Sexual dysfunction related to the treatment of young women with breast cancer

Women have a 13.4% chance of developing breast cancer over their lifetime, and an estimated 60,000 women aged 20-50 will develop breast cancer in 2005. Surgical, radiologic, and chemotherapeutic treatments used to treat breast cancer can alter women's body image and menopausal status, ultimately affecting sexual health. A diagnosis of breast cancer is more traumatic for young women because of psychosocial concerns, side effects of treatment, and a potentially shortened life expectancy. Alterations in sexual health interfere with intimate relationships. Nurses can play a pivotal role in improving the sexual health of young women with breast cancer. This article explores the potential side effects of treatment that can affect sexual health, the unique needs of young women, and nursing interventions that systematically address sexual health concerns.     

Quality of life of African American breast cancer survivors: how much do we know?

Women affected by breast cancer experience an array of quality-of-life issues that affect their daily living in both short-term and long-term survivorship. Because African American women experience disparities in breast cancer survival, their quality-of-life concerns may paint a different picture from those of other racial and ethnic groups. To gain a better understanding of quality of life in African American women breast cancer survivors, we conducted a review, using an adaptation of Brenner's quality-of-life proximal-distal continuum, of studies that have investigated these women's experiences and associated variables. Twenty-six studies, qualitative and quantitative, were reviewed that identified both deficits and positive outcomes of breast cancer treatment and sequelae, including physical, emotional, social, and patient-provider problems as well as heightened spirituality and positive growth. Although overall global quality of life was favorable in both African American and white survivors, differences existed in the nature and extent of deficits between these 2 survivor groups. Nursing implications of this review point to the need for further rigorous research and wide dissemination of results. Recommendations for practice include tailoring assessments and interventions within the context of the lives of African American women breast cancer survivors.     

Risk factors for chronic pain following breast cancer surgery: a prospective study.

Chronic pain following breast cancer surgery is associated with decreased health-related quality of life and is a source of additional psychosocial distress in women who are already confronting the multiple stresses of cancer. Few prospective studies have identified risk factors for chronic pain following breast cancer surgery. Putative demographic, clinical, and psychosocial risk factors for chronic pain were evaluated prospectively in 95 women scheduled for breast cancer surgery. In a multivariate analysis of the presence of chronic pain, only younger age was associated with a significantly increased risk of developing chronic pain 3 months after surgery. In an analysis of the intensity of chronic pain, however, more invasive surgery, radiation therapy after surgery, and clinically meaningful acute postoperative pain each independently predicted more intense chronic pain 3 months after surgery. Preoperative emotional functioning variables did not independently contribute to the prediction of either the presence or the intensity of chronic pain after breast cancer surgery. These findings not only increase understanding of risk factors for chronic pain following breast cancer surgery and the processes that may contribute to its development but also provide a basis for the development of preventive interventions. PERSPECTIVE: Clinical variables and severe acute pain were risk factors for chronic pain following breast cancer surgery, but psychosocial distress was not, which provides a basis for hypothesizing that aggressive management of acute postoperative pain may reduce chronic pain.     

Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study.

As more individuals are being treated for cancer with high-dose therapy and autologous stem cell rescue (ASCR), there is growing interest in treatment side effects and their impact on quality of life. The primary aim of this study was to determine if the severity of fatigue and its impact on quality of life is significantly greater in women undergoing ASCR for breast cancer than in women of similar age with no history of cancer. A group of women being treated with ASCR for breast cancer (n = 31) and a group of women of similar age with no history of cancer (n = 49) participated in this study. Patients completed measures of fatigue and psychosocial functioning prior to treatment, midway through treatment, and toward the end of treatment. Healthy comparison subjects completed the same measures three separate times. Breast cancer patients undergoing ASCR reported significantly more frequent fatigue and more severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in patients than in women with no cancer history. Fatigue during ASCR for breast cancer was related to both medical factors (i.e., time since transplant) and psychosocial factors. During ASCR for breast cancer, women experience fatigue which is worse than what is "normally" experienced and which interferes with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue.     

