Abstract
This study investigated latent distress and coping mechanisms existing in the experiences of relapsed breast cancer patients in order to identify strategies for improving support structures for this population. Semi-structured interviews were performed with 26 subjects receiving care from two medical facilities in the Tokyo Metropolitan area. In this study, the life-line methodology was selected as a tool to express the subjective QOL of subjects. Specifically, we used life-lines to examine the changing processes of the subjective QOL and to explore latent distress and coping mechanisms.We found that 1) the life-lines of approximately half of the subjects regained a pre-initial diagnosis level of psychosocial equanimity after both the initial diagnosis of cancer and the first episode of recurrence ; however, the life-lines of some subjects remained depressed as they suffered multiple recurrences and a concomitant loss of hope, 2) relapsed patients faced an awareness of death and a sense of uncertainty, a decline in pleasures, and a declining ability to find meaning in life, 3) the recovery of the level of the life-line accompanied changes corresponding to a scale recalibration, a change in values, and a reconceptualization as described in response shift theory. These changes were confirmed in two areas : those related to sickness, treatment and survival, and those related to finding a significance in life itself and asserting one's reasons for living. Furthermore, as a result of cognitive coping strategies, the maintenance of life-line levels after recovery were attained in the same two areas as stated above, 4) when compared with a SF-8 survey methodology measuring a health-related QOL, the life-line methodology was more consistent with the mental health rather than the physical health domains, especially as related to identifying a personal meaning in one's life, and 5) relapsed patients combined characteristics of patients in both treatment and terminal stages of the disease.Study results reinforce the recognition that relapsed breast cancer patients have an unmet need for support systems tailored to respond to their individual psychological characteristics.
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