Psychosocial Responses in Breast Cancer Survivors

Stress and nursing care needs of women with breast cancer during primary treatment: a qualitative study

PURPOSE

The primary surgical therapy for breast cancer represents a special phase in the course of the disease. The aim of this study was to find out the specific strains influencing the women affected during this time, and the needs and expectations they had of the nurses.

METHOD

In a semistructured interview, 42 women at an early stage of breast cancer were asked about their strains and care needs.

RESULTS

The results show that the women interviewed suffer more from psychological strains than physical ones, and express the wish for, above all, emotional support. Analysis of the interviews provides 4 categories of strains: immediate strains regarding the surgery, fear through uncertainty, change of self-perception and the strains caused by the social environment. Care needs can be divided into 3 main areas: wishes for (a) the relationship to the nurses, (b) professional competence and (c) the external conditions of care.

CONCLUSIONS

Nurses can support the women well by listening to them, accepting their emotions and informing them in detail. Therewith, they can convey a sense of security to the women and help them to maintain hope and the ability to deal with reality.

Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial

OBJECTIVES

The purpose of this present study was to evaluate Self-care Improvement through Oncology Nursing (SCION) program to reduce distressing anorexia, nausea, and emesis (ANE) in cancer patients undergoing chemotherapy.

METHODS

Two hundred eight patients receiving chemotherapy with moderate to high emetogenic potential participated in a cluster randomized trial on 14 wards in two German university hospitals. Additionally to standard antiemetic treatment, patients from the intervention wards received the SCION program consisting of four modules: advisory consultation, optimizing emesis prophylaxis, nutrition counseling, and relaxation. Patients from the control group received standard antiemetic treatment and standard care. Primary outcome was the group difference in ANE intensity assessed by Common Terminology Criteria for adverse events (CTCAE).

MAIN RESULTS

The SCION program did not result in a significant difference in the incidence of ANE symptoms as compared to standard care: mean difference on CTCAE scale was 0.24 pts (95%CI, -1.17 to 1.66 pts; P = 0.733). No difference could be found regarding patients' knowledge of side effects, self-care interventions, and agency. Health-related quality of life was significantly better for patients in the control group (mean difference 10.2 pts; 95%CI, 1.9 to 18.5; P = 0.017).

CONCLUSIONS

Contrary to our expectations, the groups did not differ in ANE intensity caused by the overall low acute or delayed symptom intensity. Symptom hierarchy in cancer patients alters and challenges nursing interventions targeting the patients' self-care strategies.

Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention

While quality of life for most breast cancer survivors (BCS) returns to normal by 1 year post-treatment, problems in sexual function and intimacy often persist. The present study tested the efficacy of a 6-week psycho-educational group intervention in improving BCS's sexual well-being. We conducted a mailed survey of BCS 1-5 years post-diagnosis to identify a sample of women who reported moderately severe problems in body image, sexual function or partner communication, and were deemed eligible for the randomized intervention trial. Using a pre-randomized design, 70% (n = 284) were assigned to a 6-week psycho-educational group intervention and 30% (n = 127) were assigned to a control condition (print material only); however, only 83 BCS agreed to participate in the intervention. Four months post-intervention, the intervention and control groups were not significantly different on the primary outcome of emotional functioning; however, BCS randomized to the intervention group were more likely to report improvements in relationship adjustment and communication as well as increased satisfaction with sex compared to controls. Members of the intervention group who were the least satisfied with their sexual relationship appeared to improve the most. Although modest in its effects, this intervention can be delivered in standard clinical settings. Having an identified treatment may help reduce physician reluctance to ask BCS about problems in intimacy and as appropriate, refer them for timely help.

A prospective examination of perceived stress as a mediator of the relationship between life-events and QOL following breast cancer

OBJECTIVES

This study prospectively investigated the relationship between life-events, perceived stress, and quality of life (QOL) following breast cancer diagnosis, using the bio-behavioural model of cancer stress as a framework.

DESIGN

A longitudinal, self-report design was used.

METHODS

Three waves of data from 10,543 mid-aged Australian women (aged 45-50 at Survey 1) were collected over 5 years as part of a population-based survey. From this group a subsample (N=140) were identified who did not have breast cancer at Survey 1, but who subsequently developed breast cancer. Random regression growth curve analyses were used to investigate whether perceived stress mediated the relationship between initial life-events and change in QOL functioning overtime.

RESULTS

Prospective evidence was generated for each of the three criteria for testing mediation. As the number of life-events before breast cancer increased, women were significantly more likely to experience corresponding increases in perceived stress over the 5-year period. As the level of perceived stress before breast cancer increased, women were more likely to experience deteriorations overtime in role emotional, role physical, vitality, bodily pain, physical functioning, and social functioning. As the number of life-events before breast cancer increased, women were at significant risk of experiencing deteriorations overtime in bodily pain, social functioning, role emotional, and vitality. Mediational analyses revealed that perceived stress fully mediated the relationship between initial life-events and two QOL domains; role-emotional and social functioning.

CONCLUSION

Results partially supported the bio-behavioural model of cancer stress, but the model does not appear to fit the data as well as predicted, and may require revision.

Patterns of objective physical functioning and perception of mood and fatigue in posttreatment breast cancer patients and healthy controls: an ambulatory psychophysiological investigation

OBJECTIVE

To monitor objective physiological and self-report measures among apparently disease-free breast cancer patients (n = 33) in the first 2 years of posttreatment recovery, using a cross-sectional design, and compare findings with women without histories of cancer or other serious disorders (n =33). Time-since-treatment also served as an independent variable. Few studies have examined adjustment of breast cancer patients after primary treatment or objectively characterized posttreatment, everyday patterns of functioning.

