Breast cancer representations in Canadian news media: a critical discourse analysis of meanings and the implications for identity

Pathways Linking Parental Care and Control to Loneliness in Breast Cancer Patients with A History of Childhood Maltreatment: Exploring the Mediating Roles of Ambivalence Over Emotional Expression and Self-Discrepancy

Childhood maltreatment is a risk factor for loneliness and is linked to breast cancer. Parental bonding experienced during one's childhood also plays a significant role in increasing or decreasing the risk of loneliness later in life. Previous research has highlighted the significance of ambivalence over emotional expression (AEE) and self-discrepancy in the psychological adaptation of breast cancer patients, particularly concerning the impact of parental care and control experienced by patients in their relationship with their parents during childhood. Nevertheless, previous studies have not examined the mediating effects of AEE and self-discrepancy on parental care and control, as well as loneliness, in breast cancer patients. This study aimed to investigate whether AEE and self-discrepancy mediate the association of childhood parental care and control with loneliness in breast cancer patients with a history of childhood maltreatment. One hundred and thirty-three breast cancer patients who were receiving chemotherapy within the first 3 months post-diagnosis were recruited from one private and three public hospitals in Tabriz, Iran, to complete questionnaires. Parental bonding, loneliness, AEE, and self-discrepancy were assessed using the Parental Bonding Instrument (PBI), University of California Los Angeles (UCLA) Loneliness Scale, Ambivalence over the Expression of Emotion Questionnaire (AEQ), and Self-Discrepancies Scale (S-DS). Mediation models were tested using structural equation modeling. Effects of parental care (β = -.17, p < .05) and control (β = .21, p < .001) on loneliness were significant. Furthermore, both AEE (β = .19, p < .05) and self-discrepancy (β = .23, p < .01) significantly predicted loneliness. The pathway between parental care and AEE was significant (β = -.21, p < .001), as was the direct effect of parental control on self-discrepancy (β = .19, p < .05). Bootstrapping results showed that AEE significantly mediated the relationship between parental care and loneliness (95% confidence interval [CI] [-0.09, -0.01]). In addition, there was a significant indirect effect from parental control to loneliness via self-discrepancy (95% CI [0.11, 0.01]). These findings suggest that AEE and self-discrepancy could potentially be utilized in preventing or addressing loneliness in breast cancer patients who have a history of childhood maltreatment. Future research could, for example, assess whether integrating psychosocial interventions focusing on these variables as part of medical care can improve the mental health status of this subgroup of breast cancer patients who have experienced childhood maltreatment.

Tailored Psychological Interventions to Manage Body Image: An Opinion Study on Breast Cancer Survivors

OBJECTIVE

Oncological care affects the body strongly, even some years after therapies. Body image, as the mental representation of one's own body, is particularly affected by breast cancer, with a high level of dissatisfaction and negative perception. Literature has shown the effectiveness of various psychological interventions to promote body image in breast cancer survivors, dealing with inner sensations and related emotions and thoughts. The present opinion study presents BI issues and personalized psychological interventions to increase a positive BI in breast cancer survivors.

CONCLUSIONS

Implementing specific and personalized psychological interventions tailored on BI, the characteristics of oncological journey and emotional and cognitive issues is fundamental. Directions for clinical practice are given.

The Effects of Lack of Awareness in Age-Related Quality of Life, Coping with Stress, and Depression among Patients with Malignant Melanoma

Almost one-third of all malignant melanoma patients exhibit emotional stress indicating the need for professional care. Considering this, patients' psychological needs are routinely overlooked and unfulfilled, even though there is substantial evidence that psychological therapies may enhance psychosocial outcomes for melanoma patients, such as low mood, sadness, and anxiety. Among developing countries and some health systems in developed regions, the lack of awareness and screening methods for skin cancer creates a high risk of psychological issues associated with more advanced diseases. Therefore, the current study aimed to investigate and compare the impact of malignant melanoma awareness for screening, prevention, and treatment on the patient's quality of life and coping with stress and depression, based on patients' age. This cross-sectional study recruited 238 patients with malignant melanoma distributed into two groups, Group A patients between 18 and 65 years and Group B patients older than 65. There were no significant gender differences and cancer staging differences between groups, although self-reported depressed mood and anhedonia were significantly more frequent in younger adults with malignant melanoma (43.8% vs. 28.9%). From the unstandardized surveys, it was observed that significantly fewer patients from Group B knew that melanoma could be caused by sun exposure (34.2% vs. 52.2%), and they were less likely to use sunscreen or visit a doctor to evaluate their skin moles (25.9% vs. 14.5%). Elderly patients preferred television as the main source of information, and only 68.4% of patients from Group B were using smart devices. There was a significantly higher physical score on the SF-12 scale among Group A patients, although patients from Group B scored higher in the mental health assessment, and the perceived helplessness on the PSS-10 scale was significantly higher compared to younger adults with melanoma (2.97 vs. 2.71, p-value = 0.036). Lower scores on the physical and mental SF-12 questionnaire determined a higher presence of depressive symptoms (rho = -0.352, respectively rho = -0.273). Higher scores on the DLQI sexual difficulties and treatment difficulties also correlated significantly with the presence of depressive symptoms and anhedonia (rho = 0.341, respectively rho = 0.264). Awareness campaigns for malignant melanoma should focus on the elderly population, too, using the television as the main communication channel. On the other hand, the more informed and knowledgeable group of adults younger than 65 are more likely to experience psychological problems and should be targeted for psycho-oncological aid.

