Social support can also take the form of support groups or therapists.3 It is important for these caregivers to listen to the unique needs and concerns of their loved one. N Engl J Med 305:1-6, 1981. National Institutes of Health Consensus Statement: Early stage breast cancer. Koopman C, Hermanson K, Diamond S, et al: Social support, life stress, pain and emotional adjustment to advanced breast cancer. 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. 24. Table 3 lists some of the most common psychosocial concerns reported by women with breast cancer. 13. Social and Emotional Side Effects of Cancer It's not uncommon for cancer patients to face a mix of emotions and adjustment issues. 33. 27. If you suffer from a prolonged sense of guilt, seek help from a psychotherapist, clergy member or support group. Almost 2,000 survey responses were received. J Clin Epidemiol 45:473-485, 1992. 17. Lansky SB, List MA, Herrmann CA, et al: Absence of major depressive disorder in female cancer patients. In the past 50 years, breast cancer has been transformed from a disease in which all women were treated with a radical and disfiguring surgical procedure that amputated the breast, removed pectoral muscles, and included an extensive axillary dissection. 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. Hewitt ME, Herdman R, Holland JC: Meeting psychosocial needs of women with breast cancer. 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. Maunsell E, Brisson J, Deschenes L: Psychological distress after initial treatment of breast cancer. “They may also still have fatigue, pain, sleep problems that affect their quality of life that they're grappling with,” Ashton adds. Fairclough DL, Fetting JH, Cella D, et al: Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Levine M, Whelan T: Decision-making process-communicating risk/benefits: Is there an ideal technique? 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. [6] In addition to these concerns, the life-threatening nature of cancer itself contributed to psychological distress. 47. Fetting JH: Psychosocial and other supportive aspects of breast cancer care. Adjusted effects of clinical and social predictors on prostate cancer treatment choice (surgery vs. radiation) (n = 435) When models were stratified by race and adjusted for age at diagnosis and tumor stage, white and black men who chose surgery were more likely (i.e., >twice and ~5.5 times, respectively) to have been influenced by a family or friend ( Table 4 ). Spirituality: Many survivors find that life takes on new meaning after cancer and will renew their commitment to spiritual practices or organized religion. 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. 19. 11. Cancer 74(4 suppl):1445-1452, 1994. The earliest research on the psychological impact of breast cancer focused on its attack on femininity, with amputation of the breast, and subsequent threat to sexual attractiveness. How this complex information is communicated, and how the physician assesses the woman’s psychological status and desire for detailed information vs more general concepts, often sets the stage how the woman will adapt to her diagnosis and need for treatment. Ganz PA, Rowland JH, Desmond K, et al: Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Natl Cancer Inst Monogr 30:143-145, 2001. Recent Results Cancer Res 152:396-411, 1998. 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. professor Graduate School of Social Work, Boston College, Chestnut Hill, MA. 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. • Younger Age-Most breast cancer occurs in women older than 50 years (about 75% of cases). J Natl Cancer Inst Monogr 30:125-129, 2001. 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. A common explanation is that socially isolated individuals fare worse due to reduced instrumental support (i.e., assistance meeting the demands of treatment). Log in to our secure, personalized website to manage your care (formerly myMDAnderson). Fisher B, Carbone P, Economou SG, et al: 1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. 44. Curr Opin Oncol 1:333-336, 1989. 14. Bloom JR: Social support, accommodation to stress and adjustment to breast cancer. A report of early findings. Cancer 69:1729-1738, 1992. 41. Consens Statement 8(6):1-19, 1990. Body image: Cancer survivors who have experienced amputations, disfigurement or a major change in physical function can suffer from a lack of self-esteem. Maunsell E, Brisson J, Deschenes L: Social support and survival among women with breast cancer. 2. 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. Reconstruction was often delayed for several years after initial treatment, requiring a second surgical procedure. In a recently completed randomized controlled trial,[48] Stanton and colleagues found that a 23-minute video, designed to facilitate emotional and physical recovery after breast cancer treatment, significantly enhanced the return of vitality. Knowing your own body can help distinguish between normal physical changes and more serious symptoms that need to be reported to your doctor. 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. This study wanted to find out more about the social, physical and emotional effects of having breast cancer that had spread. Relationships: You may find that friends, coworkers and family members treat you differently after a cancer diagnosis. 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. 29. Even the most psychologically strong individual will be overwhelmed by the number of medical visits, procedures, and waiting times during the initial diagnostic process. Frost MH, Suman VJ, Rummans TA, et al: Physical, psychological and social well-being of women with breast cancer: The influence of disease phase. Patients fighting breast cancer experience psychological distress. In her classic 1980 paper on the psychosocial correlates of breast cancer and its treatments, Meyerowitz pointed out that during this time, most patients were not told their diagnosis, for fear of the emotional response it would evoke. 30. J Natl Cancer Inst 96:376-387, 2004. In some cases, this can be severe. 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. Español. Ganz PA, Desmond KA, Leedham B, et al: Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J Natl Cancer Inst Monogr 16:177-182, 1994. 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. Wolmark N, Fisher B: Adjuvant chemotherapy in stage-II breast cancer: An overview of the NSABP clinical trials. 40. Effects of a Randomized Couple-based Intervention on Quality of Life of Breast Cancer Patients and Their Partners Karen Kayser, PhD. It also costs us the people we love. 39. Dorval M, Maunsell E, Deschenes L, et al: Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls. They include experts in survivorship, social work, rehabilitation, alternative medicine, nutrition and other specialties. Ganz PA, Lee JJ, Sim MS, et al: Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. Univ British Columbia. 