The quality of life of African American women with breast cancer

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.     

Breast cancer screening barriers and disability

There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.     

Meeting the needs of younger women with breast cancer

In 1999 over 40,000 women were diagnosed with breast cancer, just over 8,000 of whom were under the age of 50 (Cancer Research UK, 2003). Premenopausal women who have been diagnosed with breast cancer often feel isolated and this article looks at some of the specific medical and psychosocial issues they may experience. Before examining these issues in depth, the article provides a brief overview of breast cancer and concludes by looking at the support and information services available to meet the needs of these women.     

Difference in patient's acceptance of early versus late initiation of psychosocial support in breast cancer

The present study was performed to assess the difference in acceptance of psychosocial counseling and resulting benefits between patients with breast cancer with early or late onset. In a prospective randomized controlled study conducted over 6 months, 41 women with a new diagnosis of early breast cancer (group 1) and 43 patients with advanced breast cancer (group 2) received individually tailored psychosocial support and were compared against controls. This therapy was free of charge, and the duration of support was determined by the patients' wishes and needs. Among the patients with new onset of disease acceptance of the psychosocial counseling was high, and these patients experienced significant improvements in their quality of life. In contrast, acceptance of psychosocial counseling was low in the advanced breast cancer group and the therapy did not improve quality of life over the observation period of 6 months. Early psychosocial support in patients with breast cancer meets with a high acceptance rate and improves quality of life.     

Women and diabetes

Women with diabetes face unique health challenges throughout their life cycle. Health concerns begin at puberty and continue throughout the reproductive years and later stages of life. Diabetes can have a significant impact on puberty, menstruation, reproduction, and cardiovascular and bone health. All women with diabetes require an individualized reproductive health plan that addresses contraception, the importance of planning pregnancies, and life-style changes. Anticipatory guidance and education in each phase of development can help the woman with diabetes avoid health care problems, reduce her risk of complications, and achieve a health outcome.     

Psychosocial adjustment to breast cancer in unmarried women

Breast cancer is a significant health problem that can affect many aspects of a woman's life. Although there is growing evidence that women with supportive husbands seem to adjust reasonably well, little is known about the impact of breast cancer among unmarried women. Relationships among primary treatment alternatives, symptom distress, perceived social support, and psychosocial adjustment to breast cancer in 101 unmarried women were investigated using data collected during the late postoperative recovery phase. The women experienced relatively low levels of psychosocial adjustment problems and perceived moderately high levels of social support. Social support and symptom distress each accounted for significant proportions of the variance in psychosocial adjustment, whereas primary treatment alternatives did not. Symptom distress emerged as the variable accounting for the most variance in psychosocial adjustment to breast cancer. Implications for health care providers to facilitate positive adjustment to breast cancer in unmarried women and directions for future studies are suggested. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 155–166, 1998     

Adjustment issues related to bilateral prophylactic mastectomy in women at elevated risk of developing breast cancer.

Breast cancer is the most common cancer diagnosis for North American and Western European women. Increased knowledge in availability of genetic testing has helped to identify those women at high risk of eventually developing breast cancer. This has resulted in more women considering bilateral prophylactic mastectomy as a viable preventative option. Although the efficacy of the procedure has been established, much less is known about the psychological impact of undergoing this procedure. In order to assess these factors, we reviewed what is currently known about the psychological impact of undergoing bilateral prophylactic mastectomy. Searches were conducted and inclusion criteria revealed articles that focused on the psychological components involved with undergoing a bilateral prophylactic mastectomy. The findings are summarized and fell broadly into one or more of the following three areas: (1) satisfaction or regret following the surgery, (2) psychosocial functioning after the surgery, and (3) predictors of quality of life. Plastic surgery nurses have a unique opportunity to impact important psychological considerations, such as expectations of the early postoperative period, body image concerns, and psychological distress.     

