Emotional self-efficacy, stressful life events, and satisfaction with social support in relation to mood disturbance among women living with breast cancer in rural communities

This study evaluated the relationships of emotional self-efficacy, stressful life events, and social support with mood disturbance among women diagnosed with breast cancer who live in rural communities. Eighty-two women completed measures of demographic characteristics, medical status, and psychosocial variables. Using multiple regression analysis, we found that greater mood disturbance was related to having less emotional self-efficacy (p < 0.001) and to having experienced more stressful life events (p = 0.02), while satisfaction with social support was not significantly related to mood disturbance (adjusted R2 = 0.39). Women living with breast cancer in rural communities who have experienced multiple stressful life events may have an increased risk for mood disturbance, whereas having greater emotional self-efficacy may provide resilience against mood disturbance.     

Sexuality and Spousal Support Among Women with Advanced Breast Cancer

Abstract: This study examines the relationships of mood, age, living with a spouse, and time elapsed since diagnosis of first recurrence to sexual interest. Seventy-two women with metastatic breast cancer and 26 of their spouses were recruited through their oncologists. Women and their spouses were administered a battery of measures designed to assess psychosocial and medical variables. Eighty-three percent of the women and 100% of the spouses indicated that sexual pleasure was something they wanted to experience; however, only 25% of the women indicating this interest and only 19% of the spouses reported that it had been easy for them to experience sexual pleasure. For patients, living with a spouse was significantly associated with being interested in experiencing sexual pleasure [p <.05]. Patients with lower mood disturbance were significantly more able to experience sexual pleasure than those with high mood disturbance scores [p <.05]. Ability to experience sexual pleasure was significantly and positively correlated between patients and their spouses ( r =.56, p <.01). Sexuality is an important aspect of quality of life for metastatic breast cancer patients and their spouses. Further research is needed to examine psychosocial factors that affect sexuality for this population.     

The psychosocial impact of ductal carcinoma in situ (DCIS): A longitudinal prospective study

DCIS is a non-invasive breast cancer, increasingly detected through routine breast screening. Patients are reassured that the condition is early and not life-threatening but they undergo surgery similar to that used in the treatment of invasive breast cancer (IBC). Little research has explored the psychosocial impact of DCIS, especially in the UK. A longitudinal, prospective study was therefore conducted to address this gap. Fifty women newly diagnosed with DCIS were followed over the first year post-diagnosis. Anxiety and depression significantly reduced from baseline to 6 months. Body image distress was relatively stable, but extensive for some women. Those undergoing mastectomy with immediate reconstruction experienced significantly greater body image concerns. This study highlights that DCIS patients can experience psychosocial distress that is often transient but in some cases extensive and prolonged. Appropriate psychosocial support is needed to help DCIS patients adjust to the diagnosis, its treatment and long-term implications.     

乳腺癌与心理社会危险因素的相关性研究

目的：探讨与乳腺癌发病有关的危险性心理社会因素。方法：对临床确诊的31例乳腺癌病人及31例正常人，进行心理行为问卷（婚姻质量问卷--ENRICH、生活事件问卷-LEs、社会支持评定量表-SSRS和特质应对方式-TCSQ）测试。结果：在乳腺癌确诊前5年内病人所经历的应激性负性生活事件（L2）明显多于对照组，其中以与家庭有关的负性生活事件（L5）及工作学习中的问题（L8）占主要位置，且病人的婚姻满意度（HS）低于对照组，在遇到应激性负性生活事件时较多地采用消极的应对方式（NC），以上差异均有统计学意义（P〈0．05）。从条件Logistic回归分析选入变量中，L5[OR=0．959，CI（0．921～0．998）]、s2[OR=0．825，CI（0．700～0．972）]和NC[OR=0．921，CI（0．847～1．002）]与乳腺癌的发病危险性关系密切。结论：病前经历较多的与家庭有关的应激性负性生活事件、面对虚激时缺乏客观社会支持及采取消极的虚对方式是女性发生乳腺癌的重要危险因素之一。     

Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical,Psychological, and Social Sequelae

