Experiences of Spouses of Women with Breast Cancer: A Content Analysis

Introduction: In addition to the affected person, diagnosis and treatment of breast cancer also severely affects her husband. Therefore, it is worth paying attention to the needs of husbands of women with breast cancer. Therefore, the aim of the present study was to explain the experiences of spouses of women with breast cancer. Method: The present study was a qualitative study with conventional content analysis approach. Purposive sampling was carried out by selecting 6 spouses of women with breast cancer. Data were collected through semi-structured interview. The recorded interviews were transcribed verbatim. Content analysis was used to reduce and name the data, obtain analytical codes, and finally recognize the theme. Results: Data analysis resulted in the extraction of 4 categories of couples’ mental challenges, multifaceted romantic meditation, multifaceted traumas caused by the disease, dual energies (inductions) of relatives, and 12 subcategories. Conclusion: In spite of suffering from all the challenges and traumas, husbands of women with breast cancer have not left their wives alone and have done their best to improve their lives; so, we can raise ““Scarifying your life to save your wife’s life”” as an extract from the experience of spouses of women with breast cancer. Knowing and understanding this point by clinical staffs and policy makers can provide pave the way for planning to provide comprehensive support to these men.     

A study of body image in long‐term breast cancer survivors

BACKGROUND:

In this controlled postdiagnosis study, the authors examined various aspects of body image of breast cancer survivors in cross‐sectional and longitudinal designs.

METHODS:

In 2004 and 2007 the Body Image Scale (BIS) was completed by the same 248 disease‐free women who had been treated for stage II and III breast cancer between 1998 and 2002. “Poorer” body image was defined as greater than the 70th percentile (N = 76 women) of the BIS scores in contrast to “better” body image (N = 172 women). Breast cancer survivors were examined clinically in 2004, and their BIS scores were compared with the scores from an age‐matched group of women from the general population.

RESULTS:

In this cross‐sectional study, poorer body image in 2004 was associated significantly with modified radical mastectomy, undergoing or planning to undergo breast‐reconstructive surgery, a change in clothing, poor physical and mental health, chronic fatigue, and reduced quality of life (QoL). In univariate analyses, most of these factors and manually planned radiotherapy were significant predictors of poorer body image in 2007. In multivariate analyses, manually planned radiotherapy, poor physical QoL and high BIS score in 2004 remained independent predictors of a poorer body image in 2007. Body image ratings were relatively stable from 2004 to 2007. Twenty‐one percent of breast cancer survivors reported body image dissatisfaction, similar to the proportion of dissatisfaction in controls.

CONCLUSIONS:

In this cross‐sectional analysis, body image in breast cancer survivors was associated with the types of surgery and radiotherapy and with mental distress, reduced health, and impaired QoL. Body image ratings were relatively stable over time, and the antecedent body image score was a strong predictor of body image at follow‐up. Body image in breast cancer survivors differed very little from that in controls. Cancer 2010. © 2010 American Cancer Society.     

Psychometric Properties of the Persian Version of the Self-Assessed Support Needs Questionnaire for Breast Cancer Cases

Background: It has been found that support given to women with breast cancer has a positive effect upontheir reactions to the illness and may even prolong their survival. Perceived support needs assessment in breastcancer women could be considered as a necessary part of nursing function. Aim: The purpose of this study wasto translate and culturally adapt the self-assessed support needs (SASN) questionnaire into Persian languageand to investigate its psychometric properties. Materials and Methods: After forward-backward translationof the questionnaire and making appropriate changes, we selected 160 women with breast cancer as our studysample. The psychometric properties of the SASN, including its internal consistency, test retest reliability, andconstruct validity were evaluated through the known-groups technique. Results: The calculated Kaiser MeyerOlkin was 0.756, indicating that the sample was sufficiently large to perform a satisfactory factor analysis. Thesix factors all together explained 50.7% of the variance; the first factor (diagnosing) explaining the biggest partof variance (10.9). Internal consistency reliability was 0.83 for the whole scale and the stability of test was 0.78.For the first factor, Cronbach’s alpha was 0.90 and factor loadings of scale’s items were found to deal withdiagnosis subscale. The domains described patients’ diagnosis, treatment, support, femininity and body image,family and friends and information. Conclusions: The reliability and validity of the adapted version of the SASNwas shown to be satisfactory. Thus, it can be used to investigate self-assessed support needs of Iranian womensuffering from breast cancer since the SASN is a multi-domain scale.     

