Patie… ); KAN (L.) Source SOCIAL SCIENCE AND MEDICINE, Vol 33, N° 2, 1991, pages 177-183, 28 réf. This study wanted to find out more about the social, physical and emotional effects of having breast cancer that had spread. J Clin Oncol 16:501-514, 1998. A full-text transcript is available. Over time, recognition of the importance of assessing patient needs, distress, and concerns, as well as the social context in which care is delivered, has become more evident.[49]. Your gift will help support our mission to end cancer and make a difference in the lives of our patients. Although serious depression is not seen in the majority of breast cancer patients and survivors, many will experience treatment-related distress, fear of recurrence, changes in body image and sexuality, as well as physical toxicities that result from adjuvant therapy. Washington, DC; National Academies Press; 2004. With the prevalence of clinically significant mental disorders among adults estimated at 15%,[40] it is not uncommon for women with breast cancer to be predisposed to cancer-related psychosocial distress. It is most common in breast cancer (42%) and head and neck cancer (41%) patients. N Engl J Med 305:1-6, 1981. Effects of two types of social support and education on adaptation to early-stage breast cancer. [13-16] This culminated in the widespread use of high-dose chemotherapy with autologous bone marrow or stem cell transplantation, which was ultimately found to be ineffective as well as highly toxic.[17]. Milestone events in their cancer journey can often trigger these feelings. 39. Thus, today there is even more information to discuss with newly diagnosed breast cancer patients than before. Women today are often well informed about the details of their cancer diagnosis and prognosis, and are increasingly involved in shared decision-making regarding treatment. Español . Common physical side effects from each treatment option for breast cancer are listed in the Types of Treatment section. 1p. 40. JAMA 257:2766-2770, 1987. 31. Authors S F Pardue, M V Fenton, L R Rounds. Ganz PA, Kwan L, Stanton AL, et al: Quality of life at the end of primary treatment of breast cancer: First results from the moving beyond cancer randomized trial. 28. Committee on Pyschosocial Services to Cancer Patients/Families in a Community Setting: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. © 2021 MJH Life Sciences and Cancer Network. Fetting JH: Psychosocial aspects of breast cancer. The major psychological and social stressors under these circumstances are related to the woman’s understanding of her disease, its prognosis, the complexity of treatment, and all too often, her access to care and/or choice of providers. Most women will not anticipate the common side effects and complications of breast cancer treatment, so that professional guidance and more intensive support as appropriate will be appreciated. Qual Life Res 8:723-731, 1999. Effects of social constraints and web-based psychoeducation on cancer-related psychological adjustment early-after breast cancer diagnosis. Breast Cancer Res Treat 38:183-199, 1996. Shimozuma K, Ganz PA, Petersen L, et al: Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recovery. J Clin Oncol 3:1553-1560, 1985. N Engl J Med 304:10-15, 1981. Honesty and open communication with loved ones can minimize negative feelings. [24,25,30-34] The specific type of breast cancer surgery, and whether a woman is receiving chemotherapy or radiation therapy does not seem to influence the level of distress. City of Hope's Vijay Trisal, M.D., shares insight on the social, psychological and financial impact of cancer. 36. For example, tamoxifen, a common breast cancer treatment, can cut a woman’s rate of breast cancer recurrence by up to 50 percent. 13. 27. High-dose therapy has been largely abandoned, and treatments have been further modified through better understanding of the molecular risk profiles for primary breast cancer, including HER2 overexpression. ); MEARS (B. Gradually, treatments became more intensive[11,12] and there was increasing interest in the measurement of quality-of-life outcomes in these clinical trials. For most women with breast cancer, active coping strategies that focus on realistic expectations and approach-oriented coping can facilitate adaptation to the illness over time. Test results can't determine your exact level of risk, at what age you may develop cancer, how aggressively the disease might progress or how your risk of death from cancer compares with other women's risks. [6] In addition to these concerns, the life-threatening nature of cancer itself contributed to psychological distress. Learn about our graduate medical education residency and fellowship opportunities. Narrow WE, Rae DS, Robins LN, et al: Revised prevalence estimates of mental disorders in the United States: Using a clinical significance criterion to reconcile 2 surveys’ estimates. [3,23-27] In studies that have examined quality of life and depression after breast cancer, most patients and survivors demonstrate high levels of functioning in the early and later years after primary treatment, for those who remain disease-free. Arch Gen Psychiatry 59:115-123, 2002. Address correspondence to Karen Kayser, Boston College, Graduate School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467; e-mail: All of these medical factors contribute to the risk of greater psychological distress in these younger women. For women with some of