Issues and concerns of young Australian women with breast cancer

Goals of work Young women tend to experience many similar issues to that of their older counterparts, although more negatively and intensively. However, they also have specific concerns, which are not so apparent in studies that include a wide age range of participants. The aim of this study was to identify and explore the issues and concerns of Australian women diagnosed with breast cancer before age 41 years.Participants and methods We conducted in-depth, semi-structured interviews with a self-selected, convenience sample of 35 Australian women with breast cancer, diagnosed at 40 years of age or younger and no more than 4 years previously. Themes found within the literature about ‘younger’ women up to 50 years of age provided guidance to the interviews. The audiotaped interviews were transcribed verbatim. The data were analysed using the basic analytical principles of data reduction, data display and drawing conclusions. The data were initially subdivided according to the literature-derived themes. Content analysis was performed on the categories developed, revealing the most pressing concerns of participants.Main results Second to fear of recurrence and future uncertainty, children and family were the most commonly reported major personal concern. Consumer-related issues and concerns for children and family were equally reported as the greatest general concern of young women with breast cancer. The greatest unmet need of participants was support.Conclusions Age-appropriate information and support for this group of young women with breast cancer remains a challenge. This paper suggests ways young Australian women with breast cancer can access additional support with the use of technology.Professor Carla Patterson died prior to publication of this article     

Fatigue in women treated with bone marrow transplantation for breast cancer: A comparison with women with no history of cancer

As more individuals undergo autologous bone marrow transplantation (BMT), there is growing interest in the impact of treatment side effects on quality of life. Fatigue is a potentially disruptive treatment side effect that has not been systematically assessed following BMT. The primary aim of this study was to determine whether the severity of fatigue and its impact on quality of life is significantly greater in women who had undergone BMT for breast cancer than in women of similar age with no history of cancer. Another aim was to identify the medical and psychosocial correlates of fatigue in women who had completed BMT. A group of women treated with autologous BMT for breast cancer (n = 43; mean age = 44; mean time since BMT = 20 months) and a group of women of similar age with no history of cancer (n = 43; mean age = 46) participated in this study. Subjects completed measures of fatigue, anxiety, depression, and sleep habits. Medical data were obtained from computerized patient records. Women who had completed BMT for breast cancer reported significantly more frequent and severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in BMT recipients than in women with no cancer history. Fatigue following BMT for breast cancer was related to both medical factors (i.e., time since BMT) and psychosocial factors (i.e., anxiety, depressive symptoms and sleep difficulties). Following BMT for breast cancer, women may experience fatigue that is worse than might normally be expected and can interfere with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue.     

Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea

The purpose of this study was to evaluate the effects of a comprehensive group rehabilitation program on the range of motion of the shoulder joint, psychosocial adjustment, and the quality of life for early breast cancer patients. Fifty-five women with early breast cancer were assigned to an intervention group or a control group. Intervention was provided three times per week for 10 weeks. The results showed an increased range of motion of the shoulder joint, and psychosocial adjustment and quality of life were shown to be significantly higher in the intervention group than in the control group. The rehabilitation program comprised psychology-based education, exercise, and peer support group activity to promote recovery of the affected shoulder joint range of motion, alleviate physical symptoms, and improve psychosocial adjustment and quality of life for early breast cancer patients in South Korea.     

