Promoting adjustment among women with breast cancer and their partners: a program of research

A three-phase program of research consisted of: (1) data collection at eight data points across one year on predictors and outcomes of adjustment among 128 women diagnosed with breast cancer and 121 partners; (2) development of phase-specific interventions: standardized education by videotape (SE), and telephone counseling (TC); and (3) a pilot study among 12 patient-partner pairs. Four phases were identified: diagnostic, post-surgical, adjuvant therapy, and ongoing recovery. Needs were categorized as those related to: (1) physical well-being, (2) emotional well-being; (3) support; and (4) the healthcare system. In the pilot study, each group consisted of 4 patient-partner pairs, randomly assigned to one of four groups. At each of the four phases, all groups received the currently accepted disease management (DM). Group 1: DM * Group 2: DM+SE * Group 3: DM+TC * Group 4: DM+SE+TC. Measures of outcomes validated in the longitudinal study were administered. The feasibility of a confirmatory randomized clinical trial was demonstrated. Preliminary evidence indicates the importance of research-based, phase-specific educational and counseling interventions that have a positive effect on adjustment among both patients and their families.     

Depression and anxiety in older women

The recommended shift in paradigm for assessment and treatment of depression and anxiety in the primary care setting includes a more holistic medical care approach, one that pays attention to the patient's mental health status and her functional level of social role recovery in addition to symptom relief. Practice Guidelines of professional specialities should be expanded to include attention to initializing mental health care in primary care practice and parameters for early referral and, if indicated, later follow-up. Our medical education system, at all levels, needs to become considerably more inclusive of issues of aging, gender, and mental health. Ongoing attention must be given to the health care cost burden of under recognition and under treatment of anxiety and depression, alleviation of stigma, treatment to functional recovery, and alleviation of caregiver burden.     

Interpersonal well-being and mental health among male partners of women with breast cancer

The focus of this investigation was on the mental health of men whose partners had recently been diagnosed with breast cancer. In accord with theoretical models that specify the importance of interpersonal relationships in maintaining mental health, men's relationship satisfaction and perceptions of social support were predicted to be positively associated with their mental health during this stressful time. The sample included 63 male partners of women with breast cancer who participated in a three-wave panel study that assessed various indicators of mental health and interpersonal well being at T1, T1 + 6 weeks, and T1 + 10 weeks. Results indicated substantial distress in at least 25% of the men. However this distress subsided over time. Relationship satisfaction was both concurrently and prospectively associated with better mental health. Social support was negatively associated with concurrent mental health but post hoc analyses suggested that men's social networks perhaps provide greater social support to the extent that the men are emotionally distressed.     

Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy

Purpose  

The purpose of this study was to examine patterns of circadian activity rhythms and their relationship with fatigue, anxiety/depression, and demographic/medical variables in women receiving breast cancer adjuvant therapy treatments (Tx) at three times within a randomized clinical trial (RCT) designed to improve sleep and modify fatigue.     

Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer

A possible diagnosis of breast cancer imposes a huge psychological impact on most women, but few studies have addressed uncertainty and anxiety changes at different diagnostic stages in women with suspected breast cancer. Thus, this longitudinal study examined uncertainty and anxiety and predictive factors for uncertainty in women with suspected breast cancer. Data were collected on uncertainty (Uncertainty in Illness Scale) and anxiety (State Anxiety Inventory) from 127 women at 3 times: upon notice of a breast biopsy, before biopsy, and after diagnosis. The results showed that uncertainty and anxiety levels were significantly higher before than after diagnosis. At the 3 data collection times, uncertainty and anxiety were significantly lower for participants diagnosed with benign tumors than for those with malignant diagnoses. Uncertainty and anxiety were positively, moderately correlated. Uncertainty was predicted by age, marital status, education level, religious status, family history of benign breast tumor, regular breast self-examination, self-perceived probability of receiving a breast cancer diagnosis, and biopsy result. Therefore, nursing professionals should be aware of the uncertainty and anxiety changes and impact of personal attributes on women with suspected breast cancer during the diagnostic period and provide care programs to alleviate their psychological distress.     

Depression and anxiety among partners of European-American and Latino patients with type 2 diabetes

OBJECTIVE: To assess the levels of and the independent contributors to depressive affect and anxiety among partners of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The partners of 75 Latino and 113 European-American patients with type 2 diabetes were assessed for level of depressive affect and anxiety and for three groups of potential stressors: demographics (age, gender, and education), patient disease status (time since diagnosis, HbA(1c), comorbidities, and BMI), and family stress (disease impact, spouse conflict, and family closeness). Dependent variables were partner depressive affect (Center for Epidemiological Studies-Depression scale) and anxiety (Symptom Checklist [SCL-90] anxiety). Predictors of partner depressive affect and anxiety and partner-patient concordance rates were computed. RESULTS: Levels of depressive affect and anxiety and rates of likely depression (21.4%) were as high for partners as they were for patients. No differences were found on depressive affect or anxiety by ethnicity, but female partners scored higher than male partners on both measures. Partner-patient concordance rates were low. The family level variables accounted for the most variance in both depressive affect and anxiety, with demographics and disease status variables contributing modest or nonsignificant independent variance. CONCLUSIONS: Partners of patients with type 2 diabetes experience levels of psychological distress as high or even higher than patients, especially if the partner is female. Low levels of concordance suggest that partners can be distressed even if patients are not. Many life stresses contribute to psychological distress among partners, not just disease-related indicators. The findings suggest the utility of evaluating both partners and patients using a life-centered rather than a disease-focused perspective.     