The Body after Cancer: A Qualitative Study on Breast Cancer Survivors' Body Representation

OBJECTIVE

The relationship with the body is a relevant issue for breast cancer survivors. Oncological treatments damage their bodies due to scars, weight gain, and other side effects. Starting from the efficacy of psychological interventions for breast cancer survivors, a tailored psychological support program was provided to promote overall well-being after illness dealing with bodily signals and related emotions and thoughts. This study presents changes in the description of the relationship with their bodies as well as participants' emotions and thoughts before and after a psychological intervention.

METHODS AND MEASURES

Eighteen women answered questions related to their bodies before and after the psychological intervention. Results were analyzed in accordance with the procedure of the Word Association Analysis through the T-Lab software and the Qualitative Thematic Analysis.

RESULTS

Participants reported a great awareness of their bodies and the desire to take care of them daily. In particular, the body is now perceived as a helper to sustain breast cancer survivors in their everyday activities.

CONCLUSION

The words and the themes that characterized the participants' reports highlighted the impact of cancer diagnosis and oncological therapies on breast cancer survivors. The participation in the psychological intervention focused on self-compassion towards their body helps women to create an improved body perception.

Side Effects of Endocrine Therapy Are Associated With Depression and Anxiety in Breast Cancer Patients Accepting Endocrine Therapy: A Cross-Sectional Study in China

Objective

Hormone positive breast cancer patients bear side effects of endocrine therapy and that may be related to depression and anxiety. We sought to find an association between mental health and side effects of endocrine therapy.

Methods

A total of 398 patients participated. Sociodemographic, disease profile, and side effects questionnaires were administered. We screened for depressive and anxiety disorders by using the SDS (Self-Rating Depression Scale) and SAS (Self-Rating Anxiety Scale).

Results

The prevalence of depression and anxiety in our study were 33.4% (133) and 13.3% (53), respectively. Depression was linked to education level (≤8 years, OR = 3.59, 95% CI: 2.22–5.78), night sweats (yes, OR = 1.90, 95% CI: 1.17–3.09), vaginal dryness (yes, OR = 2.22, 95% CI: 1.19–4.16), and fatigue (yes, OR = 1.94, 95% CI: 1.21–3.11); anxiety was associated with education level (≤8 years, OR = 3.13, 95% CI: 1.62–6.08), time to diagnosis (≤ 3 years, OR = 2.14, 95% CI: 1.13–4.07), osteopenia (yes, OR = 2.43, 95% CI: 1.26–4.70), loss of hair (yes, OR = 2.80, 95% CI: 1.10–7.15), and fatigue (yes, OR = 2.89, 95% CI: 1.54–5.43). A stratified analysis according to age (≤45 years and > 45 years) was performed as an exploratory. None of factor-age interactions was statistically significant.

Conclusion

Side effects of endocrine therapy were significantly associated with anxiety and depression. Side effects deserve greater emphasis and clinical interventions are needed to reduce anxiety and depression in breast cancer patients accepting ET.

The Experiential Learning Pathway of Cancer Survivors as They Recover Their Lives Post-Treatment: A Qualitative Study

For many cancer survivors, post-treatment challenges are predominantly related to their personal and social lives. These challenges are part of an experiential learning process linked to a survivor's identity, their desire to preserve independence, their social roles, and responsibilities along with a return to their normal lives. We used interpretive description to describe the experiential learning process of cancer survivors as they recover post-treatment. Data from five group discussions with 27 participants were combined with data from 9 in-depth individual interviews that examined post-treatment challenges. Through an iterative qualitative analysis, we uncovered 3 experiential learning pathways. Narrative vignettes are used to portray and highlight learning involved in accepting loss, asking for help, and rebuilding authentic social networks. Experiential learning shares recognizable features among individuals identified as milestones. These lead to a greater understanding of how cancer survivors acquire a new sense of self and recover their lives post-treatment.