METHODS

A 24-hour ambulatory minute-by-minute cardiorespiratory functioning and accelerometry activity were measured during one day, together with multiple repeated assessments of mood and fatigue. Traditional retrospective measures of well-being were also evaluated. Our ambulatory methodology permitted estimation of physiological rhythms of cardiorespiratory and accelerometry activity.

RESULTS

Patients reported lower ambulatory levels of energy and poorer mood during the daytime than controls. Time-since-treatment was related directly to both momentary mood and energy as well as to objective measures of activity and respiratory parameters. Retrospective self-reports of impaired mood and symptoms persisted in patients, independently of time-since-treatment and of ambulatory physical or physiological activity. Ambulatory self-report data were associated with concurrent respiratory measures. Chemotherapy-related elevation of heart rate was found but was unrelated to self-report measures.

CONCLUSIONS

Impaired sense of well being based on retrospective measures is not associated with pattern of physical or physiological functioning after treatment for breast cancer. However, ambulatory, momentary levels of mood and fatigue seem to be related to concurrent ventilatory activity and time-since-treatment. This is the first investigation that relates ambulatory and retrospective measures of affect and fatigue to concurrent, real-life physical functioning.

Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors

OBJECTIVE

Psychosocial comorbidity and quality of life (QOL) and its association with knowledge, utilization, and need for psychosocial support have been studied in long-term breast cancer survivors.

METHODS

One thousand eighty-three patients were recruited through a population-based cancer registry an average of 47 months following diagnosis (66% response rate). Self-report measures (e.g., Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, and Short-Form Health Survey) were used.

RESULTS

Thirty-eight percent of patients had moderate to high anxiety, and 22% had moderate to high depression; posttraumatic stress disorder was observed in 12%. The overall psychological comorbidity was 43% and 26% for a possible and probable psychiatric disorder. Disease progress, detrimental interactions, less social support, a lower educational level, and younger age were predictors of psychological comorbidity (P<.004). Lower QOL (P<.01) and higher levels of anxiety (P<.001) were observed in cancer survivors compared to age-adjusted normative comparison groups. Time since diagnosis had no significant impact on psychological comorbidity as well as QOL. Forty-six percent of women felt insufficiently informed about support offers. Insufficient knowledge was associated with older age and lower education (P<.05). Since diagnosis, 57% had participated in cancer rehabilitation and 24% in other psychosocial support programs. Fifteen percent of all patients and 23% of those with a possible psychiatric disorder expressed their need for psychosocial support. Women with distress and perceived support needs who did not participate in past support programs were older, less educated, and less informed (P<.05).

CONCLUSION

Findings show the long-term impact of breast cancer and indicate need for patient education, screening for psychosocial distress, and implementation of psychological interventions tailored in particular for older women.

New research in psychooncology

PURPOSE OF REVIEW

The objectives of this review are to identify new studies in the area of psychooncology, and ascertain the directions current studies are taking.

RECENT FINDINGS

New studies relate to the measurement of distress, which is being strongly proposed as the sixth vital sign in the assessment of patients with cancer. Attempts to use different scales and instruments to screen for depression and psychiatric morbidity in patients with cancer have also been made. Posttraumatic stress disorder, fatigue, somatization and cognitive dysfunctions have been studied. The field of psychoneuroimmunology has further strengthened our understanding of the impact of stress on immune function. Cancer survivors and their coping methods, sexual health, and suicidality have been the focus of research in the last year. Quality of life of caregivers has also been studied, as has spirituality. Cognitive behaviour group therapy in relatives of patients with cancer appears to be helpful.

SUMMARY

New studies in psychooncology have focused on the relationship between psychosocial factors and cancer, such as detection of distress and psychiatric morbidity, intervention, coping methods used by survivors, and psychoneuroimmunology. Research in psychooncology is an exciting area despite numerous challenges.

Breast cancer and psychological distress: mothers' and daughters' traumatic experiences

GOAL OF WORK

The objective of this exploratory retrospective study was to assess the effects of breast cancer diagnosis upon the psychological distress of adult breast cancer patients and their mothers, particularly mothers who experienced past trauma.

MATERIALS AND METHODS

Four groups of mother-daughter dyads were evaluated using self-reporting measures of psychological distress [Brief Symptom Inventory (BSI)], familial support (PFS), and adjustment to cancer (MAC, IES): breast cancer patients whose mothers were Holocaust survivors (group 1), breast cancer patients with non-traumatized mothers (group 2), healthy daughters of Holocaust survivor mothers (group 3), and a control group of healthy daughters with non-traumatized mothers (group 4).

MAIN RESULTS

Distress levels of both mothers and daughters in group 1 were significantly higher than distress levels of mothers and daughters in the other three groups. Daughters' distress levels in all four groups were found to be significantly related to mothers' distress levels, with the highest correlation found in both groups of cancer patients. The factors of having a clinically distressed mother and being a second-generation daughter contributed the most to predicting the clinical distress of the daughter.

CONCLUSIONS

The outcomes imply that the mother's traumatic past intensifies the distressing effect of cancer diagnosis upon both the patient and her mother. The findings concerning the impact of cancer diagnosis upon the patients' non-traumatized mothers were more ambiguous. The results support the idea that in the case of breast cancer patients, a complete psychological evaluation must include not only spouses and children but also the familial background of the patient and the history of the patients' mothers.