Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study

PURPOSE

To explore the experiences of women with breast cancer and pelvic floor (PF) dysfunction and the perceived enablers and barriers to uptake of treatment for PF dysfunction during their recovery.

METHOD

Purposive sampling was used to recruit 30 women with a past diagnosis of breast cancer and PF dysfunction. Semi-structured interviews were conducted, and data were analysed inductively to identify new concepts in the experiences of PF dysfunction in women with breast cancer and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework to identify the enablers and barriers to the uptake of treatment for PF dysfunction in women with breast cancer.

RESULTS

Participants were aged between 31 and 88 years, diagnosed with stages I-IV breast cancer and experienced either urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction; bother was exacerbated by embarrassment from experiencing PF symptoms in public. Barriers to accessing treatment for PF dysfunction included a lack of awareness about PF dysfunction following breast cancer treatments and health care professionals not focussing on the management of PF symptoms during cancer treatment. An enabler was their motivation to resume their normal pre-cancer lives.

CONCLUSION

Participants in this study reported that there needs to be more awareness about PF dysfunction in women undergoing treatment for breast cancer. They would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment. Therefore, a greater focus on managing PF symptoms by clinicians may be warranted in women with breast cancer.

How to know what to know: Information challenges for women in the diagnostic phase of breast cancer

OBJECTIVE

To explore how women describe efforts to seek, appraise and interpret information during the diagnostic phase of her breast cancer care.

METHODS

Qualitative interviews with 35 women with breast cancer across Canada, using audio/video recording. Thematic analysis was used to identify topics important to participants (original results published: www.healthexperiences.ca). Secondary analysis of transcripts to identify how women described information flow, content, and management strategies.

RESULTS

Women adopt different strategies to optimize access to information, while acknowledging the negative effects of information overload and lack of relevant information. They propose small steps towards gathering and managing information, and to focus initially on understanding their illness.

CONCLUSION

Different strategies can help to ensure that women have the right information, in the right format, at the right time. Some of these strategies include developing guidance on how to 'handle' information, helping healthcare professionals identify patient's information preferences, improving the availability, quality and access to experiential information, and facilitating acces to electronic information that can tailor information. Further research to understand how women handle information can inform strategies to help newly-diagnosed patients navigate available information.

PRACTICE IMPLICATIONS

Healthcare professionals can work in partnership with patients to tailor reliable information to support informed decision-making.

The requirements of a specialist breast centre

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.

An exploration of the experiences of women treated with radiotherapy for breast cancer: Learning from recent and historical cohorts to identify enduring needs

PURPOSE

Recent decades have seen improvements in UK breast cancer services and treatments. Despite this, it is recognised that a range of patients' psychological and emotional needs remain unmet, both at the time of treatment and into survivorship. Using data from two distinct cohorts of women: those treated with radiotherapy for breast cancer historically, and women treated more recently, this study sought to identify and explore those needs and concerns that have continued to persist, despite advances in treatment and care.

METHOD

Data from N = 13 semi-structured interviews were analysed using Interpretative Phenomenological Analysis. An heuristic framework was applied to extract themes common to both participant cohorts.

RESULTS

Participants' data evidenced an enduring vulnerability amongst cancer patients that has not diminished with new treatment pathways. Themes common to both cohorts highlighted the ongoing importance of personal factors such as resilience, and strategies to help retain a sense of normality. Extrinsic support was important too, especially high quality communication by healthcare professionals and having access to ongoing emotional support from others, particularly when active treatment ends. Participants' suggestions for future service development included the provision of ongoing continuity of care and greater access to emotional support services.

CONCLUSIONS

This study highlights the psychological needs and concerns of breast cancer patients that have persisted, despite the many advances in patient-centred care. Findings are of value to nurses and other healthcare professionals in highlighting the ongoing importance of recognising, acknowledging and addressing patients' concerns and needs, even within current cancer care pathways.