Post-traumatic growth in breast cancer patients post-mastectomy: body image mediates self-actualization and ego strength

BackgroundCancer diagnosis and treatment usually trigger positive and negative psychological health outcomes. Social support is a coping resource for psychological health outcomes. However, little research is available on the relationships between social support, body image, and overall psychological health outcomes in breast cancer (BC) patients. This study aimed to estimate the prevalence of depressive symptoms and post-traumatic growth (PTG) and examine the mediating roles of social support between body image and depressive symptoms and PTG among BC patients, respectively.MethodsA cross-sectional study was conducted in the Northeast China from December 2015 to August 2017. All the participants were diagnosed with BC and underwent surgery. This study was conducted with 405 BC patients from the First Affiliated Hospital of China Medical University. Participants completed the Center for Epidemiologic Studies Depression scale, Post Traumatic Growth Inventory, Body Image Scale, and Perceived Social Support Scale. The associations of social support, body image with depressive symptoms, and PTG were examined by hierarchical linear regression analysis. Asymptotic and resampling strategies were used to explore the mediating role of social support.ResultsThe prevalence of depressive symptoms was 88.1%, and 67.2% of the patients had moderate-high PTG, 52.84% of the patients had body concerns, and 264 (65.19%) patients had high-level social support. Body image was positively associated with depressive symptoms (β = 0.445, P < 0.001) and social support was negatively associated with depressive symptoms (β = −0.219, P < 0.001). Body image was negatively associated with PTG (β = −0.095, P = 0.023), whereas social support was positively associated with PTG (β = 0.533, P < 0.001). Social support significantly mediated the associations among body image, depressive symptoms (effect size = 0.057), and PTG (effect size = −0.304), respectively.ConclusionsSocial support played mediating role in the relationships between body image and depressive symptoms and PTG. The interventions based on social support and body image should be included in psychological health prevention.

The diagnosis and treatment of cancer triggers not only a negative psychological response for the patient, but also a positive psychological outcome. Positive dyadic coping, as a form of coping for mental health outcomes, can maintain or reestablish internal stability between the patient and his or her spouse, resulting in positive physical and psychological changes. However, there is a paucity of research on body image, dyadic coping, and post-traumatic growth in breast cancer patients. The purpose of this study was to explore the relationship and pathways between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A cross-sectional study was conducted from November 2022 to November 2023 at a tertiary care hospital in Wuxi, Jiangsu, China. This study was conducted among 154 breast cancer patients treated at the Affiliated Hospital of Jiangnan University, all of whom completed demographic and clinical information questionnaires, Body image self-rating questionnaire for breast cancer (BISQ-BC), Dyadic Coping Inventory (DCI) and Post Traumatic Growth Inventory (PTGI). A Pearson correlation analysis was used to explore the relationship between body image, dyadic coping, and post-traumatic growth. Structural equation modeling was used to analyze the path relationships among the three and to explore the mediating role of dyadic coping. The level of body image was negatively correlated with post-traumatic growth (r = -0.462, p < 0.01); and the level of body image was negatively correlated with dyadic coping (r = -0.308, p < 0.01). And dyadic coping was positively associated with post-traumatic growth (r = 0.464, p < 0.01). The structural equation modeling results supported the mediation model with the following model fit indices, chi-square to degrees of freedom ratio (χ2/df = 2.05), goodness of fit index (GFI = 0.93), comparative fit index (CFI = 0.99), canonical fit index (NFI = 0.93), incremental fit index (IFI = 0.99), non-canonical fit index (TLI = 0.99) and the root mean square of the difference in approximation error (RMSEA = 0.03). Body image and dyadic coping directly affected post-traumatic growth (β = -0.33, p < 0.05; β = 0.43, p < 0.05). And body image indirectly influenced post-traumatic growth through dyadic coping (β = -0.17, p < 0.05). Interconnections between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A preliminary validation of the mediating role of dyadic coping between body image and post-traumatic growth, body image can have an impact on dyadic coping, which in turn can have an impact on post-traumatic growth. Whereby higher levels of dyadic coping in patients may also be associated with higher levels of post-traumatic growth, whereas body image disturbance may impede levels of post-traumatic growth.