Women with metastatic breast cancer face a wide range of medical, practical, and emotional challenges that impact their quality of life. Research to date, however, has not focused on the quality‐of‐life concerns of metastatic breast cancer patients with significant distress. The present study examined a range of concerns among distressed metastatic breast cancer patients, including physical and emotional distress, social functioning, and existential issues. Forty‐four distressed women with metastatic breast cancer wrote their deepest thoughts and feelings regarding their illness. These essays were thematically analyzed for effects of the illness on quality of life. Three themes were identified in patients' essays. First, metastatic breast cancer and its treatment may result in a number of quality‐of‐life concerns, including physical symptom burden, emotional distress, body image disturbance, and disrupted daily activities. Second, social constraints on disclosure of cancer‐related concerns may exacerbate patients' distress. Third, many women experience a heightened awareness of life's brevity and search for meaning in their cancer experience. Results highlight a range of quality‐of‐life concerns following a metastatic breast cancer diagnosis and suggest that addressing social constraints on cancer‐related disclosure and the search for meaning may improve patients' psychological adjustment.     

When Breast Cancer Recurs: A 3-Year Prospective Study of Psychological Morbidity

Abstract: In a prospective study of 269 women diagnosed with early breast cancer, 61 (23%) developed recurrence of their disease within the 3-year study period. Thirty-eight of these women were interviewed following this diagnosis. Women with recurrence of their breast cancer were significantly more likely to experience psychiatric morbidity than women who were disease-free (p < 0.001). There was no statistically significant difference in psychiatric disorder at the interview before recurrence occurred, nor in anxiety personality trait preoperatively between these two groups: mental state prior to the diagnosis of recurrence did not appear to predict which women would develop secondary disease. Fifty percent of the 38 women were found to be clinically anxious, depressed, or both at interview. This psychiatric distress was not associated with the side effects of current cancer treatments, nor with age, but appeared to be a direct response to the cancer having spread. Thirty of the 38 women did not receive any support, directly or by referral, from their hospital, following discovery of recurrent disease. There were some interesting differences in psychiatric morbidity between women, depending on how they interpreted information given to them about their prognosis. These findings have implications for the management of recurrent disease. Many patients in this distressing situation are in need of psychosocial support; doctors also need to receive appropriate training for conveying difficult information about both diagnosis and prognosis.?     

Coping With a Diagnosis of Breast Cancer-Literature Review and Implications for Developing Countries

Abstract:  Breast cancer is the most common cancer affecting women worldwide. Women are at an increased risk of developing both physical and psychological morbidity after diagnosis; however, many use different strategies to cope with the disease. The aim of this article is to review the available literature on the impact of breast cancer diagnoses and the strategies used by women to cope with this disease. The implications of these emerging findings are extrapolated within the context of health services provided in developing countries. Electronic databases were used to search the relevant literature. The findings showed that women who were diagnosed with breast cancer are at risk of developing several psychological morbidities such as depression, anxiety, fatigue, negative thoughts, suicidal thoughts, fear of dying, sense of aloneness, sexual and body images problems, as well as an overall decrease in the quality of life. Several strategies are used by women with breast cancer to cope with the disease, including positive cognitive restructuring, wishful thinking, emotional expression, disease acceptance, increased religious practice, family and social support, and yoga and exercise. Breast cancer diagnoses have been associated with several devastating psychological consequences; however, many women have used different coping strategies to adjust their lives accordingly. Healthcare professionals in developing countries, who work with women with breast cancer, should be aware of the different coping mechanisms that women use when diagnosed with cancer. Integrating a coping strategy into the treatment regimen would constitute an important milestone in the palliative care of patients with breast cancer.     

Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy

INTRODUCTION

Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults’ well-being and body image. As part of a study into damaging effects of abuse on adjustment to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse.

PATIENTS AND METHODS

We recruited 355 women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months later.

RESULTS

Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after controlling for abuse.

CONCLUSIONS

One interpretation of these findings is that history of abuse influences women''s decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women''s adjustment should be a priority for research.     

Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: A qualitative study

Background

Distress is common among cancer patients and leads to worse postoperative outcomes. Surgeons are often the first physicians to have in-depth conversations with patients about a new colorectal cancer diagnosis; therefore, it is important that these surgeons understand how patients cope with the distress of a diagnosis and how they can help patients manage this distress.

