Psychosocial Consequences of Breast Cancer Treatment

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Psychosocial Consequences of Breast Cancer
Treatment

• Terry Badger, PhD, RN, PMHCNS-BC,FAAN
• Professor and Division Director, Systems
• College of Nursing, University of Arizona
• Member, Arizona Cancer Center
• Email tbadger_at_nursing.arizona.edu

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Objectives

• Describe four common fears/worries of breast
  cancer survivors
• Discuss self esteem and role transitions
• Describe emotional distress
• Discuss the role of the partner/family in
  decreasing psychosocial consequences

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Reach and Influence of Cancer

• One in 10 households has a family member with
  cancer, diagnosed and treated within the past 5
  years
• 10 and a half million Americans live with cancer
• Survival rates are increasing
• Patients and their families continue to report
  unmet psychosocial needs (USA Today et al., 2006)
  and dissatisfaction with cancer care

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Caring for the Whole Patient Meeting
Psychosocial Needs (IOM, 2008)

• Cancer care today often provides
  state-of-the-science biomedical treatment, but
  fails to address the psychological and social
  (psychosocial) problems associated with illness.
  This failure can compromise the effectiveness of
  health care and thereby adversely affect the
  health of cancer patients

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Psychosocial Consequences

• Fears/Worries
• Self Esteem
• Emotional Distress

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Four Cancer-related health fears/worries

• About cancer coming back
• Symptoms experienced may indicate the recurrence
  of cancer
• About future diagnostic tests
• About another type of cancer
• Deimling, et al., 2005

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Relationship between fear/worries and emotional
distress
Emotional Distress Depression and Anxiety
Health Related Fears/Worries
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Psychosocial Consequences-One year later
Baker et al., 2005.
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What can we do about these fears?

• Acknowledge them
• Address the uncertainty related to the fears
  (Mishel et al., 2005)
• Providing information or information resources
  throughout the survivor period
• Social support-Family, Friends, HCP
• Assess throughout survivorship

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Self Esteem Issues

• 60 unhappy with appearance
• 58 report breast sensitivity
• 50 sexual dysfunction
• 43 general aches and pains
• 34 muscle stiffness
• 26 hot flashes

Ganz et al., 2004 Thewes et al., 2004
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Roles Transition with Illness
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Relationship between low self-esteem and
emotional distress
Emotional Distress Depression and Anxiety
Low self-esteem
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Working with Role Transitions

• Evaluation of the old role
• Encouraging expression of affect (guilt, anger,
  loss)
• Acquiring new skills
• Establishing social supports
• Identifying any positive aspects of the role

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Emotional Distress

• Unpleasant emotional experience of a
  psychological, social and/or spiritual nature
  that may interfere with the ability to cope with
  cancer, it physical symptoms and treatment. May
  range from normal feelings of sadness and fears
  to problems that become disabling such as
  depression (NCCN, 2008)
• NCCN, 2008. Distress Management Clinical
  Practice Guidelines in Oncology. Accessed at
  http//www.nccn.org

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• Why is it important to examine emotional distress
  in breast cancer patients?

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Emotional distress can

• Adversely influence health and health care
• Lower quality of life
• Impair Social functioning, ability to marshal
  social support
• More disability
• Existential or spiritual crises
• Fann et al., 2008

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Emotional distress can

• Cause more difficulties with symptom burden and
  symptom management (Badger et al., Spitzer et al)
• Influence adherence
• Influences immune functioning and mortality
  (Kroenke, et al., Weihs et al.)

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Emotional Distress can

• Decrease healthy lifestyle behaviors (IOM, 2001)
• Smoking
• Drinking/Substances
• Eating
• Exercise
• Sleep
• Pleasurable Activities

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How unusual is this?

• Estimates are that about 15-25 of cancer
  patients suffer from emotional distress severe
  enough to warrant referral and treatment (NCI)

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Psychosocial Care is a TEAM Effort

• Together
• Everyone
• Achieves
• More

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Key Assumptions

• cancer is experienced by the whole family system
• marital/close relationship quality can positively
  or negatively impact QOL for the person with
  cancer
• partners are sometimes as distressed or more
  distressed as the patient (Fann et al.,
  2008,Segrin et al., 2007 Northouse et al., 2006)

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Maunsell et al. (1995) Cancer, 76, 631-637
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Emotional Contagion comes from family systems
theories

• interpersonal transmission of affect
• observation and mimicry of nonverbal behaviors
• taking cues from others for appropriate
  experience and display of affect
• can happen between strangers
• extensive opportunity in close relationships

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Survivor and Partner Distress
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Dyadic Interdependence in Anxiety Over Time
Segrin, C., Badger, T.A., Dorros, S.M., Meek,
P., Lopez, A.M. (2007). Interdependent anxiety
and psychological distress in women with breast
cancer and their partners. Psycho-Oncology, 16,
634-643.
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Conclusions

• Addressing these consequences will improve both
  short-term and long-term well-being
• Will improve patient and family satisfaction

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Current Studies

• Spanish-speaking Latinas and Partners (funded by
  LAF)
• Anglo women and partners (funded by ACS)
• Contact Terry Badger
• 520-730-7455