The ability to derive growth from a traumatic event, such as a cancer diagnosis, can facilitate effective adaptation to the challenges associated with cancer survivorship. In two studies, we investigated the possible cognitive mechanisms explaining the relationship between post-traumatic stress and post-traumatic growth in female survivors of breast cancer. Specifically, Study 1 examined the role of interpretation bias, and Study 2 examined the role of cognitive restructuring of trauma. In Study 1, 113 participants completed questionnaires assessing stress- and anxiety-related symptomatology, post-traumatic stress and growth, perceived cognitive functioning, and positive interpretation bias. In Study 2, 117 participants completed questionnaires assessing stress and anxiety-related symptoms, rumination, perceived cognitive functioning, cognitive restructuring of trauma, and post-traumatic stress and growth. In both studies, post-traumatic stress was negatively related to post-traumatic growth. In Study 1, positive interpretation bias explained a significant amount of variance in the relationship between post-traumatic stress and post-traumatic growth, with perceived cognitive functioning moderating the relationship between interpretation bias and post-traumatic growth. In Study 2, cognitive restructuring explained a significant amount of variance in the relationship between post-traumatic stress and post-traumatic growth, with deliberate rumination moderating the effects of cognitive restructuring on post-traumatic growth. Cognitive mechanisms are key to understanding the relationship between post-traumatic stress and growth and should be targeted in interventions to improve cognitive flexibility and resilience among breast cancer survivors.

Breast cancer, menopause, and long-term survivorship: critical issues for the 21st century

This study aimed to explore the relationships between gender-role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post-treatment. A total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI-related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender-Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy-Breast Quality-of-Life Instrument (FACT-B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT-B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance. Significant positive correlations were found between the two BI scales and (a) GRSS (average r = 0.53, p < 0.000), (b) Body Shame (average r = 0.53, p < 0.000) and Surveillance (average r = 0.48, p < 0.000). The BIS and BIBCQ were negatively associated with the FACT-B (r = -0.62, -0.73, respectively; p < 0.000). Results from the path analysis demonstrated support for the proposed model. Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self-surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post-treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment.

Breast cancer (BC) diagnosis and treatment can affect women both physically and psychologically. Women with BC undergo various painful and debilitating therapies as well as emotional trauma. Additionally, treatment modalities can bring about multiple changes, causing distress and alteration in one’s appearance. This study aimed to assess the psychological distress and body image disturbances after modified radical mastectomy (MRM) among BC survivors. Correlational research design was used to conduct this quantitative research. Survey was administered with closed ended questionnaires as method of data collection. Purpose sampling technique was employed to select the sample of study 50 (married=31, unmarried=19) breast cancer survivors. Three were two research instrument were used; DASS-21 (Henry &amp; Crawford, 2005) and Body Image Scale ((Hopwood et al., 2001). Findings of study reveal that there is positive correlation between psychological distress and body image disturbance. Moreover, depression, anxiety and stress are the significant positive predictors of body image disturbance. BC survivors experience high rates of depression, anxiety, stress, and body image dissatisfaction. Furthermore, unmarried breast cancer survivors report higher score of psychological distress and body image disturbance as compared to married. Depression, anxiety, stress, and body image issues are common among BC survivors. Follow-up management plans for BC survivors should also include evaluation and treatment of psychological distress and addressing body image disturbances in patients undergoing mastectomy.