番禺区大石街农村妇女乳腺癌患病率及乳腺癌预防知信行调查分析

目的：通过对番禺区大石街农村妇女的乳腺癌患病率及乳腺癌预防知信行的调查结果,分析番禺区农村妇女乳腺癌预防的现状及存在问题,为有关机构及部门如何制定对策,预防农村妇女乳腺癌的发生发展提供参考依据。方法采用随机整群抽样法,通过乳腺检查及乳腺癌预防知信行问卷调查的方式,调查番禺区大石街1428名农村妇女乳腺癌患病率及乳腺癌预防的知信行现状,回收有效问卷1420份。结果受调查者对乳腺癌的12项危险因素平均知晓率为42.25%,乳腺癌的5项征兆的平均知晓率为41.06%;对乳腺癌预防的3项态度调查,同意及非常同意的平均占89.74%,不一定及不同意的平均占10.26%;乳腺彩超或X线检查中从未检查的13.73%,定期检查的18.31%,乳腺自检中从未自检的37.75%、定期自检的仅0.99%;乳腺癌患病率为0.14%,其他乳腺疾病以乳腺增生和乳腺囊肿为主,患病率依次为29.44%、6.55%。结论番禺区大石街农村妇女对乳腺癌预防基本知识的知晓率低,约10%对乳腺癌预防持消极态度,乳腺定期检查率低,乳腺癌及其他乳腺疾病患病率较高。社区卫生服务机构及其主管部门应针对存在问题制定对策,有效防控农村妇女乳腺癌的发生发展。     

Method of Breast Cancer Presentation and Depressed Mood 1 Year After Diagnosis in Women with Locally Advanced Disease

Background   Differences in psychological outcomes of breast cancer patients with locally advanced disease who presented with abnormal screening mammograms or palpable mass have not been reported. Methods   We interviewed 120 women with clinical stage II/III breast cancer enrolled onto a prospective phase 2 clinical trial at diagnosis and 1 year after diagnosis, inquiring about demographics, depressive symptoms, social support, and perceived risk of disease recurrence. Presentation method (abnormal screening mammogram or symptoms) was determined by chart review. Change in depressed mood was assessed by repeated measures analysis of covariance, grouping by presentation method. Results   A significant interaction was observed between presentation method and change in depressed mood among 86 women without disease progression who completed both interviews. Women presenting with breast symptoms experienced a decrease and women presenting with abnormal screening mammogram experienced an increase in depressed mood (P = 0.032). Conclusions   Women diagnosed with locally advanced breast cancer by screening mammography showed increased depressed mood a year after diagnosis. Therefore, identification of locally advanced breast cancer by screening mammogram may be a risk factor for posttreatment depression. Presented at the 9th Annual Meeting of the American Society of Breast Surgeons, New York, April 30–May 4, 2008.     

Disengagement and social support moderate distress among women with a family history of breast cancer

Using a cross-sectional, exploratory design, this pilot study analyzed the relationships between familial history of breast cancer and psychological distress in order to evaluate who is more distressed and to assess the possible need for intervention. Coping style, social support, and family relations were investigated as potential moderators of these relationships. Participants were 45 women with a familial history of breast cancer recruited from the Family Registry for Breast Cancer (FRBC) at the Northern California Cancer Center (NCCC). Contrary to previous reports of similar cohorts, the overall level of psychological distress in this cohort was comparable to normative samples. The number of relatives with breast cancer was related to distress as measured by the State-Trait Anxiety Inventory (STAI) scale, but there was no significant differentiation in distress associated with the number of first-degree as compared to second- and third-degree relatives with breast cancer. Having more relatives that had died from breast cancer was associated with greater distress on a number of measures. The number of first-degree relative deaths, including maternal death, was also associated with distress. Positive and network support, disengagement coping responses, and family cohesion were each significant moderators of the impact of family history on distress. This association between distress and disengagement is similar to that found in metastatic breast cancer patients themselves, and the findings suggest a subgroup that merits and might respond to more intensive intervention to provide support and facilitate emotional expression.     