Factors related to anxiety and depression in women with breast cancer and their husbands: role of alexithymia and family functioning

Goals of work The purpose of this study was to explore alexithymia, family functioning, and other factors that might affect anxiety and depression levels in women with breast cancer and in their husbands. Patients and methods A cross-sectional study was undertaken in 46 postsurgical ambulatory women with breast cancer and their husbands. Documented informed consent for the study was obtained from each subject. All subjects completed the Zung self-rating anxiety scale (SAS), the Zung self-rating depression scale (SDS), the 20-item Toronto alexithymia scale (TAS-20), and the family assessment device (FAD). Main results Multiple regression analysis revealed that a high degree of alexithymia in patients correlated with a high degree of patient anxiety. Patient perceptions of inappropriate affective responsiveness among family members correlated with a high degree of depression. Among husbands, a high degree of anxiety was correlated with their own high level of alexithymia or low level of education, and with the occurrence of adjuvant therapy in their wives. Husband perceptions of inappropriate sharing of roles among family members, their own low education level, and a large number of family members correlated with high degrees of depression among them. Conclusions The present study revealed that alexithymia and family functioning are associated with anxiety and depression, respectively, in both women with breast cancer and in their husbands. Individual traits such as alexithymia and family functioning should be taken into account when we intervene to treat anxiety and depression in breast cancer patients and their husbands.     

Effect of supportive care on the anxiety of women with suspected breast cancer

Title.  Effect of supportive care on the anxiety of women with suspected breast cancer.
Aim.  This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.
Background.  Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.
Methods.  For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group ( n  =   62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group ( n  =   60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).
Findings.  After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy ( P  =   0·017) and after diagnosis ( P  =   0·001) than those of women receiving routine care.
Conclusion.  Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.     

Depression and anxiety disorders in palliative cancer care

Depression and anxiety disorders are thought to be common in palliative cancer care, but there is inconsistent evidence regarding their relevance for other aspects of quality of life. In the Canadian National Palliative Care Survey, semi-structured interviews assessing depression and anxiety disorders were administered to 381 patients who were receiving palliative care for cancer. There were 212 women and 169 men, with a median survival of 63 days. We found that 93 participants (24.4%, 95% confidence interval=20.2-29.0) fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for at least one anxiety or depressive disorder (20.7% prevalence of depressive disorders, 13.9% prevalence of anxiety disorders). The most frequent individual diagnosis was major depression (13.1%, 95% confidence interval=9.9-16.9). Comorbidity was common, with 10.2% of participants meeting criteria for more than one disorder. Those diagnosed with a disorder were significantly younger than other participants (P=0.002). They also had lower performance status (P=0.017), smaller social networks (P=0.008), and less participation in organized religious services (P=0.007). In addition, they reported more severe distress on 14 of 18 physical symptoms, social concerns, and existential issues. Of those with a disorder, 39.8% were being treated with antidepressant medication, and 66.7% had been prescribed a benzodiazepine. In conclusion, it appears that depression and anxiety disorders are indeed common among patients receiving palliative care. These disorders contribute to a greatly diminished quality of life among people who are dying of cancer.     

Rehabilitation in women with breast cancer

The diagnosis and treatment of breast cancer in women has undergone profound changes in the past century. Although much research and clinical attention has been focused on saving the lives of women with this condition, less focus has been on rehabilitation aspects. This postacute care should be a distinct phase of treatment. The field of physical medicine and rehabilitation has much to offer women who undergo extremely toxic although life-prolonging therapies for breast cancer. The focus of rehabilitation should include improving strength and cardiovascular conditioning, alleviating pain and improving fatigue. With respect to exercise, this can help women to physically recover from treatment and potentially prevent cancer recurrence. Many exciting opportunities will be available for rehabilitation specialists to improve the care of women with breast cancer and to participate in research in the field of oncology rehabilitation.     

Adjustment of women and their husbands to recurrent breast cancer

The psychosocial adjustment of women with recurrent breast cancer (N = 81) and their husbands (N = 74) were compared to determine if they report different levels of adjustment, support, symptom distress, hopelessness, and uncertainty. Women with recurrent breast cancer reported more emotional distress than their husbands, but both had a similar number of psycho-social role problems. Women and husbands differed in the amount of support and uncertainty they reported but not in the levels of symptom distress or hopelessness they perceived. Women, in contrast to their husbands, expressed more surprise that their cancer recurred and found the recurrent phase of illness more distressing than the initial diagnosis. ©1995 John Wiley & Sons, Inc.     

