Women Facing Breast Cancer Research Articles

Efficacy of group therapy to reduce mental distress in women with non-metastatic breast cancer: A systematic review and meta-analysis of randomized controlled trials.

Group treatments have proven to be effective for many mental disorders and showed beneficial effects in patients with medical illness. Aim of this systematic review and meta-analysis is to summarize the efficacy of group therapy for women with non-metastatic breast cancer. We included studies comparing group therapy for women with non-metastatic breast cancer to non-active control groups, active control conditions, and individual psychotherapy. The primary outcome was mental distress, secondary outcomes were quality of life, coping, existential outcomes, fatigue, pain, and sideeffects. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, PsycINFO, and DARE complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. Thirty-seven studies (5902 patients) were included. Small effects on mental distress in favor of group treatment were found (non-active control groups: n=19, g=0.42, 95% CI [0.29; 0.56], I2 =61.6%; active control conditions: n=6, g=0.20, 95% CI [0.06; 0.35], I2 =0%). Cognitive-behavioral therapy (CBT) and third wave CBT group approaches proved to be most effective. Group treatments also showed beneficial effects on secondary outcomes, with most profound evidence on quality of life and coping. Results suggest that group interventions have the potential to reduce mental distress in women facing breast cancer. In the light of the considerable heterogeneity of most study effects, there is a need for more rigorous studies to strengthen the promising evidence and for trials examining the impact of patient and intervention characteristics on outcomes. PROSPERO international prospective register of systematic reviews, CRD42020184357.

Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity

Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer. Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery. Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes. Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects. Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.

Depression and Health-Related Quality of Life Among Young Adult Breast Cancer Patients: The Mediating Role of Reproductive Concerns.

Biological motherhood plays an important role in the lives of many young women facing breast cancer and threats to reproduction may be disruptive. In this study, we explored the indirect effects of the importance of parenthood and childlessness on depression and health-related quality of life (HRQoL) among cancer patients 18-40 years of age (n = 104) through reported reproductive concerns. These specific concerns fully mediated the relationship between the importance of parenthood in women's lives and HRQoL. Greater importance of parenthood was directly associated with higher depression symptoms. Interventions should address the reproductive needs and concerns of patients to improve their HRQoL.

Childhood maltreatment, psychological resources, and depressive symptoms in women with breast cancer

Childhood maltreatment is associated with elevated risk for depression across the human lifespan. Identifying the pathways through which childhood maltreatment relates to depressive symptoms may elucidate intervention targets that have the potential to reduce the lifelong negative health sequelae of maltreatment exposure. In this cross-sectional study, 271 women with early-stage breast cancer were assessed after their diagnosis but before the start of adjuvant treatment (chemotherapy, radiation, endocrine therapy). Participants completed measures of childhood maltreatment exposure, psychological resources (optimism, mastery, self-esteem, mindfulness), and depressive symptoms. Using multiple mediation analyses, we examined which psychological resources uniquely mediated the relationship between childhood maltreatment and depressive symptoms. Exposure to maltreatment during childhood was robustly associated with lower psychological resources and elevated depressive symptoms. Further, lower optimism and mindfulness mediated the association between childhood maltreatment and elevated depressive symptoms. These results support existing theory that childhood maltreatment is associated with lower psychological resources, which partially explains elevated depressive symptoms in a sample of women facing breast cancer diagnosis and treatment. These findings warrant replication in populations facing other major life events and highlight the need for additional studies examining childhood maltreatment as a moderator of treatment outcomes.

Attachment and couple satisfaction as predictors of expressed emotion in women facing breast cancer and their partners in the immediate post-surgery period.