the increased risk factors for psychological distress described earlier, adaptation and coping may be more challenging, and professional counseling may be indicated. J Clin Oncol 16:2382-2391, 1998. Ganz PA, Rowland JH, Desmond K, et al: Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. If you suffer from a prolonged sense of guilt, seek help from a psychotherapist, clergy member or support group. Women receiving this treatment suffered terrible cosmetic deformity, with loss of arm function through resection of the pectoral muscles, high risk for lymphedema as the result of extensive axillary nodal dissection, and significant pain and tightness across the chest wall. J Natl Cancer Inst Monogr 30:143-145, 2001. Choose from 12 allied health programs at School of Health Professions. In addition, breast cancer in younger women is often temporally related to a recent pregnancy or may occur during pregnancy, and thus, these women often have small children to care for at the same time that they must deal with a life-threatening disease. If you have questions about MD Anderson’s appointment process, our For younger women who have not already had their children, the diagnosis and treatment of breast cancer leads to the specter of death, the likelihood of infertility as a result of treatments, and the symptomatic burden of premature menopause, in addition to the acute toxicities of chemotherapy treatments. J Clin Oncol 6:1795-1797, 1988. N Engl J Med 292:117-122, 1975. If you have radiation for breast cancer, you may experience a red rash that looks similar to sunburn in the affected area. The good news is that you don’t have to suffer alone. Ganz PA, Rowland JH, Meyerowitz BE, et al: Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Fetting JH: Psychosocial and other supportive aspects of breast cancer care. Univ British Columbia. This may be particularly important in patients with advanced breast cancer. Call 713-563-6666 to request a referral. Welch HG, Mogielnicki J: Presumed benefit: Lessons from the American experience with marrow transplantation for breast cancer. Return to usual physical and social activities was also reportedly diminished in many women. Breast Cancer Res Treat 54:47-57, 1999. 34. Spirituality: Many survivors find that life takes on new meaning after cancer and will renew their commitment to spiritual practices or organized religion. It's not surprising that breast cancer treatment, which can alter or destroy a woman’s secondary sex characteristics, can also alter and destroy her body image and sex life. 47. The first large trials of adjuvant chemotherapy were reported in high-profile medical journals in the 1970s and 1980s,[7-10] leading to the rapid expansion of clinical trials of this treatment across all stages of breast cancer throughout the world, with testing of new drugs and their combinations, including the addition of endocrine therapies to the treatment strategy. As part of our mission to eliminate cancer, MD Anderson researchers conduct hundreds of clinical trials to test new treatments for both common and rare cancers. Langer AS: Side effects, quality-of-life issues, and trade-offs: The patient perspective. Curr Opin Oncol 3:1014-1018, 1991. 4. Fisher B, Redmond C, Brown A, et al: Treatment of primary breast cancer with chemotherapy and tamoxifen. Ganz PA, Hirji K, Sim MS, et al: Predicting psychosocial risk in patients with breast cancer. Grief is a natural result of loss. 3. Ganz PA, Coscarelli A, Fred C, et al: Breast cancer survivors: Psychosocial concerns and quality of life. Depression: It is estimated that 70% of cancer survivors experience depression at some point. How and where to find this type of care. J Clin Oncol 16:487-494, 1998. 46. Create a caregiving plan with this 1-page fact … Body image: Cancer survivors who have experienced amputations, disfigurement or a major change in physical function can suffer from a lack of self-esteem. Thus, for women in their 30s and 40s who are diagnosed with breast cancer, this is a relatively uncommon event, and certainly one that is not expected. professor Graduate School of Social Work, Boston College, Chestnut Hill, MA. Finally, Meyerowitz described common fears and concerns that women reported, and these include fear of recurrence-tumors were much larger and 50% of women could expect to have a recurrence in spite of radical surgery-as well as the mutilation and loss of feminity as a result of mastectomy. Ganz PA, Hirji K, Sim MS, et al: Predicting psychosocial risk in patients with breast cancer. A negative body image can affect your desire for intimacy and social interaction. The B-Cell Lymphoma Moon Shot is revolutionizing the conventional medical research approach to rapidly translate findings into patient treatment options and develop personalized therapeutic strategies. information page may be the best place to start. A number of different psychological and social factors can affect the emotional stability and physical outcomes for patients with breast cancer. Such resources are widely available in the community. PTSD can linger for years: Another 2018 study, published in the journal Cancer, found that about 6 percent of women still struggle with the disorder's physical and mental symptoms four years later. According to The National Cancer Institute: One in three people with cancer experience mental or emotional distress. Curr Opin Oncol 1:333-336, 1989. 