Challenges in the gynecologic care of premenopausal women with breast cancer

Premenopausal women with a new diagnosis of breast cancer are faced with many challenges. Providing health care for issues such as gynecologic comorbidities, reproductive health concerns, and vasomotor symptom control can be complicated because of the risks of hormone treatments and the adverse effects of adjuvant therapies. It is paramount that health care professionals understand and be knowledgeable about hormonal and nonhormonal treatments and their pharmacological parameters so they can offer appropriate care to women who have breast cancer, with the goal of improving quality of life. Articles for this review were identified by searching the PubMed database with no date limitations. The following search terms were used: abnormal uterine bleeding, physiologic sex steroids, endometrial ablation, hysteroscopic sterilization, fertility preservation in endometrial cancer, tranexamic acid and breast cancer, menorrhagia treatment and breast cancer, abnormal uterine bleeding and premenopausal breast cancer, levonorgestrel IUD and breast cancer, tamoxifen and gynecologic abnormalities, tamoxifen metabolism, hormones and breast cancer risk, contraception and breast cancer, pregnancy and breast cancer, and breast cancer and infertility treatment.     

"If looks would kill then I would be dead": intimate partner abuse and breast cancer in older women

The objective of this study was to describe the experiences of older women diagnosed with breast cancer while experiencing intimate partner abuse (IPA), determined by scores on the Women's Experience With Battering (WEB) Scale. Semi-structured qualitative interviews were conducted with a convenience sample of 11 women ages 51 to 84 (mean age = 64.8). Data were analyzed using hermeneutic phenomenological analysis. Themes that emerged were Cancer and Control, Negative Relationship Changes, Changes in Intimacy, and Moving On. Older women simultaneously experiencing IPA and breast cancer have unique needs due to the complex interplay among three factors: age, IPA, and breast cancer. Gerontological nurses should be aware of issues surrounding older women with breast cancer and older women experiencing IPA. Assessment of older breast cancer patients should take into consideration patients' social support network and quality of intimate partner support.     

Issues in the treatment of metastatic breast cancer

OBJECTIVES: To provide a discussion of the treatment of metastatic breast cancer, nursing interventions, and quality of life issues for women with advanced breast cancer. DATA SOURCES: Journal articles and internet web sites. CONCLUSIONS: Advances in the discovery of new chemotherapeutic regimens, monoclonal antibodies, and bisphosphonates have offered more options for the treatment of metastatic breast cancer. Treatment is aimed at improving survival while maintaining quality of life. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use this information to educate patients about their cancer treatment. It provides nurses with strategies for management of treatment side effects and will enhance their understanding of quality of life issues for women with metastatic breast cancer.     

Symptom clusters in breast cancer across 3 phases of the disease

The purpose of this exploratory, secondary analysis was to compare the prevalence of symptoms attributable to breast cancer or its treatment and to identify and describe symptom clusters across 3 phases of the disease. A pooled analysis was conducted by combining existing symptom data collected at the baseline assessment from 3 independent studies of women with breast cancer. Study I had 40 women with early-stage breast cancer following primary surgery for their disease and prior to the initiation of adjuvant therapy. Study II had 88 women with stage I, II, or III breast cancer who had completed surgery and adjuvant chemotherapy and may have been receiving hormonal therapy. Study III had 26 women with metastatic breast cancer (stage IV). Three symptom clusters were identified corresponding to 3 different phases of the breast cancer experience. Each cluster was composed of symptoms related to fatigue, perceived cognitive impairment, and mood problems. Future studies are needed to prospectively examine whether these symptoms cluster across 3 phases of breast cancer and the effect of these clusters on the functional ability and quality of life in women with breast cancer.     

Psychosocial issues associated with increased breast and ovarian cancer risk: findings from focus groups.

The advent of genetic testing for breast and ovarian cancer susceptibility has raised concurrent psychosocial issues. Within the context of limited health care resources, the ability to identify a subgroup of women who are at increased genetic risk for breast and ovarian cancers and who are also vulnerable to significant psychosocial sequelae is critical. Use of a focus group methodology substantiated the notion that there are factors that may predispose certain women who are at increased risk for developing breast and ovarian cancer to sustained psychosocial problems. In this era of rapid scientific strides coupled with efforts to contain health care costs, it is imperative that screening instruments be developed that can identify women who are at risk for significant psychosocial sequelae so that interventions can be instituted in a timely fashion.