To investigate expressed emotion (EE) in couples facing breast cancer in the immediate post-surgery period. EE may be predictive of psychological disturbances that hinder both partners' capacities to cope with the stress of the disease. Severity of the disease, attachment tendencies, and couple satisfaction were tested as predictors of EE. The design was cross-sectional. Couples (N=61) were interviewed 2weeks after the women's breast surgery. Expressed emotion was assessed in women and in partners with the Five-Minute Speech Sample, with a focus on overt and covert criticisms. Self-reported EE, attachment tendencies, and couple satisfaction were assessed with questionnaires. Hierarchical regression analyses were performed to test the predictors and possible interactions between them. Both partners expressed overt and covert criticisms; women expressed more overt criticisms than did their partners. Cancer stage was inversely related to the number of overt criticisms in women and to the number of covert criticisms in partners. Regression analyses showed that in women, higher attachment anxiety and lower couple satisfaction were positive predictors of overt criticisms; in partners, a higher cancer stage was a negative predictor of overt and covert criticisms. Practitioners should pay attention to the couple relationship in breast cancer. EE is most likely to appear when the cancer stage is low, showing that even when the medical prognosis is optimal, relational and emotional disturbances may occur. Statement of contribution What is already known on this subject? The couple relationship is of paramount importance in breast cancer. Expressed emotion (EE) is related to negative individual and relational psychological outcomes in psychiatric and somatic diseases. Expressed emotion has not yet been studied in the context of breast cancer. What does this study add? Expressed emotion is present in breast cancer situations, especially when the cancer stage is low. There was more EE in women than in their partners. Cancer stage, attachment tendencies, and couple satisfaction are predictors of EE.

Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity.

The aim of this study was to assess, in the immediate postsurgical period, the influence of attachment avoidance and anxiety on distress and body image disturbances in women facing breast cancer. Seventy-five women participated in the study 3 weeks after surgery. Questionnaires were used to assess study variables. To predict distress and body image disturbances, we controlled for several variables known to influence adjustment to the stress of breast cancer. The results of hierarchical regression analyses show that attachment explains the outcomes above and beyond other influential variables. Insecurely attached women are especially vulnerable to the stress of the disease.

How can nurses best help women facing breast cancer?

How can nurses best help women facing breast cancer?

The relationship between body image, age, and distress in women facing breast cancer surgery

Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery. Older (≥ 65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific). Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (p's < 0.01); and, (3) age moderated the relationship between body image and emotional distress (p's < 0.06). The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.

Family Interaction Patterns and Their Association With Family Support Among Women With Breast Cancer

Family support often plays a major role in helping women accept, cope with, and recover from breast cancer, and yet its association with specific family interaction patterns among racially diverse women facing breast cancer has been insufficiently examined. The aim of the study was to examine what specific family interaction patterns exist among diverse women with breast cancer and determine if these family interaction patterns are significantly associated with levels of perceived family support and family support satisfaction reported by these women. Participants were 73 white women and 18 African American women with breast cancer. Three different family interaction patterns were identified (ie, cohesive-expressive, conflictual, and nonexpressive). Also, (a) the African American women in cohesive-expressive families versus conflictual families were more satisfied with their emotional family support, (b) the non-Hispanic white women in conflictual families versus nonexpressive families perceived that they received significantly more tangible family support, and (c) the non-Hispanic white women in cohesive-expressive families and those in conflictual families perceived that they received significantly more emotional support from their family members than did non-Hispanic white women in nonexpressive families. Three main family interaction patterns were found among African American and non-Hispanic white women with breast cancer, which were associated with levels of satisfaction with family support or perceived family support. Findings from this study can be used to (a) more accurately assess the levels of satisfaction with family support experienced by diverse women with breast cancer and (b) implement family interventions to increase family support for these women.

The Goldilocks mastectomy

ObjectiveTo reconstruct a breast mound from cutaneous mastectomy flap tissue alone, obviating the need for additional flap or implant techniques. Summary background dataWith growing numbers of obese and elderly women facing breast cancer, options outside of simple mastectomy without reconstruction and formal breast reconstruction using complex autologous flap harvesting techniques or artificial implants need to be explored. MethodsPatients who declined traditional methods of breast reconstruction were offered standard skin sparing mastectomy with closure utilizing a standard Wise pattern. A completely autologous breast mound was created by preserving and de-epithelializing residual mastectomy flap tissue. ResultsOver 24 months, 32 women (50 breasts) underwent mastectomy and closure using this technique. Seromas occurred in 1of 50 operated breasts and cellulitis developed in 3 of 50 breasts. One of the two patients had active hidradenitis at the time of surgery which made expander placement a contraindication and post operative infection a high risk. There has been no incidence of locoregional breast cancer recurrence. ConclusionsSome patients are poor candidates for traditional methods of breast reconstruction secondary to medical comorbidities, while others may decline for more personal reasons. For these patients, we describe an additional option. The procedure is performed in a single stage and does not necessitate closure by a reconstructive surgeon, although a team approach can improve aesthetic results. Disadvantages include limited applicability in patients with small, non-ptotic breasts. Deemed the “Goldilocks Mastectomy”, it is neither amputation of the breast, nor is it full reconstruction. It is a third, middle option. This offers an aesthetic advantage for women over simple mastectomy without reconstruction and potentially decreases cost and number of procedures sometimes associated with formal reconstruction.