Religion and spirituality in coping with breast cancer: perspectives of Chilean women

This study examined the roles of religion and spirituality in relation to coping with breast cancer in Chilean women. Specifically, the purpose of the study was to examine how these patients used religion and spirituality to cope with their illness; how their illness changed the roles of religion and spirituality in their lives; and their views regarding whether, and if so how, spiritual faith can help patients recuperate from breast cancer. Twenty-seven women with breast cancer who were patients at a clinic in Santiago, Chile were recruited to participate in one-on-one interviews. The transcribed interviews were analyzed using the "constant comparative method" to seek patterns and organize the content into specific themes. Women viewed religion and spirituality as primary resources for themselves and others to use in coping with breast cancer. Women's use of religion and spirituality was manifested in praying, in their perceived dependence on God to intercede and guide them through their illness, and in obtaining social support from other persons in their faith community. Half (13/26) of the women reported that their cancer prompted an increased emphasis on religion and spirituality in their lives by deepening their faith in God. Almost all (26/27) participants endorsed the belief that spiritual faith can help cancer patients to recuperate. These findings suggest that health care providers working should be aware of the culturally dependent roles that religion and spirituality play in women's coping with breast cancer.     

Distress in partners of high-risk women undergoing breast cancer surveillance

BackgroundPartners are an importance source of support for women at risk for hereditary breast cancer. The impact of regular breast cancer surveillance in at-risk women on psychological distress in the partners of these women is unknown. This study aimed to (1) examine the levels and courses of psychological distress of partners and high-risk women around breast cancer surveillance appointments at the clinic, (2) to explore the relationship between partners’ and women's distress, and (3) to identify factors that were associated with distress in partners.MethodsPartners of 77 high-risk women adhering to breast cancer surveillance, and participating in a psychological follow-up study, completed questionnaires measuring psychological distress 2 months before (T0), on the day of (T1) and 1 to 4 weeks after (T2) two consecutive biannual appointments for the women at the clinic.ResultsPartners’ breast cancer-specific distress was positively related to the women's cancer-specific distress prior to breast cancer surveillance. Fatherhood and affective risk perception were positively associated with distress in partners.ConclusionsOur findings indicate that the psychological distress associated with stressful waiting for the breast cancer surveillance appointment, and – after the appointment – for the results, is an interpersonal experience, which is shared within the couple. These findings underscore the importance of involving partners in the clinical interventions for high-risk women. Clinicians should address the affective risk perception of partners, i.e. how they experience the increased breast cancer risk of the woman.     

Chemotherapy and psychological side-effects in breast cancer patients

To find out the significance of psychosocial compared to physical reactions we interviewed 56 breast cancer patients who had finished intravenous adjuvant chemotherapy. In general, psychological distress was rated to be less tolerable than physical side-effects. Active coping proved to be relevant, especially for the incidence of anticipatory reactions.     

Cancer fear and mood disturbance after radical prostatectomy: consequences of biochemical evidence of recurrence

PURPOSE: Biochemical recurrence of prostate cancer often precedes any clinical sign or symptom of disease recurrence by several years. Thus, patients may have laboratory evidence of recurrence and do not know what it portends in terms of the future disease course. Little is known about the emotional consequences of biochemical recurrence. We compared cancer fear and mood disturbance in men with biochemical recurrence of prostate cancer versus those without recurrence. In addition, associations among urinary symptoms, cancer fear and mood disturbance were examined. MATERIALS AND METHODS: A survey including the American Urological Association symptom index, a cancer fear measure and the Profile of Mood States was mailed to patients at a urology clinic at a tertiary care hospital in 1999. Of the sample of 270 patients with prostate cancer who underwent radical prostatectomy 126 (47%) responded to the mailed survey. A total of 45 men with biochemical prostate cancer recurrence were compared to 81 patients without recurrence. RESULTS: Higher urinary tract symptoms were associated with increased cancer fear and mood disturbance (each p <0.05). Biochemical cancer recurrence was not independently associated with increased cancer fear and mood disturbance. However, men with biochemical recurrence and more severe urinary tract symptoms reported the highest levels of cancer fear and mood disturbance (each p <0.01). CONCLUSIONS: Psychological distress was highest in men with biochemical recurrence and elevated clinical symptoms. Urinary symptoms may be an important contributor to psychological distress in patients with prostate cancer who have biochemical recurrence.     