‘You Owe It to Yourself, Everyone You Love and to Our Beleaguered NHS to Get Yourself Fit and Well’: Weight Stigma in the British Media during the COVID-19 Pandemic—A Thematic Analysis

The portrayal of obesity in the media can impact public health by guiding peoples’ behaviours and furthering stigma. Individual responsibility for body weight along with negative portrayals of obesity have frequently dominated UK media discourses on obesity. This study aims to explore how the media has represented obesity during the COVID-19 pandemic through a thematic analysis of 95 UK online newspaper articles published in The Sun, The Mail Online, and The Guardian. The first theme, lifestyle recommendations, accounts for media coverage providing ‘expert’ advice on losing weight. The second theme, individual responsibility, emphasises media appeals to self-governance to tackle obesity and protect the NHS during the pandemic. The third theme, actors of change, explores how celebrities and politicians are presented as examples of weight management. These results suggest that individuals are held responsible for their weight and accountable for protecting the NHS during the COVID-19 pandemic. Stigma can be furthered by the decontextualisation of lifestyle recommendations and exacerbated by the actors of change presented: Celebrity profiles reveal gendered goals for weight management, and politicians exemplify self-governance, which consolidates their power. In conclusion, individualising and stigmatising discourses around obesity have taken new forms during the pandemic that link health responsibility to protecting the NHS and invokes celebrities and politicians to foster action.

News Media Representations of Responsibility for Alcohol-Related Liver Disease Requiring Liver Transplantation

Alcohol-related liver disease (ARLD) is a common indication for liver transplantation yet it is considered ethically controversial in academic, clinical and public discourses. Various social groups consider people with ARLD as personally responsible for their condition and question whether they should have access to a scarce resource. How the news media constructs responsibility for ARLD may influence public opinions toward those who are ill as well as related healthcare policies. Since the organ transplantation system relies on the willingness of individuals to donate organs, understanding how the media portrays controversial issues is a matter of vital importance for public health and health policy. We investigated how responsibility for ARLD requiring liver transplantation is presented for public consumption in the news media. Using a keyword search of two online news databases, we selected 81 articles from the United Kingdom, Canada and the United States. We analyzed the articles using a discursive psychological approach. We found that the news media ascribed responsibility for ARLD to three main actors: individuals with ARLD, biological predisposition, and policy and industry representatives. How responsibility for ARLD requiring liver transplantation is presented in the news media may have implications for people diagnosed with other substance-related disorders who present for transplant candidacy or are on the transplant waiting list. Investigating how responsibility for ARLD is constructed in news media may provide insights into how responsibility is understood in other stigmatized health conditions and its potential implications for population health equity.

Breast Cancer messaging in Vietnam: an online media content analysis

Background

Breast cancer incidence is increasing in Vietnam with studies indicating low levels of knowledge and awareness and late presentation. While there is a growing body of literature on challenges faced by women in accessing breast cancer services, and for delivering care, no studies have sought to analyse breast cancer messaging in the Vietnamese popular media. The aim of this study was to investigate and understand the content of messages concerning breast cancer in online Vietnamese newspapers in order to inform future health promotional content.

Methods

This study describes a mixed-methods media content analysis that counted and ranked frequencies for media content (article text, themes and images) related to breast cancer in six Vietnamese online news publications over a twelve month period.

Results

Media content (n = 129 articles & n = 237 images) sampled showed that although information is largely accurate, there is a marked lack of stories about Vietnamese women’s personal experiences. Such stories could help bridge the gap between what information about breast cancer is presented in the Vietnamese media, and what women in Vietnam understand about breast cancer risk factors, symptoms, screening and treatment.

Conclusions

Given findings from other studies indicating low levels of knowledge and women with breast cancer experiencing stigma and prejudice, more nuanced and in-depth narrative-focused messaging may be required.

A critical discourse analysis of gendered cardiovascular disease meanings of the #MoreMoments campaign on Twitter

The purpose of this study was to explore how the Heart and Stroke Foundation of Canada and Canadian Twitter users linked women's experiences and health identities with the #MoreMoments cardiovascular disease awareness campaign. Critical discourse analysis of Twitter data between September 2017 and November 2017 identified two primary discourses (tragedy and loss, and life and health) and two identity/subject positions (visionary leaders and successful survivors). Responsibility for women's health was attributed to the Heart and Stroke Foundation of Canada, also limiting neo-liberal healthism and risk identification. Novel findings included resistance through use of 'small stories' within discourses regarding the targeted demographic for health promotion and knowledge translation.

