A number of different psychological and social factors can affect the emotional stability and physical outcomes for patients with breast cancer. Assessing the psychological aspects of breast cancer treatment and identifying activities that can alleviate stress involved in the treatment process, could reduce the anxiety and emotional upheaval associated with breast cancer. This paper will look at some of the most common psychosocial issues facing breast cancer patients and some of the latest developments in treating these problems.
Despite exceptional developments in both the treatment of breast cancer and the aftercare provided by medical professionals, many women still endure significant psychological and social issues, both while they are receiving care and after completion of their treatment plan. Feelings of isolation (Cacioppo and Hawkley 2003, S44), issues with body image (Schover 1991, 113-114) and lack of information about the extent and type of care visits required (Burton and Parker 1994, 42) are among the most commonly reported issues for women after undergoing surgical treatments for breast cancer. Finding ways to address these problems is essential to ensure the best outcomes for patients in the healthcare setting.
Identifying the underlying issues that could contribute to emotional, psychological or social difficulties for women can allow healthcare professionals and support staff to direct their efforts more efficiently during the treatment and recovery process. Studies have shown that clear lines of communication are essential to ensure optimal care for women with breast cancer (Liang et al. 2002, 1009-1010). Making sure patients have access to the most up-to-date information on their treatment plan and that they can participate in online or in-person support structures can create a more conducive environment for healing and recovery.
Breast cancer can be particularly difficult for younger women (Froude et al. 2017, 1488) who may not yet have built social support networks outside their own family. Adolescents and young adults often need added help in coping with issues associated with breast cancer and its treatment. By focusing attention not only on the physical aspects of this condition but also on the psychosocial effects of breast cancer on these vulnerable individuals, healthcare professionals can deliver a more effective healing experience for younger women dealing with these issues.
This paper will look at some of the most commonly reported social and psychological difficulties experienced by patients during and after breast cancer treatment and will suggest some techniques for addressing these issues adequately.
Common Issues Among Breast Cancer Patients
Issues with Body Image
A study conducted by Stanford University (Fobair et al. 2005, 579-594) and published in Psycho-Oncology in 2005 indicated that women under 50 could experience severe problems with body image following breast cancer surgery. These issues were less pronounced in women who had a positive self-image before the diagnosis and treatment of this condition. (Pikler and Winterowd 2003, 634)
Loss of sexual appeal and femininity were subjectively reported (White 2000, 183-192) by a high percentage of women who had undergone surgery to treat breast cancer. The Stanford study indicated that, despite these issues, nearly two-thirds of the women who participated reported being sexually active during and after their treatment (Pikler and Winterowd 2003, 632-637). A 2002 study (Ganz, Desmond and Belin 1999, 2371-2380) found that women were more likely to engage in sex during this period with an unmarried partner than with a spouse. This may reflect increased pressures to engage in these activities outside of a committed relationship or may merely indicate an increased frequency of sexual intimacy in unmarried people compared with married couples.
In many cases, problems with body image or perceived loss of femininity and sex appeal resolve themselves over time or with the completion of reconstructive surgical procedures to restore the body to a close approximation of its former appearance. Some studies suggest, however, that women may take much longer to recover from body image issues than previously thought (Przezdziecki et al. 2013, 1872-1879). The degree to which these women can show compassion to their condition can be a determining factor in their recovery from body image issues.
Lack of Information
Fatigue, worry, and stress are associated commonly with breast cancer treatment and its aftermath. These emotional changes can lead to depression and withdrawal in some cases. (Hall, Mishel and Germino 2014, 2490) Younger women may be especially vulnerable to these symptoms if they feel uncertain about their treatment plan, their prognoses, or their self-care regimen during and after breast cancer procedures.
While primary caregivers in the healthcare community can do a great deal to promote a more comfortable and informed experience for women with breast cancer, social media venues and other contact points can sometimes serve as an added source for information and support during the recovery process. Making sure that patients are aware of all relevant aspects of their care and referring them to support services as necessary is a substantial step in the right direction for addressing these psychosocial issues.
Studies have shown that women are more likely to withstand breast cancer and its aftermath if they have at least one supportive confidante. Socially isolated individuals had a 66 percent higher chance of death by all causes within the scope of one such study (Kroenke et al. 2006, 1106-1107), which considered the presence of close relatives, friends, spouses and living children as part of a necessary framework for social interaction. This represents a serious issue that must be addressed to reduce patient mortality during and after the treatment process.
A study published in Psychoneuroendocrinology in April 2014 (Hughes et al. 2014, 39-40) indicated that breast cancer survivors experienced greater physical pain and increased risk of depression during the recovery process if they lacked close social connections prior to beginning treatment.
One reason for these results might be the lack of supportive care typically provided by family members and friends. Without these social connections, women may suffer from a lack of essential care at home during the critical treatment phases during and after breast cancer surgery. Integrating questions about the degree of social support available to patients as part of the intake process could be an excellent first step toward decreasing mortality rates and improving the quality of life among these at-risk patients.