Traumatic stress symptoms among women with recently diagnosed primary breast cancer

This study examined the concurrent and longitudinal relationships between traumatic stress symptoms and demographic, medical, and psychosocial variables among women recently diagnosed with primary breast cancer. Participants were 117 women drawn from a parent study for women recently diagnosed with primary breast cancer. At baseline, the Impact of Event Scale (IES) total score was related to intensity of postsurgical treatment and lower emotional self-efficacy. At the 6-month follow-up, the IES total score was significantly related to younger age, to the increased impact of the illness on life, and to the baseline IES total score assessment. These results suggest that it is important to intervene for traumatic stress symptoms soon after the diagnosis of breast cancer. Furthermore, these results suggest women at greatest risk are those who are younger, who receive postsurgical cancer treatment, who are low in emotional self-efficacy and whose lives are most affected by having cancer.     

Psychosocial Consequences of Genetic Counseling: A Population-Based Follow-up Study

Abstract:  We aimed to examine the psychosocial impact of genetic counseling for hereditary breast and ovarian cancer 1 year following genetic counseling. We conducted a population-based prospective follow-up study of 213 women who received genetic counseling for hereditary breast and ovarian cancer, 319 women who underwent mammography (Reference Group I), and a random sample of 1,070 women from the general population (Reference Group II). The prevalence of anxiety decreased by 4.7% (95% CI: −3.5; 12.8) from baseline to 1 year of follow-up in the Genetic Counseling Group. Likewise, it decreased by 2.5% (95% CI: −4.5; 9.5) in Reference Group I and by 1.1% (95% CI: −2.3; 4.7) in Reference Group II. The prevalence of depression increased equally (1–3%) in the three study groups. 52% of the women referred for genetic counseling experienced cancer-specific distress at baseline and this proportion decreased to 41% after 12 months of follow-up. This decrease of 10.8% (95% CI: 1.4; 20.8) exceeded the decrease observed in both Reference Groups. However, it was statistically significant only in the case of Reference Group II (p = 0.006). Our findings indicate that genetic counseling can help alleviate cancer-specific distress among women with a family history of breast and ovarian cancer. Further, genetic counseling does not appear to have an adverse impact on general anxiety, symptoms of depression, or health-related quality of life.     

Evolving psychosocial,emotional, functional,and support needs of women with advanced breast cancer: Results from the Count Us,Know Us,Join Us and Here & Now surveys

Although medical advances have marginally improved survival of women with advanced breast cancer, their psychosocial, emotional, and functional needs remain unmet. Two surveys, Count Us, Know Us, Join Us (Count Us) and Here & Now (H&N), were conducted to understand the unique challenges faced by women with advanced breast cancer and to identify ways of addressing these issues. A total of 1577 women with advanced breast cancer (Count Us, N = 1273; H&N, N = 304) participated in the two surveys, which revealed several previously unreported challenges. Nearly half the women felt isolated and worried, and slightly more than half experienced declines in income because of change in employment; 41% of women felt that support from family and friends decreased over time, and many patients believed information about advanced breast cancer was inadequate and difficult to find. Concerted efforts by people who care for and support women with advanced breast cancer are urgently needed to address these issues.     

Is Pregnancy After Breast Cancer Safe?

Abstract: The impact of treatment on subsequent fertility and the safety of childbearing are major complicating factors for young women diagnosed with breast cancer. As national data indicate women are postponing first pregnancy to older ages; therefore, many young patients are seeking clinical guidance regarding the safety of conception and treatment options that may not prevent subsequent pregnancy. Newly developed chemotherapy protocols of brief duration have improved life expectancy enabling some women to consider childbearing. This study was conducted to compare prognosis among breast cancer patients with and without a subsequent pregnancy. Medical record review of female members of a Northern California prepaid health care plan enabled the identification of 107 women with one or more subsequent pregnancies and 344 cases without a pregnancy, who were diagnosed between 1968 and 1995. Sets were matched on age, year and stage at diagnosis, months of survival and recurrence status at conception. Among the matched sets, neither risk of recurrence nor death differed significantly by subsequent pregnancy history during an average 12 years of follow‐up (adjusted hazard ratio [HR] recurrence: 1.2 [0.8, 2.0]; adjusted HR death: 1.0 [0.6, 1.9]). Women interested in preserving their fertility and considering pregnancy are a self‐selected population; therefore, to reduce potential bias, cases were matched on recurrence status at time of conception. Although the number of cases was limited, subgroup analyzes indicated a small, nonsignificant adverse effect among women who conceived within 12 months of diagnosis. This analysis of carefully matched cases provides reassurance that long‐term prognosis was not adversely affected by subsequent pregnancy.