30. J Clin Epidemiol 42:765-771, 1989. Eastern Cooperative Oncology Group (ECOG). • Preexisting Mental Illness or Psychological Distress-Although it appears that cancer, in general, does not heighten the risk for serious depression in women with breast cancer,[39] a prior history of depression and the presence of pain and physical limitations are associated with a greater likelihood of depression after diagnosis. 23. 12. The “Moving Beyond Breast Cancer” video is available at no cost through the National Cancer Institute Cancer Information Service (1-800-4-CANCER or The first step in coping with psychosocial changes is realizing that you have an issue and having the courage to reach out for help. 24. Although it's rare, your treatment for breast cancer may cause new problems, such as: pain and stiffness in your arms and shoulders after surgery, and the skin in these areas may be tight It is not surprising that a woman who is already having ongoing depression or psychological distress prior to the cancer diagnosis would have it exacerbated as a result of the stress associated with a new cancer diagnosis and its treatment. 25. Among breast cancer patients, inadequate social support is associated with a substantial increase in cancer-related mortality. Not until the 1990 National Institutes of Health (NIH) Consensus Conference[2] on early-stage breast cancer was a concerted effort made to encourage breast conserving surgery, based on the mounting evidence of its efficacy in randomized trials conducted in the 1980s. Immediate reconstruction and autologous tissue flaps, widely used today, did not become widespread until the turn of the 21st century. Another important aspect of this historical time in breast cancer treatment was the stigma associated with a cancer diagnosis, and the lack of support for patients beyond their families as they went through cancer diagnosis and treatment. Women today are often well informed about the details of their cancer diagnosis and prognosis, and are increasingly involved in shared decision-making regarding treatment. 49. • Younger Age-Most breast cancer occurs in women older than 50 years (about 75% of cases). Fisher B, Carbone P, Economou SG, et al: 1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. In this study, the collaborative partners are Finland, Denmark and Sweden. Vancouver BC; HISLOP (T.G. Now, for the majority of women, it is usually managed with only minimal removal of breast tissue and sampling of a few axillary nodes. This is then followed by the need to organize care with multiple providers (surgeon, radiation oncologist, medical oncologist, plastic surgeon) and often second opinions to assist in decision-making. © 2021 The University of Texas MD Anderson Cancer Center. Attempts to restore body image with external prostheses were variably effective, and reconstructive surgery with implants did not become widely available until the last 2 decades of the 20th century. Find information and resources for current and returning patients. J Clin Oncol 11:783-793, 1993. Soc Sci Med 16:1329-1338, 1982. Effective strategies for enhancing coping are actively being studied by many research groups. [39,41] This appears to be independent of age,[42] although the likelihood of greater comorbidity at diagnosis is increased with age. Assessing the psychological aspects of breast cancer treatment and identifying activities that can alleviate stress involved in the treatment process, could reduce the anxiety and emotional upheaval associated with breast cancer. J Natl Cancer Inst Monogr 16:177-182, 1994. Our personalized portal helps you refer your patients and communicate with their MD Anderson care team. What is Palliative Care? Getting Started With Palliative Care. Therapy, support groups, social media and community resources are available to help you cope with these issues. Social and Emotional Side Effects of Cancer It's not uncommon for cancer patients to face a mix of emotions and adjustment issues. Blood Donor Center locations are being held by appointment only. • Social Support-Social support for the woman with breast cancer includes instrumental support, such as transportation to appointments, preparation of meals, and help with activities of daily living, as well as emotional support, meaning the availability of someone to share ones fears, feelings, and concerns. 35. A report of early findings. However, it is the responsibility of the health-care team to orient women to the likelihood of needing these services at some point along their journey with breast cancer. Patients fighting breast cancer experience psychological distress. 43. Almost all cancer survivors will face psychological and emotional issues that can show up many years after treatment. Many people with breast cancer are successfully treated every year. MD Anderson’s Psychiatric Oncology Center provides counseling and medication for anxiety and depression. [1], Sample Publications Authored or Coauthored by Martin Abeloff on the Psychosocial Aspects of Cancer, This was not always the case, and we must be grateful to the pioneering work of Dr. Martin Abeloff and his colleagues, who more than 3 decades ago recognized the intimate relationship between the psychological and social impact of cancer and its treatments on patients’ lives (see Table 1). There can be significant psychosocial effects of a cancer diagnosis, especially amongst patients with a pre-existing mental health condition. Social support is regarded as a complex construct which has long been suggested to have