Interaction of social support and psychological stress on anxiety and depressive symptoms in breast cancer patients

Purpose: The aim of the present study was to assess the association of psychological stress and social support with anxiety and depressive symptoms in Chinese newly diagnosed breast cancer patients. Methods: Four hundred and one patients with breast cancer were recruited. Their demographic characteristics, psychological stress and social support were determined with a structured questionnaire, and their anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. Results: Psychological stressors caused by breast cancer diagnosed originated from five major sources, as determined by factor analysis. These included “Worrying about health being harmed,” “Fear of decline of physical function,” “Fear of work being harmed,” “Worry about daily life and social relationship being restricted,” and “Fear of family being harmed.” Hierarchical linear regression analysis indicated that, after adjusting for gender, age, marital status, educational level, and duration of illness, solid social support can alleviate such symptoms. Conclusions: The results of this study suggest that there are strong associations between patients’ needs and psychological distress with newly diagnosed breast cancer. Social support might affect these associations in Chinese women with breast cancer.     

Physical and Emotional Experiences of Chemotherapy: a Qualitative Study among Women with Breast Cancer in Southern Thailand

Background: Chemotherapy treatment can increase survival rates among women with breast cancer elsewhere.However, it also has negative impact on women’s general appearance, body image and psychological functioning.This study aimed to describe the experiences of chemotherapy treatment among Thai women with breast cancerin rural communities, sounthern Thailand. Methods: Qualitative approach was employed to gain insights aboutthe experiences of the women. In-depth interviewing and drawing methods were conducted with 20 Thai womenwho had been diagnosed with breast cancer. Thematic method was used to analyse the data. Results: Three themesemerged from the findings: I feel so weak: Lack of physical energy; experiencing physical and emotional burdens andmanaging health and life. Women were traumatized by effects of chemotherapy and suffered severe physical side effects.Most received inadequate professional support from health care providers and had to rely on their own judgment anduse local resources to deal with the effects of their treatment and to improve their health and well-being. Conclusions:Chemotherapy brought about traumatic experiences to Thai women with breast cancer. Continual support is needed forthe women to reduce the difficulties they might encounter. Support groups should be established for these women whenreceiving and completing chemotherapy treatment. Our finding suggested that social support programs that meet theirneed are salient means that could reduce the sufferings of these women. Nurses and other health care professionals inthe local community should play their important role to establish such group and make it accessible for all.     

Body Image of Women Submitted to Breast Cancer Treatment

Background: The study of body image includes the perception of women regarding the physical appearance oftheir own body. The objective of the present study was to verify the prevalence of body image dissatisfaction and itsassociated factors in women submitted to breast cancer treatment. Methods: A cross-sectional study carried out with103 female residents of the municipality of Natal (Northeast Brazil), diagnosed with breast cancer who had undergonecancer treatment for at least 12 months prior to the study, and remained under clinical monitoring. The variable bodyimage was measured through the validated Body Image Scale (BIS). Socioeconomic variables and clinical history werealso collected through an individual interview with each participant. The Pearson’s chi-squared test (Fisher’s Exact)was utilized for bivariate analysis, calculating the prevalence ratio with 95% confidence interval. Poisson regressionwith robust variance was utilized for multivariate analysis. The statistical significance considered was 0.05. Results:The prevalence of body image dissatisfaction was 74.8% CI (65%-82%). Statistically significant associations wereobserved between body image and multi-professional follow-up (p=0.009) and return to employment after treatment(p=0.022). Conclusion: It was concluded that women who reported employment after cancer treatment presented morealterations in self-perception concerning their appearance. Patients who did not receive multi-professional follow-upreported negative body image, evidencing the need for strategies that increase and improve healthcare, aiming to meetthe demands of this population.     