3. 16. Such resources are widely available in the community. Fetting JH: Psychosocial aspects of breast cancer. 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. Med Care 31:419-431, 1993. 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. What is Palliative Care? Our personalized portal helps you refer your patients and communicate with their MD Anderson care team. Finally, for younger women this is often the first encounter with the health-care system (other than childbirth or minor health conditions), and this adds considerable distress. A number of different psychological and social factors can affect the emotional stability and physical outcomes for patients with breast cancer. It is most common in breast cancer (42%) and head and neck cancer (41%) patients. All of these medical factors contribute to the risk of greater psychological distress in these younger women. The first step in coping with psychosocial changes is realizing that you have an issue and having the courage to reach out for help. A study of 152 breast cancer patients found that approximately 32% experienced GAD, an anxiety disorder in which a general feeling of unease or fear is present, despite little or no threat. [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. 35. Schag CA, Ganz PA, Polinsky ML, et al: Characteristics of women at risk for psychosocial distress in the year after breast cancer. Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article. Milestone events in their cancer journey can often trigger these feelings. Support groups often provide this type of assistance and should be offered. Care for social, financial, emotional, and spiritual needs. 34. Physical, Emotional, and Social Effects of Cancer. survivors to help you cope with life after cancer: Due to our response to COVID-19, all blood donations at MD Anderson 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 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. [45-47], Common Psychosocial Issues in Women With Breast Cancer. Among breast cancer patients, inadequate social support is associated with a substantial increase in cancer-related mortality. Qual Life Res 8:723-731, 1999. Social support plays an important role in quality of life and health outcomes after breast cancer diagnosis and treatment. N Engl J Med 304:10-15, 1981. At the OHSU Knight Cancer Institute, we offer teams of specialists who can help. J Natl Cancer Inst 93:979-989, 2001. Ganz PA: Quality of life and the patient with cancer. J Natl Cancer Inst 94:39-49, 2002. Women who underwent chemotherapy had a 27 percent higher job loss rate among more than 1,500 breast cancer survivors surveyed. The “Moving Beyond Breast Cancer” video is available at no cost through the National Cancer Institute Cancer Information Service (1-800-4-CANCER or http://cis.nci.nih.gov/). One in three breast cancer survivors end up unemployed after treatment. 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. Explore www.cancer.org or call our National Cancer Information Center toll-free number, 1-800-227-2345. What makes each of these patient characteristics a risk factor for psychosocial distress after breast cancer? 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. Researchers have examined social support and its relations with QOL overall, but less is known about effects of social support on changes in QOL. If you have questions about MD Anderson’s appointment process, our Breast Cancer Res Treat 38:183-199, 1996. 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. Lash TL, Silliman RA: Patient characteristics and treatments associated with a decline in upper-body function following breast cancer therapy. Abeloff MD, Beveridge RA, Donehower RC, et al: Sixteen-week dose-intense chemotherapy in the adjuvant treatment of breast cancer. 20. 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). N Engl J Med 326:1147-1149, 1992. 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. 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]. 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. Needs assessment and referral should be integrated into routine oncology care, as recently suggested by an Institute of Medicine report. 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. Loss can include your health, sex drive, fertility and physical independence. Introduction People in a patient's social support network include family members, spouses, children and friends. To some degree, all of these concerns are expected and are experienced by all women at some point after their diagnosis and treatment for breast cancer. This may be particularly important in patients with advanced breast cancer. Authors S F Pardue, M V Fenton, L R Rounds. Understanding the Psychological Effects of Breast Cancer. 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. Almost all cancer survivors will face psychological and emotional issues that can show up many years after treatment. J Clin Oncol 6:1795-1797, 1988. [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). Cross-sectional and prospective studies show a positive association between perceived social support and psychological adjustment following cancer treatment. Find information and resources for current and returning patients. Immediate reconstruction and autologous tissue flaps, widely used today, did not become widespread until the turn of the 21st century. Ganz PA, Rowland JH, Meyerowitz BE, et al: Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Effects of social relationships on survival for women with breast cancer : a prospective study. Individual and policy implications. In this study, the collaborative partners are Finland, Denmark and Sweden. For example, tamoxifen, a common breast cancer treatment, can cut a woman’s rate of breast cancer recurrence by up to 50 percent. 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. Breast Cancer Network Australia (BCNA) commissioned Deloitte Access Economics to survey its members about the out-of-pocket costs of their breast cancer treatment and care, and other associated costs. Patie… Return to usual physical and social activities was also reportedly diminished in many women. 23. Whether breast cancer patients are newly diagnosed, survivors, or at the end of life, attending to their psychological and social concerns will enhance the effectiveness of our treatments and palliation of symptoms. Anxiety about developing cancer.Having an altered BRCA gene doesn't mean you'll definitely get breast or ovarian cancer. Ganz PA, Hirji K, Sim MS, et al: Predicting psychosocial risk in patients with breast cancer. Soc Sci Med 19:831-837, 1984. Call 713-563-6666 to request a referral. 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