direct and buffering effects on patients' wellbeing and emotional adjustment to cancer. These range from cancer-specific concerns, such as fear of cancer recurrence, to more generalized symptoms such as worry, trouble sleeping, fatigue, being anxious about going to the doctor. BMJ 324:1088-1092, 2002. • Social Support-Social support for the woman with breast cancer includes instrumental support, such as transportation to appointments, preparation of meals, and help with activities of daily living, as well as emotional support, meaning the availability of someone to share ones fears, feelings, and concerns. In today’s environment, a woman who has an image-guided breast biopsy and receives a cancer diagnosis is immediately approached by other women-from her work, church, or other social network-who are breast cancer patients/survivors, and who are immediately ready to help her get through the early diagnosis and staging of the cancer, and provide support and encouragement. All rights reserved. What makes each of these patient characteristics a risk factor for psychosocial distress after breast cancer? In a prospective study of newly diagnosed breast cancer patients, Maunsell et al[25] found that a past history of depression and serious life events in the 5 years preceding the cancer diagnosis were both predictive of higher levels of distress after breast cancer. In his passing, many tributes noted Marty’s important contributions to oncology, as a pioneer in the treatment of breast cancer and as the leader of a major cancer center. MD Anderson has a caring network of professionals, volunteers and 38. van Gestel YR, Voogd AC, Vingerhoets AJ, et al: A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ. Introduction People in a patient's social support network include family members, spouses, children and friends. This discussion should include physical, emotional, and social effects of cancer. Maunsell E, Brisson J, Deschenes L: Psychological distress after initial treatment of breast cancer. 1. Lash TL, Silliman RA: Patient characteristics and treatments associated with a decline in upper-body function following breast cancer therapy. Bull AA, Meyerowitz BE, Hart S, et al: Quality of life in women with recurrent breast cancer. Social & Emotional Impacts of Cancer Almost all cancer survivors will face psychological and emotional issues that can show up many years after treatment. Moreover, for women who do not have a spouse or intimate partner, there may be heightened concerns about future potential for such a relationship after a breast cancer diagnosis. How it differs from hospice care and tips for talking about your needs and expectations. Schag CA, Ganz PA, Polinsky ML, et al: Characteristics of women at risk for psychosocial distress in the year after breast cancer. Bloom JR: Social support, accommodation to stress and adjustment to breast cancer. [3,4,31,35,36] In fact, women with noninvasive breast cancer have similar concerns about recurrence as women with invasive disease.[37,38]. The trauma of breast cancer surgery has diminished substantially in the past 2 decades, but women are still left with many physical and psychological problems as a result of complex multimodal treatments, including chemotherapy and adjuvant endocrine therapies.[3-5]. Accessing psychosocial services is easier today than ever before, through electronic and other media, as well as through in-person support services. If genetic testing reveals a BRCA gene mutation, you might experience a range of responses to learning your test results, including: 1. 44. The one that caught my attention noted remarks he made at a Johns Hopkins event in the year before his death, where he is reported to have said, “Therapies have been lengthy, toxic, and disfiguring, adding to the amount of suffering that a patient and family endures. It was noted that there are nine different types of social support, with "emotional support" being one of the most i … The social impact of cancer Dimens Oncol Nurs. Given the limited amount of information exchanged between doctors and patients at this time regarding the natural history of breast cancer and its prognosis, as well as the lack of adjuvant therapies to prevent a recurrence, it is not surprising that these fears were commonplace. Log in to our secure, personalized website to manage your care (formerly myMDAnderson). Spring 1989;3(1):5-13. Loss can include your health, sex drive, fertility and physical independence. Med Care 31:419-431, 1993. Is there a difference in psychological adjustment or quality of life in the year after surgery? J Natl Cancer Inst 93:979-989, 2001. Further refinements in surgical staging, including the sentinel lymph node biopsy, have now begun to limit the extent of axillary surgery for women with small tumors and low metastatic potential. Greenfield S, Blanco DM, Elashoff RM, et al: Patterns of care related to age of breast cancer patients. “They may also still have fatigue, pain, sleep problems that affect their quality of life that they're grappling with,” Ashton adds. Koopman C, Hermanson K, Diamond S, et al: Social support, life stress, pain and emotional adjustment to advanced breast cancer. Anxiety about developing cancer.Having an altered BRCA gene doesn't mean you'll definitely get breast or ovarian cancer. To this end, I review what we have learned about the psychological and social aspects of breast cancer during Dr. Abeloff’s distinguished career, and how leaders such as he have promoted the integration of psychosocial services into the standard care of oncology patients through their words and their actions. You simply can’t treat cancer without paying attention to the psychological and social aspects of the disease.”