Quality of Life and Psychological Well-Being of Breast Cancer urvivors in Jordan

Introduction: Breast cancer is the most common cancer among Jordanians. Breast cancer patients sufferfrom several negative consequences after treatment and these include pain, fatigue, sexual problems, appearanceand body image concerns, with psychological dysfunction. This could affect the patient quality of life andpsychological well-being. To the best of our knowledge, there is no published quantitative data on the quality oflife and psychological well-being of breast cancer patients in Jordan. The objective of this study was to obtainsuch data and assess predictors with calculated scores. Methods: In this cross-sectional study conducted amongbreast cancer patients in Jordan diagnosed in 2009 and 2010, assessment was performed using the EuropeanOrganization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), theBreast Module (QLQ-BR23) and the Hospital Anxiety and Depression Scale (HADS). Clinical, demographic andpsychosocial indicators that could predict patient quality of life scores were collected. Results: The number ofpatients interviewed was 236 (mean age=50.7±10.7 years). The mean Global Health score for the QLQ-C30 was63.7±20.2 SD. Among functional scales, “social functioning” scored the highest (mean=78.1±28.6 SD), whereas“emotional functioning” scored the lowest (mean=59.0±SD 33.5). For the QLQ-BR23, the worst scores withinthe functional scales were for “body image” (mean=52.1±36.8 SD) and “future perspective” (mean=52.9±38.5SD) . The worst symptom was “upset by hair loss” (mean=69.8±43.0). The mean HADS scores was 18.±9.0 SD.Out of study participants, 53% scored abnormal on the anxiety scale and 45% on the depression scale. Severedepression and severe anxiety were detected among 8% and 14% of study participants, respectively. Statisticallysignificant predictors for individual scores were similar to those reported in published studies, such as the presenceof recurrence since baseline, family history of cancer, low educational status, current social problems, extent ofthe disease, presence of financial difficulties, and employment status. Conclusions and Recommendations: Breastcancer survivors in Jordan have overall good quality of life scores when compared with patients from Westerncountries. However, their psychological wellbeing is more impaired. There is an urgent need for psychosocialsupport programs and psychological screening and consultation for breast cancer patients at hospitals of theMinistry of Health in Jordan.     

Health care experiences among women diagnosed with gestational breast cancer

Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi‐structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were “communication” and “comprehensive care.” “Communication” had two sub themes: “interdisciplinary communication” (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and “patient communication” (how they communicated this to the woman). The “comprehensive care” theme incorporated three sub themes: “the spirit” (psychological care); “the mind” (information provision); and “the body” (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.     

Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia

Objective: Fear of cancer recurrent, side effects of treatment and belief in food taboos encourage cancer survivors to make changes in their dietary practices after diagnosis of cancer. The objective of this study was to determine the impact of dietary changes on quality of life (QoL) among Malay breast and gynaecological cancer survivors. Methods: Questionnaire of dietary changes was modified from WHEL study and adapted to typical Malay’s food intake in Malaysia. A total of 23 items were listed and categorized by types of food and cooking methods.  Four categories of changes “increased”, “decreased”, “no changes” or “stopped” were used to determine the changes in dietary practices. Score one (+1) is given to positive changes by reference to WCRF/AICR and Malaysia Dietary Guideline healthy eating recommendations. Malay EORTC QLQ-C30 were used to determine the QoL. Sociodemographic, clinical characteristics and anthropometric measurement were also collected. Results: The mean age of the subjects (n=77) was 50.7±7.8 years old with duration of survivorship 4.0±3.1 years. Subjects mean BMI was 27.8±4.9 kg/m2 which indicate subjects were 31.2% overweight and 32.5% obese. The percentage score of positive dietary changes was 34.7±16.4%. Positive dietary changes were increased intake of green leafy vegetable (49.4%), cruciferous vegetable (46.8%) and boiling cooking methods (45.5%). Subjects reduced their intake of red meat (42.9%), sugar (53.2%) and fried cooking method (44.2%). Subjects stopped consuming milk (41.6%), c 2008-5862 heese (33.8%) and sweetened condensed milk (33.8%). With increasing positive dietary changes, there was a significant improvement on emotional function (rs=0.27; p=0.016) and reduced fatigue symptoms (rs=-0.24; p=0.033). Conclusion: Positive changes in dietary intake improved emotional function and reduced fatigue symptoms after cancer treatment. By knowing the trend of food changes after cancer treatment, enables the formation of healthy food intervention implemented more effective.     

Association between Socioeconomic Status and Altered Appearance Distress,Body Image,and Quality of Life Among Breast Cancer Patients

Background: Breast cancer patients experience a variety of altered appearance - such as loss or disfigurementof breasts, discolored skin, and hair loss - which result in psychological distress that affect their quality of life.This study aims to evaluate the impact of socioeconomic status on the altered appearance distress, body image,and quality of life among Korean breast cancer patients. Materials and Methods: A cross-sectional survey wasconducted at advocacy events held at 16 different hospitals in Korea. Subjects were eligible to participate ifthey were 18 years of age or older, had a histologically confirmed diagnosis of breast cancer, had no evidence ofrecurrence or metastasis, and had no psychological problems at the time of the survey. Employment status, maritalstatus, education, and income were assessed for patient socioeconomic status. Altered appearance distress wasmeasured using the NCI’s cancer treatment side effects scale; body image and quality of life were measured by theEORTC QLC-C30 and BR23. Means and standard deviations of each outcome were compared by socioeconomicstatus and multivariate linear regression models for evaluating the association between socioeconomic statusand altered appearance distress, body image, and quality of life. Results: A total of 126 breast cancer patientsparticipated in the study; the mean age of participants was 47.7 (SD=8.4). Of the total, 83.2% were married,85.6% received more than high school education, 35.2% were employed, and 41% had more than $3000 inmonthly household income. About 46% had mastectomy, and over 30% were receiving either chemotherapy orradiation therapy at the time of the survey. With fully adjusted models, the employed patients had significantlyhigher altered appearance distress (1.80 vs 1.48; p<0.05) and poorer body image (36.63 vs 51.69; p<0.05)compared to the patients who were unemployed. Higher education (10.58, standard error (SE)=7.63) and familyincome (12.88, SE=5.08) was positively associated with better body image after adjusting for age, disease stage atdiagnosis, current treatment status, and breast surgery type. Similarly, patients who were married and who hadhigher education had better quality of life were statistically significant in the multivariate models. Conclusions:Socioeconomic status is significantly associated with altered appearance distress, body image, and quality of lifein Korean women with breast cancer. Patients who suffer from altered appearance distress or lower body imageare much more likely to experience psychosocial, physical, and functional problems than women who do not,therefore health care providers should be aware of the changes and distresses that these breast cancer patientsgo through and provide specific information and psychosocial support to socioeconomically more vulnerablepatients.     