Diagnosis and treatment of breast cancer is traumatic for both patients and their relatives. It is crucial to understand the factors that enhance the psychological resilience of breast cancer survivors. This study aims to investigate posttraumatic growth following breast cancer and its relationship with psychiatric disorders, social support, and stigma. The study included 100 female breast cancer patients and 100 relatives. Patients underwent a DSM-5-based structured psychiatric interview and were assessed with the Posttraumatic Growth Inventory (PTGI), the Hospital Anxiety-Depression Scale (HADS), the Cancer Patient Perceived Social Support Scale (CPPSSS), and Cancer-related Attitudes Measurement Questionnaire (CRAMQ)-patient version. The patient's relatives were administered the PTGI, HADS, and CRAMQ-community versions. Psychiatric disorders were diagnosed in 40% of individuals with breast cancer, most commonly major depressive disorder (22%). Posttraumatic growth demonstrated a negative correlation with age and a positive association with being employed. The presence of psychiatric disorders and elevated anxiety levels are associated with reduced personal growth. Perceived emotional/confidence social support were associated with increased growth. A subscale of stigma 'impossibility of recovery', led to a positive shift in life philosophy and interpersonal relationships. Additionally, both patients' age and the level of growth in their relatives were found to predict posttraumatic growth in the patients (B=-0.499, p=0.021; B=0.211, p=0.044, logistic regression). Posttraumatic growth is negatively associated with age and the presence of a psychiatric disorder, and positively associated with employment and social support. Additionally, relatives' posttraumatic growth and patients' age predict posttraumatic growth in patients. Stigmatising the perception of "impossibility of recovery" is associated with positive psychological change, possibly reflecting a more traumatic perception of the cancer diagnosis, a reduction in denial, and increased acceptance of the illness. This acceptance of mortality may lead to deeper personal transformation for a more meaningful life and improved interpersonal relationships.

Background: The diagnosis of breast cancer is a traumatic experience that might have a psychological impact on patients. Studies have revealed that self-compassion is significantly related to body image and post-traumatic growth. Objectives: We aimed to compare the relationship between self-compassion, post-traumatic growth, and body image between healthy individuals and patients with breast cancer. Materials and Methods: This study was designed as a causal-comparative model and was conducted between May 8, 2022, and June 15, 2022, via open social media platforms. We enrolled women aged 18-65 years who resided in Mersin, Türkiye. Our cohort consisted of women with breast cancer and a control group of healthy women who had not been diagnosed with breast cancer. We used the Post-Traumatic Growth Inventory, Self-Compassion Scale, the Body Cathexis Scale, and sociodemographic data forms for collecting information from participants. Results: We enrolled 174 participants; 80 patients with breast cancer, and 94 healthy controls. Self-compassion showed a higher prediction for post-traumatic growth in the group of patients with breast cancer (P &lt; 0.001), whereas it showed a higher prediction for body image in the group of healthy individuals (P &lt; 0.001). In patients with breast cancer, changes in relationships with others (P, 0.032) were higher, while body perception (P &lt; 0.001) and self-compassion (P, 0.046) were lower than in individuals without a diagnosis of breast cancer. Furthermore, we found that patients with breast cancer who perceived that they had been provided with sufficient disease-related information showed higher scores on the self-compassion scale (P, 0.013). Conclusions: Self-compassion is an internal resource that can aid women in adjusting to the physical and psychological changes resulting from cancer or any kind of traumatic experience. Furthermore, self-compassion can be a solution for body dissatisfaction.