. 19. Learn about clinical trials at MD Anderson and search our database for open studies. Cancer 74(4 suppl):1445-1452, 1994. Almost 2,000 survey responses were received. 6. Fortunately, most women manage their psychosocial distress relatively well, using personally available support systems (spouse, family, friends, clergy) as well as some professional resources that are accessible within many clinical settings (nurses, social workers, community resources, and support groups). 10. Background: Breast cancer diagnosis as well as diversity of the treatment process deteriorates women’s quality of life (QOL). 37. Our challenge today is to translate what we know is the right thing to do into the routine delivery of cancer care. Psychooncology 7:101-111, 1998. [43] Physical recovery after breast cancer surgery may be impaired in women with greater comorbidity,[44] and this may contribute to greater psychological distress as well. [6] For many women, every ache and pain would trigger fear and anxiety about potential recurrence. Specialized Programs of Research Excellence (SPORE) Grants, Prevention & Personalized Risk Assessment, Office of Clinical Research Administration, Comparative Effectiveness Training (CERTaIN), Post Graduate Fellowship in Oncology Nursing, Professional Student Nurse Extern Programs. N Engl J Med 326:1147-1149, 1992. Cancer costs us billions of dollars. Fetting JH, Gray R, Fairclough DL, et al: Sixteen-week multidrug regimen versus cyclophosphamide, doxorubicin, and fluorouracil as adjuvant therapy for node-positive, receptor- negative breast cancer: An Intergroup study. Ganz PA: Treatment options for breast cancer-beyond survival. Given the urgent demands of treatment, it can be easy for primary care providers, like Family Nurse Practitioners, to focus on physical aspects of care when a diagnosis occurs. Fetting JH: Evaluating quality and quantity of life in breast cancer adjuvant trials. Breast Cancer Res Treat 3(suppl):S19-S26, 1983. What varies, however, is the extent to which a woman accepts these concerns, copes with them, and adapts to living with a degree of uncertainty about the future, as opposed to living in a state of persistent rumination about the illness and the inability to control what will happen to her. Understanding the Psychological Effects of Breast Cancer. Ganz PA, Schag AC, Lee JJ, et al: Breast conservation versus mastectomy. Assessment of potential risk factors. [21,22], The literature on the psychosocial aspects of breast cancer suggests that the vast majority of women adjust well to the diagnosis of breast cancer and manage to endure the complex and sometimes toxic treatments associated with primary treatment and later recurrence. These findings in the late 1970s were gradually disseminated to physicians and patients, and resulted in the beginnings of psychosocial support groups in the early 1980s. Cancer 69:1729-1738, 1992. Recent Results Cancer Res 152:396-411, 1998. Cross-sectional and prospective studies show a positive association between perceived social support and psychological adjustment following cancer treatment. Med Care 31:419-431, 1993. Washington, DC; National Academies Press; 2007. Auteur SAMAREL (Nelda); TULMAN (Lorraine); FAWCETT (Jacqueline) Source RESEARCH IN NURSING AND HEALTH, Vol 25, N° 6, 2002, pages 459-470, réf. Here are some of the most common psychosocial issues that cancer survivors may deal with: Fear of recurrence: Many survivors worry that their cancer will come back at some point. The Lyda Hill Cancer Prevention Center provides cancer risk assessment, screening and diagnostic services. [6] In some of the first systematic and comparative studies, mastectomy patients were found to be more distressed than women with benign lumps, and often this distress persisted for more than a year following surgery, but over time seemed to resolve. Bloom JR, Spiegel D: The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer. Social support plays an important role in quality of life and health outcomes after breast cancer diagnosis and treatment. 20. For almost a century, the Halsted radical mastectomy was the standard surgical treatment for breast cancer. Abeloff MD, Beveridge RA, Donehower RC, et al: Sixteen-week dose-intense chemotherapy in the adjuvant treatment of breast cancer. Ganz PA, Desmond KA, Leedham B, et al: Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. The involvement of mental health experts in the problems of persons with health conditions began to accelerate during the 1960s and 1970s, just as the national focus on cancer treatment and the war on cancer was taking shape. Factors That Put Women at Higher Risk for Psychosocial Distress, A number of risk factors have been identified that are associated with psychosocial distress (see Table 2). [3,23,27,28] Even for women with a recurrence of breast cancer, psychological well-­being is often maintained.[26,27,29]. Your gift will help make a tremendous difference. Cancer 70:120-125, 1992. Physical, Emotional, and Social Effects of Cancer. From coping with the diagnosis, to the challenges of treatment, and a lifetime of fear of a recurrence, emotions brought on by the cancer experience can be substantial and difficult to handle.