Quality of Life and Psychological Wellbeing of Breast Cancer Survivors in the Kingdom of Saudi Arabia

Introduction: Breast cancer is the most common cancer among Saudi population. Breast cancer patients suffer from several negative consequences after treatment and these include pain, fatigue, sexual problems, appearance and body image concerns, with psychological dysfunction. This could affect the patient quality of life and psychological well-being. Methods: a multicenter cross-sectional study to assess quality of life and psychological wellbeing and their predictors for female breast cancers survivors diagnosed between 1 January 2015 and May 2017 with the assessment conducted at 12 to 36 months after initial diagnosis. Assessment was performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Breast Module (QLQ-BR23) and the Hospital Anxiety and Depression Scale (HADS). Results: 246 Breast cancer patients participated in the study with a mean age of 49.5±10.9. The mean global health status has a mean of 72.7±23.5. The worst domain of the functioning scales was physical functioning (mean score of 62.14±26.03, while the best scores were for social functioning of 80.06±29.18. For the symptom scales, the worst scores were reported for fatigue and pain. Results of HADS scale showed that 57% had moderate to severe depression, while 44% had moderate to severe anxiety. Only 6.8% of the participants reported receiving psychosocial support. Discussion: Breast cancer survivors in the KSA have overall good quality of life scores when compared with patients from Western countries. However, their psychological wellbeing is more impaired. There is an urgent need for psychosocial support programs and psychological screening and consultation for breast cancer patients at cancer care centers in the KSA.     

The Effect of Good Enough Sex (GES) Model-Based Sexual Counseling Intervention on the Body Image in Women Surviving Breast Cancer: A Randomized Clinical Trial

Introduction: Women undergoing breast cancer treatment experience a number of changes, including loss or deformity of one or both breasts, surgical wounds, skin changes, and weight gain. These changes are very closely related to physical appearance and body image and often lead to reduced mental health, marital quality and psychological stress.  Objective: This study aimed to determine the effect of Good Enough Sex (GES) model-based counseling intervention on the body image in women surviving breast cancer. Patients and Methods: This randomized clinical trial was a kind of quantitative study with control group carried out on 100 women (50 women in the intervention group and 50 women in the control group) who randomly entered into the study after completing the informed consent form. The intervention included 4 sessions of 120-190 minute sexual counseling with 2 and 3 months follow-up. The data were collected consisting of demographic characteristics and disease-related information, Body Image Scale (BIS) and analyzed using ANOVA repeated measures. Results: The results showed a statistically significant difference between the mean of body image in the intervention and control groups (P <0.001). Conclusion: The educational and counseling intervention program based on a socio-psychological model was effective in improving the body image among women surviving breast cancer. The inclusion of educational and counseling programs in service centers in this regard has an effective role in the reproductive health of women with breast cancer. Trial Registration: Registration of trial protocol has been approved in Iranian registry of clinical trials (IRCT20120609009975N8, https://en.irct.ir/trial/42030, ethical code; IR.TUMS.FNM.REC.1396.4865).     

The Lived Experience of Australian Women Living with Breast Cancer: A Meta-Synthesis

Background: Breast cancer is the second most common cancer among Australian women. In 2019, an estimated 19,000 women in Australia were diagnosed with breast cancer, with around 3,058 women dying from the disease in the same year. Although many qualitative studies published in Australia exist which examine breast cancer from various perspectives, only limited literature is available which addresses Australian women’s lived experience of breast cancer from diagnosis, treatment and beyond. Method: Meta-synthesis of qualitative studies. Participants who took part in either semi-structured interviews or surveys with open-ended questions were included. A thematic synthesis analysis approach was used. Results: Five themes and 13 sub themes emerged from the data analysis which illustrated the lived experience of Australian women diagnosed with breast cancer. Emotional burden and women’s response towards their breast cancer diagnosis were key themes. Experience of decision- making , social distress, symptoms beyond changes in their body, fertility considerations and their role as mothers were some of the challenges during their treatment. Women coped and adjusted with these challenges through the support of their family, and healthcare providers. Women developed greater empowerment by making their life choices after treatment. Life choices such as getting into a new relationship was challenging for single women. Conclusion: Although most women were emotionally supported following their diagnosis, there are still areas where women could be better supported such as when having to break the news of their breast cancer diagnosis to their children, provision of ongoing emotional support for caregivers of women with breast cancer, providing constant emotional and informational support at the point of diagnosis and during their treatment, tailoring treatments according to different stages of pregnancy, and discussion of fertility treatments in timely manner by healthcare professionals.     