The impact of physicians' reactions to uncertainty on patients' decision satisfaction

Patients' and physicians' response to uncertainty may affect decision outcomes. The purpose of this study was to explore the impact of patients' and physicians' reactions to uncertainty on patients' satisfaction with breast health decisions. Seventy-five women facing breast cancer prevention or treatment decisions and five surgeons were recruited from a breast health centre. Patients' and physicians' anxiety from uncertainty was assessed using the Physicians' Reactions to Uncertainty Scale; wording was slightly modified for patients to ensure the scale was applicable. Patients' decision satisfaction was assessed 1-2 weeks after their appointment. A mixed-effects logistic regression model was used to assess associations between patients' and providers' anxiety from uncertainty and patients' decision satisfaction. A provider-specific random effects term was included in the model to account for correlation among patients treated by the same provider. Patients' decision satisfaction was associated with physicians' anxiety from uncertainty (beta = 0.92, P < 0.01), but not with patients' anxiety from uncertainty (beta = -0.18, P > 0.27). This study suggests that physicians' reactions to uncertainty may have an effect on decision satisfaction in patients. More research is needed to confirm this relationship and to determine how to help patient-provider dyads to manage the uncertainty that is inherent in most cancer decisions.

“The Body Gives Way, Things Happen”: Older women describe breast cancer with a non-supportive intimate partner

PurposeMany women identify their intimate partner as important source of support during cancer diagnosis and recovery, but little is known about how women deal with breast cancer while in a relationship self-described as difficult. The purpose of this article is to describe the aging-related experiences of older women who were diagnosed with breast cancer while in a non-supportive, difficult intimate relationship. MethodSemi-structured qualitative interviews were conducted with a convenience sample of 16 women aged 55–84 years (mean 68.1 years) in community settings in the mid-Atlantic United States. Data were analyzed using hermeneutic phenomenological analysis. ResultsParticipants self-identified as being in a difficult intimate relationship (relationship length range: 1 year- 60 years, mean 35.6 years). Reasons for relationship difficulty ranged from intimate partner abuse to terminal illness. The findings included the themes: “At my Age”: participants reflect on aging and breast cancer; breast cancer, sexuality, and aging; and silence. ConclusionsIssues related to aging such as changes in sexual relationships, comorbidities, and partner illness complicated the women’s breast cancer experience. Despite relationship difficulties, these women coped effectively with breast cancer in various ways. Study findings will increase awareness about the unique, complex needs of older women facing breast cancer with non-supportive intimate partners. Nurses should assess older breast cancer patients keeping in mind physical functioning, comorbidities, social support network, and quality of intimate partner support.

Development and pilot-testing of a Decision Aid for use among Chinese women facing breast cancer surgery

Women choosing breast cancer surgery encounter treatment decision-making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four-day post-consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. The original DA was read/partially read by 66/22% (n = 84) of women, whilst the revised version was read/partially read by 74/16% (n = 35), including subliterate women (χ(2) = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P < 0.001; P2: F = 3.744, d.f. 2, P = 0.034). The revised, shorter version was graphically rich and resulted in improved perceived utility, [except for the 'treatment options' (χ(2) = 5.50, P = 0.019) and 'TDM guidance' (χ(2) = 8.19, P = 0.004) sections] without increasing anxiety (F = 0.689, P = 0.408; F = 3.45, P = 0.073). The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial.