Review question/objective What are the psychosocial experiences of women with breast cancer across the lifespan, including similarities and differences in the psychosocial experiences of younger, middle-aged and older women with breast cancer? Inclusion criteria Types of participants This review will consider studies that include women with a breast cancer diagnosis of any type or stage, with the exception of a cancer recurrence. Women with a recurrence will be excluded since the experience of recurrence has been shown, through research, to be dissimilar to the experience of the first diagnosis and treatment of the disease. The experience of women in all treatment modalities will be included (i.e. lumpectomy, mastectomy of all types with or without breast reconstruction, chemotherapy, radiation therapy and hormone therapy). This review will consider studies that include age as a primary area of interest in the study design. That is, the study will focus on: 1) younger women or older women, or 2) a psychosocial issue and compare it across the lifespan from younger to older. The definition of “younger” and “older” will not be described by the reviewers prior to the review because no consensus has been reached in the literature about defining “young” and “old” in cancer. However, this will be observed in the studies and reported on in the analysis. Therefore, studies that identify the participants as “young” and/or “old”, and provide a range of ages of the participants, will be included. Studies will be excluded if they do not define their population(s) by age or if they combine younger and older populations together. Phenomenon of interest The phenomenon of interest is women’s psychosocial experience of breast cancer, including the social, psychological, emotional, spiritual and quality-of-life aspects of cancer. Context This review will include women from all geographical regions. It will also include all cancer care contexts (e.g. acute care hospital, ambulatory care setting, home care, primary health care).

Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group. A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy - Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health-related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF. Eighty-three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire - Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = -0.23), and overall SF (r = -0.25). Vaginal dryness (β = -0.50), body stigma (β = -0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF. Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues.

Background:Treatment for breast cancer can give rise to complications with important psychological impact. One change in patients regards body image. The aim of this research was to study the effect of a midwifery-based counseling support program on the body image of breast cancer survivors.Materials and Methods:In this randomized clinical trial, the study population was constituted by 80 breast cancer patients referred to Tuba Clinic in Sari, north of Iran, randomly assigned to two groups. Inclusion criteria included breast cancer diagnosis, mastectomy experience, age of 30 to 60 years, primary school education or higher, being married, and receiving hormone therapy. The Body Image Scale and Beck Depression Inventory were completed by intervention and control groups prior to the intervention and again afterwards. This program was implemented to the intervention group (two groups each consisting of 20 patients) for six weekly sessions, each lasting 90 minutes. The collected data were analyzed suing SPSS through Mann-Whitney U and Wilcoxon tests.Results:The results showed that the average age of participants in the intervention and control groups were 46.8 ± 6.85 and 48.9 ± 5.86, respectively. Body image scores in the intervention and control groups before the support program were respectively 21.82 ± 1.66 and 21.7 ± 1.48, and after the support program they were 7.05± 2.70 and 22.92 ±1.49, respectively. Therefore, the results indicate that the support program was effective in improving body image.Conclusion:This study showed that the support program had a positive effect on the body image of patients. Therefore, it is suggested that it should be used as an effective method for all breast cancer survivors.