A Nonheroic Cancer Narrative: Body Deterioration, Grief, Disenfranchised Grief, and Growth

This longitudinal nonheroic narrative study allows familiarity with personal and societal transitions in the self-identity of individuals with life-threatening cancer. The theoretical anchor is Bion's container-contained theory. Five interviews with a terminally ill hospitalized male in his 30s were conducted along intervals of between 6 and 8 weeks, up to 2 months before his death. Data were analyzed using the selection mechanisms method. Findings provide insights about the hospitalization experience, his grief, and disenfranchised grief. A rigid mode of container-contained relationships with clinicians created disenfranchised grief. Reflection and coherence among self-identities lead to inner strength and emotional growth despite the body's deterioration. Clinicians have a role in holistic identity transitions of individuals with cancer. Findings illuminate practical recommendations that clinicians may adopt to improve the experience of individuals suffering from cancer at the chronic and terminal phase of illness.

Exploring Gender-Related Experiences of Cancer Survivors Through Creative Arts: A Scoping Review

Negative health consequences of cancer and its treatments are multifaceted. Research suggests numerous psychosocial benefits may be gained by cancer survivors who engage in arts-based practices. To grasp the breadth of this literature, we undertook a scoping review exploring the intersection between arts-based practices, gender, and cancer. Three databases were searched according to the following criteria: (a) participants older than 18 years, (b) use of arts-based practices, (c) explore cancer survivorship, and (d) gender-based analysis component. A total of 1,109 studies were identified and 11 met inclusion criteria. Themes extracted illustrate four transformative moments related to gender identities postcancer diagnosis: (a) fostering reflection after a cancer diagnosis, (b) constructing new narratives of gender postcancer, (c) navigating gender norms in search of support for new identities, and (d) interrogation of perceived gender norms. Findings demonstrate potential contributions of arts-based practices in shaping cancer-related gender identities. Future research should investigate these experiences across a wider population.

Constructing women’s heart health and risk: A critical discourse analysis of cardiovascular disease portrayals on Facebook by a US non-profit organization

Women’s cardiovascular disease portrayals were explored on Facebook by the US non-profit organization Women’s Heart Alliance and public users in February 2017. Portrayals were explored using critical discourse analysis which also identified subject positions. Women’s cardiovascular disease was constructed within two central discourses: achieving health equity and healthism, with the following subject positions: altruistic fighters, health activists, and compliant patients and consumers. These findings affirmed and resisted problematic forms of cardiovascular disease risk reduction. Recommendations are made using discursive resources and subject positions within social media forms as concrete entry points of resistance and change to raise women’s cardiovascular disease awareness.

Investigating relationships between ancestry, lifestyle behaviors and perceptions of heart disease and breast cancer among Canadian women with British and with South Asian ancestry

BACKGROUND

Ethnic minority groups including Asians in Canada have different knowledge and perceptions of heart disease and breast cancer compared with the ethnic majority group.

AIM

Examine relationships between perceptions of heart disease and breast cancer, and lifestyle behaviors for Canadian women with British and with South Asian ancestry.

METHODS

Women with South Asian ( n = 170) and with British ( n = 373) ancestry ( M_age = 33.01, SD = 12.86) reported leisure time physical activity, intended fruit and vegetable consumption, disease perceptions (ability to reduce risk, control over getting the diseases, and influence of family history), and demographic information. Mann-Whitney tests and multiple hierarchical linear regressions were used to examine the relationships between lifestyle behaviors and disease perceptions, with ancestry explored as a possible moderator.

RESULTS

Participants with South Asian ancestry believed they had greater ability to reduce their risk and have control over getting breast cancer than participants with British ancestry. Family history influences on getting either disease was perceived as higher for women with British ancestry. Age was positively related to all three perceptions in both diseases. Intended fruit and vegetable consumption was positively related to perceptions of ability to reduce risk and control of both diseases, but was stronger for women with South Asian ancestry regarding perceptions of breast cancer. Leisure time physical activity was positively related to perceptions of control over getting heart disease for women with British ancestry.

CONCLUSIONS

Women's disease perceptions can vary by ancestry and lifestyle behaviors. Accurate representation of diseases is essential in promoting effective preventative behaviors.

Social media for health promotion: What messages are women receiving about cardiovascular disease risk by the Canadian Heart and Stroke Foundation?

The aim of this study was to explore the meanings of women's cardiovascular disease constructed within the Canadian Heart and Stroke Foundation Facebook page. Posts from Heart and Stroke Foundation and public user comments surrounding the launch of the Heart and Stroke Foundation re-branding were of interest. Ethnographic content analysis was employed to analyse text (n = 40), images (n = 32), videos (n = 6), user comments and replies (n = 42) from November 2016 to March 2017. Constructions (re)presented on Facebook of 'typical' women at risk and risk reduction were problematic as women most at risk were excluded through the use of consumerist, medicalized identities which also excluded promotion of healthy behaviour changes.