilience. Find Mindful Strategies for Adult Clients with Adverse Childhood Experiences in paperback and kindle here: https://amzn.to/3NNZBjb

Here’s a great resource to share with your patients’ caregivers: Stress Reduction for Caregivers from the Caregiver Coalition of San Diego

Kathleen Helen Lisson is board certified in therapeutic massage and bodywork and is a Certified Lymphedema Therapist. She has spoken at the AVLS, FDRS, MLD UK, S4OM and NLN conferences. She is a coauthor of the Standard of Care for Lipedema in the United States and the author of six books, including Mindful Strategies for Adults with Adverse Childhood Experiences and Stress Reduction for Lymphedema. She lives with her husband Arun and their dog in sunny San Diego, CA. Find her on Instagram and Threads at @StressReductionForLymphedema

Resources:

Bahri N, Fathi Najafi T, Homaei Shandiz F, Tohidinik HR, Khajavi A. The relation between stressful life events and breast cancer: a systematic review and meta-analysis of cohort studies. Breast Cancer Res Treat. 2019 Jul;176(1):53–61. doi: 10.1007/s10549–019–05231-x. Epub 2019 Apr 19. PMID: 31004298. Retrieved from: https://www.researchgate.net/profile/Javad-Khajavi/publication/332533655_The_relation_between_stressful_life_events_and_breast_cancer_a_systematic_review_and_meta-analysis_of_cohort_studies/links/5d8c7d31299bf10cff0e92dc/The-relation-between-stressful-life-events-and-breast-cancer-a-systematic-review-and-meta-analysis-of-cohort-studies.pdf

Heshmati R, Azmoodeh S, Kheiriabad M, Ghasemi A, Lo C. Loneliness in Breast Cancer Patients with Early Life Adversity: An Investigation of the Effects of Childhood Trauma and Self-Regulation. Curr Oncol. 2023 May 18;30(5):5145–5157. doi: 10.3390/curroncol30050389. PMID: 37232847; PMCID: PMC10217438. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217438/

Hu Z, Kaminga AC, Yang J, Liu J, Xu H. Adverse childhood experiences and risk of cancer during adulthood: A systematic review and meta-analysis. Child Abuse Negl. 2021 Jul;117:105088. doi: 10.1016/j.chiabu.2021.105088. Epub 2021 May 8. PMID: 33971569.

Lovering, N. (2022 July 22) The Link Between Childhood Trauma and Feeling Lonely. Retrieved from: https://psychcentral.com/pro/loneliness-rooted-in-relational-trauma

Pino O, Cadena RT, Poli D. A Comprehensive Review on Multifaceted Mechanisms Involved in the Development of Breast Cancer Following Adverse Childhood Experiences (ACEs). Int J Environ Res Public Health. 2022 Oct 2;19(19):12615. doi: 10.3390/ijerph191912615. PMID: 36231913; PMCID: PMC9565960. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9565960/