Background: Our group previously reported that young breast cancer (BC) survivors have a higher risk of osteopenia/osteoporosis compared to their cancer-free peers. In order to develop successful interventions we need to understand the major contributing factors. Therefore, we investigated bone loss in young BC survivors by age at diagnosis, tumor characteristics and BC treatment compared to their cancer-free peers. Methods: We studied 775 women (211 BC survivors, 564 cancer-free) with familial risk of breast and/or ovarian cancer in the Breast and Ovarian Surveillance Service (BOSS) cohort at Johns Hopkins. Survivors were diagnosed with stage 0-III BC &amp;lt;5 years prior to enrollment. The comparison group was cancer-free women at enrollment. Osteopenia and osteoporosis were ascertained based on self-reported physician diagnosis in baseline and follow-up questionnaires. Prevalent cases of osteopenia or osteoporosis were excluded. Multivariable (MV)-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of osteopenia and/or osteoporosis among BC survivors compared to cancer-free women. BC survivors were stratified by age at diagnosis, estrogen-receptor (ER) tumor status, and BC treatment. MV models were adjusted for age, menopausal status, body mass index, physical activity, smoking, alcohol use, hormone replacement therapy and early oophorectomy. Results: Mean time from BC diagnosis to enrollment was 1.4 years for survivors and mean age at BC diagnosis was 47 years. At baseline, BC survivors were more likely to be slightly older, postmenopausal, and current vitamin D users and less likely to have had an early bilateral oophorectomy compared to cancer-free women. During a mean follow-up time of 5.7 years, 66% of BC survivors and 54% of cancer-free women reported having ≥1 bone density exam and 112 incident cases of osteopenia/osteoporosis were identified (75% osteopenia only). BC survivors diagnosed at age ≤50 years had a 2-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.05, 95% CI=1.24-3.40). Risk of bone loss was similar among survivors with ER-positive tumors compared to cancer-free women (HR=2.04, 95% CI=1.30-3.22). No association was observed for BC survivors treated with tamoxifen only or chemotherapy only. BC survivors treated with aromatase inhibitors (AIs) only had almost 3-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.92, 95% CI=1.38-6.17). BC survivors treated with chemotherapy + tamoxifen and chemotherapy + AIs had over 2- and 4-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.28, 95% CI=1.04-5.00; HR=4.09, 95% CI=1.99-8.42, respectively). Results suggest that risk of bone loss was highest within 5 years after BC diagnosis. Conclusion: Our results demonstrate that osteopenia/osteoporosis incidence is higher in BC survivors compared to cancer-free women and risk varies by age at diagnosis, ER-status and BC treatment. Our findings provide support for a baseline evaluation of bone density close to diagnosis in BC survivors with familial risk. Future studies are needed to address the frequency of monitoring among specific age and treatment groups. Citation Format: Ramin CA, May BJ, Roden RBS, McCullough M, Armstrong DK, Visvanathan K. Understanding the etiology of osteopenia and osteoporosis in young breast cancer survivors compared to cancer-free women [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-12.

Background: A breast cancer's diagnosis and treatment can bring changes related to women’s body image and sexuality, which can have a devastating impact on intimate relationships and sexuality. The study aim to examine the effectiveness of PLISSIT Counseling Model on female sexuality, body image and couple satisfaction for breast cancer women undergoing treatment. Subjects &methods a quasi-experimental design was used. The study was conducted at Out-patient Oncology Institute, Menoufia University-Egypt. A purposive sample of 66 women with breast cancer was included. Four tools were used to collect data., a structured interviewing questionnaire, body image scale, female sexual function index (FSDI), the revised dyadic adjustment scale. Results. A significant relationship was found between treatment side effects pre and post intervention regarding nausea & vomiting, diarrhea and pain. The mean score of body image, couple satisfaction and sexual dysfunction were improved after application of PLISST counseling model. Conclusion: application of PLISSIT model was effective in enhancing sexual functioning, body image and couple satisfaction for breast cancer women under treatment regimen. Recommendation: Adopting PLISSIT sexual counseling model in addressing sexual dysfunction in a cancer treatment institutions. Applying the evidence –based nursing interventions to address and manage the effects of breast cancer on sexuality.

Breast cancer (BC) is potentially a traumatic stressor which may be associated with negative outcomes, such as post-traumatic stress disorder (PTSD) or positive changes, such as post-traumatic growth (PTG). This study aims to identify the core issues of BC related PTSD, PTG and psychological distress by interrogating the literature in BC survivors. We have also highlighted issues related to the assessment, diagnosis and clinical management of PTSD and PTG. The authors systematically reviewed studies published from 1985 to 2014 pertaining to PTSD, psychological distress and PTG in BC survivors with particular attention paid to incidence rates and causative factors. Multiple studies intimated that women with BC have evidence of PTSD at the initial stages of diagnosis, whereas PTG develops once patients undergo treatment. Early diagnosis and treatment of PTSD/PTG is paramount from literature review but the previously mentioned relationship between PTSD and PTG in BC patients could not be verified. It is evident from the literature that a small percentage of BC patients experience PTSD, while the majority experience PTG after BC diagnosis and treatment. Future research should include prospective studies focusing on high-risk patients, causative factors and the development of psychological interventions.

Sexual dysfunction in women with cancer