“Being connected” The experience of African American women with breast cancer: A community-based participatory research project: Part I

The objective was to understand the breast cancer experience of African American (AA) women using a community-based participatory research framework. Qualitative data were collected from five focus groups with 29 participants in four urban cities. “Being Connected” was the major theme that explained the importance of people in their lives as they coped with the diagnosis, treatment, and life after therapy. Faith, talking, information, support, and living with changes were important factors in the process. The breast cancer experience was situated with the AA culture and community and unique aspects were identified for clinical practice in the care of these women.     

Experiences of Turkish Women with Breast Cancer During the Treatment Process and Facilitating Coping Factors

Background: Breast cancer is the most common type of cancer among women in Turkey and around theworld. Treatment adversely affects women’s physical, psychological, and social conditions. The purpose of thisstudy was to identify the experiences of Turkish women with breast cancer and the facilitating coping factorswhen they receive chemotherapy. Methods: A phenomenological approach was used to explain the experiencesand facilitating factors of breast cancer patients during the treatment period. Data were collected throughindividual semi-structured interviews. The sample comprised 11 women with breast cancer receiving treatment.Results: At the end of the interviews conducted with women with breast cancer, two main themes were identified:adjustment and facilitating coping factors. The adjustment main theme had two sub-themes: strains and coping.Women with breast cancer suffer physical and psychological strains as well as stress related to social and healthsystems. While coping with these situations, they receive social support, turn to spirituality and make new sensesof their lives. The facilitating coping factors main theme had four sub-themes: social support, disease-relatedfactors, treatment-related factors and relationships with nurses. It has been determined that women receivinggood social support, having undergone preventive breast surgery and/or getting attention and affection fromnurses can cope with breast cancer more easily. Conclusions: Women with breast cancer have difficulty in allareas of their lives in the course of the disease and during the treatment process. Therefore, nurses should provideholistic care, teaching patients how to cope with the new situation and supporting them spiritually. Since familysupport is very important in Turkish culture, patients’ relatives should be informed and supported at every stageof the treatment.     

Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy?

Background: Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. Methods: A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen’s Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. Results: Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on “most people with genital HPV have no visible signs/symptoms” and less than 18% answered correctly on “I can transmit HPV to my partner(s) even if I have no HPV symptoms.” Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy. Conclusions: Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.     

Psychosocial factors affecting the therapeutic decision-making and postoperative mood states in Japanese breast cancer patients who underwent various types of surgery: body image and sexuality

OBJECTIVE: We conducted an empirical study to clarify how psychosocial factors (e.g. body image and sexuality) influence therapeutic decision-making and to identify the factors that affect post-operative mood states in Japanese women who underwent various types of surgery. METHODS: One hundred and two patients who had undergone surgical treatment for breast cancer participated in this study. Twenty-five patients had undergone mastectomy, 67 breast conserving treatment and 11 skin-sparing mastectomy and immediate breast reconstruction. The participants were evaluated based on a battery of questionnaires including value estimates of decision-making factors, a shortened version of the Profile of Mood States and self-efficacy. RESULTS: The patients regarded the possibility of cure and recurrence of cancer as well as the physician's support as important, regardless of the treatments they had chosen. The patients that had immediate breast reconstruction placed significantly more importance on their body image and sexuality (i.e. physical appearance, attractiveness to partner and self-evaluation of femininity and sexuality) than the mastectomy patients. After surgery, the former group tended to have a more negative mood on the shortened version of the Profile of Mood States than the latter group. Degree of self-efficacy had a marked influence on the patients' mood after surgery. CONCLUSIONS: This study suggests the importance of discussing body image and sexuality that has tended to be disregarded in therapeutic decision-making situations in breast cancer patients in Japan. Self-efficacy is a crucial variable for improving mood after treatment.