Smoking and prognosis in women with breast cancer

The hypothesis was that smokers might have more aggressive types of breast cancer because of either delayed diagnosis or higher grade and hence have a worse prognosis. A cohort of breast cancer patients completed a lifestyle questionnaire at the time of diagnosis, including whether they were current smokers, ex-smokers or lifelong non-smokers. Ex-smokers were asked when they had stopped. The participants were 166 women with stage I/II invasive breast cancer diagnosed between October 1984 and March 1987. Participants were divided into three groups: current smokers, ex-smokers and non-smokers. Survival curves were produced by using Cox proportional hazards analysis, with outcome variables for overall and breast cancer-specific survival together with distant relapse-free survival. Smoking was the third most important predictor of distant relapse-free, breast cancer-specific and overall survival after stage and age at diagnosis. These results suggest that smokers are not only more likely to die of other diseases, but also have a higher mortality from breast cancer, compared with those with the disease who have never smoked. The best prognosis, however, was found in those who had given up smoking.     

Differences in depression,anxiety, and quality of life between women with and without breast pain prior to breast cancer surgery

Purpose of the researchLittle is known about the relationships between pain, anxiety, and depression in women prior to breast cancer surgery. The purpose of this study was to evaluate for differences in anxiety, depression, and quality of life (QOL) in women who did and did not report the occurrence of breast pain prior to breast cancer surgery. We hypothesized that women with pain would report higher levels of anxiety and depression as well as poorer QOL than women without pain.Methods and sampleA total of 390 women completed self-report measures of pain, anxiety depression, and QOL prior to surgery.Key resultsWomen with preoperative breast pain (28%) were significantly younger, had a lower functional status score, were more likely to be Non-white and to have gone through menopause. Over 37% of the sample reported clinically meaningful levels of depressive symptoms. Almost 70% of the sample reported clinically meaningful levels of anxiety. Patients with preoperative breast pain reported significantly higher depression scores and significantly lower physical well-being scores. No between group differences were found for patients' ratings of state and trait anxiety or total QOL scores.ConclusionsOur a priori hypotheses were only partially supported. Findings from this study suggest that, regardless of pain status, anxiety and depression are common problems in women prior to breast cancer surgery.     

The religiousness as a way of coping with anxiety in women with breast cancer at different disease stages

Background  Anxiety is an unpleasant emotion affecting patients with cancer, and there are various ways of coping with it. Little is known about the relationship between the anxiety level and physical, somatic or spiritual (e.g. religiousness) factors in breast cancer patients at different stages of the disease. Objectives  The purpose of the study was to assess the intensity of anxiety at different stages of breast cancer, to define the relationship between religiousness and physical (somatic) condition and anxiety in the study subjects and to find out if religiousness is an effective coping strategy at any breast cancer stage. Materials and methods  The study involved 180 women aged between 28 and 77, who were qualified to one of five study groups, according to their disease stage. The following research instruments were used: the State–Trait Anxiety Inventory (STAI), Scale of Personal Religiousness, the Rotterdam Symptom Checklist as well as medical history and data from patients’ medical records. Results  There is a significant correlation between state anxiety and trait anxiety measured by STAI in study groups. Breast cancer stage differentiates the study groups in respect of revealed anxiety level. Somatic condition has no significant impact on the intensity of anxiety in terminal breast cancer patients. Amongst the studied variables, only religiousness is an important factor that influences the anxiety level of end-stage cancer patients. Conclusions  The obtained results allow us to conclude that: (a) religiousness is an effective factor of coping with anxiety only of the end-stage breast cancer patients; (b) cancer stage is a differentiating factor in respect of revealed anxiety level in study subjects; (c) exacerbation of somatic symptoms does not influence the anxiety level in terminal cancer patients and at disease-free period.     

Postmenopausal women with breast cancer: their experiences of the chemotherapy treatment period

This article illustrates the experience of 20 postmenopausal women with breast cancer who had received chemotherapy treatment. The interviews were of narrative nature and analyzed with content analysis. Four themes, including 12 subthemes, described these women's life during treatment as a journey from the negative experiences of fear of the unknown, affects on body and mind, to the more positive to get by, and a transformed life. The treatment was compared with an assault on the body, and the loss of their hair was experienced more negatively than the loss of a breast. The women described a feeling of imbalance in their relationships due to lack of support from those close to them. The support from healthcare professionals was experienced both positively and negatively, and many of the women revealed variation in the professional's attitude, knowledge, and empathy. The women who chose not to work during the treatment felt pressure from society and healthcare professionals to get back to work as soon as possible. For many, especially those in a leading position, this was experienced as very difficult. The women expressed a feeling of not being afraid of dying but wanted more time to prepare themselves.