The effects of age and emotional acceptance on distress among breast cancer patients

This study examined whether emotional acceptance moderates the relationship between age and distress among breast cancer patients near the end of the first year after diagnosis. The Emotional acceptance scale and the Profile of Mood States scale were completed by 79 women with Stage II or III breast cancer. Results showed that younger women reported greater distress than older women. Those who were less accepting of their emotions also reported greater distress than those who were more accepting, regardless of age. These results suggest that emotional acceptance may be beneficial for both younger and older women facing breast cancer. Additional implications of these findings are discussed.

Surgeon's recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery

to identify factors influencing Chinese women's choices between breast-conserving therapy (BCT), mastectomy (MRM) or MRM followed by breast reconstruction (MRM+R). of 405/443 Hong Kong Chinese women receiving surgery for early breast cancer who were interviewed one week post-surgery about their pre-surgical consultation, available treatment alternatives, whether their surgeons had indicated a surgical preference, perceived efficacy of the surgical options and considerations influencing their treatment decisions (TDM), 198 (49%) reported they were offered a choice of surgery. among women offered a choice of surgery, BCT was chosen by 34/43 (79%) of women whose surgeons recommended BCT but by only 34/96 (37%) of women whose surgeons expressed no treatment recommendation. Multivariate adjustment showed women choosing MRM were influenced more by avoiding both cancer recurrence (p = 0.003) and further treatment (p = 0.009) when choosing surgical option than women choosing BCT. In contrast, women choosing MRM+R and BCT, placed more emphasis on appearance (p < 0.001) and body image (p < 0.001) concerns as influencing treatment choice than did women who chose MRM. survival concerns rather than physical appearance, age and lack of recommendation push Chinese women to choose MRM as BCT is, incorrectly often seen as less efficacious. Recommending BCT increases BCT choice.

Functional impact of breast cancer by age at diagnosis.

To explore changes in physical and psychosocial function before and after breast cancer by age at diagnosis. A total of 122,969 women from the Nurses' Health Study (NHS) and NHS 2, ages 29 to 71 years, who responded to pre- and postfunctional status assessments were included; 1,082 women were diagnosed with breast cancer between 1992 and 1997. Functional status was measured using the Medical Outcomes Study Short Form 36 (SF-36). Mean change in health-related quality of life (HRQoL) scores was computed across categories representing the combination of incident breast cancer (yes or no) and age at diagnosis (< or = 40, 41 to 64, or 65+ years). Compared with women < or = 40 years without breast cancer, women with breast cancer experienced significant functional declines. Young (age < or = 40) women who developed breast cancer experienced the largest relative declines in HRQoL (as compared with middle-aged and elderly women) in multiple domains including physical roles (-18.8 v -11.5 and -7.5 points, respectively), bodily pain (-9.0 v -2.7 and -2.7 points), social functioning (-11.3 v -4.3 and -4.4 points) and mental health (-3.1 v 0.0 and +0.4 points). Much of the decline in HRQoL among elderly (age > or = 65) women with breast cancer was age related. Young women may fare worse than middle-aged or elderly women in both physical and psychosocial dimensions after breast cancer diagnosis. The needs of women facing breast cancer may be better understood within a life stage framework.

Le binôme oncologue-psychanalyste : parcours de patientes

In oncological medicine, professionals work with patients in very separate areas of specialization. This specialization does not always seem the best approach, however, this kind of specialized care can benefit the patients. We would like, in the following text, to share with you a daily experience of an oncologist and a psychoanalyst treating a patient. First, we will present the oncologist’s point of view : his way of undestanding the patient’s journey, his role which is sometimes difficult to accept and maintain between taking action and speaking, the richness and benfits of multidisciplinary care, the oncologist/patient relationship which unfolds over a longterm and finally, his stance facing what wee call the ‘end of life’. Secondly, the psychoanalyst will consider her place in a medical service, working witj women facing breast cancer. Through oncological case studies, wee will follow in detail the psychological work which unfols during regular sessions between patients and the psychoanalyst. We will try to analyse the dynamic in the triad: oncologist/patient/psychoanalyst, and the potential journey from this triad to a triangulation, rich in potential for psychological elaboration and evolution. Both, the oncologist and the psychoanalyst will illustrare their work’s pecularities and will try to show how their care and intervention in a case come together in one common goal: to be listenning to both the physical and the psychological distress of their patients.