Coping Strategies for Women with Breast Cancer
Resolving Body Image Issues
Modern reconstructive and cosmetic surgery techniques can have a positive effect on the body dysmorphia sometimes experienced by women after breast cancer surgery. A 1999 survey of 254 patients aged 20 to 69 years (Al-Ghazal, Fallowfield and Blamey 1999, 572-573) indicated that 90 percent of women who underwent surgery to restore their breasts were satisfied with the results and experienced lower levels of anxiety and depression after these surgical treatments. A study published in 2010 (Damen et al. 2010, 94-95) reported similar satisfaction levels among women undergoing a more advanced breast reconstructive technique.
Women who continue to experience body dysmorphia even after completion of reconstructive procedures may need further counselling. Determining whether body dysmorphic disorder is present prior to breast reconstruction can provide added help for clinicians in addressing expectations and ensuring that patients know the risks and the likely outcomes of these procedures before the surgery. (Metcalfe et al. 2014, 735-736) In some cases, encouraging patients to reach out to friends, family and other support groups can provide help in navigating these issues efficiently.
A Network to Rely On
A 2013 study of personal networks and support mechanisms (Kroenke et al. 2013, 520-521) indicated that women who maintained numerous personal connections were more likely to enjoy a higher quality of life and more support during their breast cancer treatments. Women who participated in the study were questioned regarding four aspects of their personal social interactions:
- Participation in religious or other social groups
- Number of close friends and family members
- Participation in volunteer activities
- Presence of a committed or consistent relationship with a partner
Women who reported the highest number of meaningful social contacts reported a better quality of life than those who were relatively socially isolated. Socially active women were more likely to have completed a higher level of education and to earn a larger income.
A study published in the Journal of Medical Internet Research (Attai et al. 2015, e188) found that Twitter provided an effective venue for educating and providing support for women with breast cancer. The convenience, ease of use and access to members of a specialized peer group was well-received by participants in the study and allowed these individuals to improve their general knowledge of their conditions.
The Breast Cancer Social Media Twitter community was founded by two breast cancer survivors and grew to include current breast cancer patients, family and friends of these patients, surgeons and other medical professionals and therapists. By offering what was described by participants as a ‘safe and welcoming forum for support and education’ (Attai et al. 2015, e188), this social network allowed women to discuss treatment plans and to obtain support for body image issues while alleviating feelings of isolation that could have led to depression. Patients participating in the study indicated lower levels of anxiety after their participation in the Twitter community as compared with relatively elevated levels of anxiety experienced before.
While surgical interventions may be the best way to address issues of body dysmorphia and poor body image after breast cancer surgeries, implementation of social media venues and the creation of social groups for women who might otherwise feel uninformed or isolated may alleviate other psychosocial problems. Making sure that patients have the information they need to prepare for their treatments and that they can obtain answers for questions that arise later can make a substantial difference in outcomes for these patients. Patients who are provided with the means to affect their treatment plans have better health outcomes and better care experiences than their less informed and less empowered peers.
By taking a more proactive approach to psychological and social aspects of breast cancer, primary health care providers can help women to achieve a greater sense of connectedness and can significantly improve their quality of life and outcomes when dealing with treatment, remission, and recovery from breast cancer. This can lead to lower mortality rates and reduced physical pain and emotional distress during the critical months and years following completion of treatment.
- Al-Ghazal, Sharif Kaf, Lesley Fallowfield and R.W. Blamey. 1999. “Does Cosmetic Outcome from Treatment of Primary Breast Cancer Influence Psychosocial Morbidity?” European Journal of Surgical Oncology 25 no. 6 (December): 571-573. http://www.sciencedirect.com/science/article/pii/S0748798399907084
• Attai, Deanna, Michael S. Cowher, Mohammed Al-Hamadani, Jody M. Schoger, Alicia C. Staley and Jeffrey Landercasper. 2015. “Twitter Social Media Is an Effective Tool for Breast Cancer Patient Education and Support: Patient-Reported Outcomes by Survey.” Journal of Medical Internet Research 17 no. 7 (July): e188. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705354/
• Burton, Mary V. and Ronald W. Parker. 1994. “Satisfaction of Breast Cancer Patients with Their Medical and Psychological Care.” Journal of Psychosocial Oncology 12 no. 1-2: 41-63.
• Cacioppo, John T. and Louise C. Hawkley. 2003. “Social Isolation and Health, with an Emphasis on Underlying Mechanisms.” Perspectives in Biology and Medicine 46, no. 3 Supplement (Summer): S39-S52.
• Damen, Tim H.C., Reinier Timman, Ellen H. Kunst, Jessica P. Gopie, Paula J. C. Bresser, Caroline Seynaeve, Marian B. Menke-Pluijmers, Marc A. M. Mureau, Stefan O. P. Hofer and Aad Tibben. 2010. “High Satisfaction Rates in Women After DIEP Flap Breast Reconstruction.” Journal of Plastic, Reconstructive & Aesthetic Surgery 63 no. 1 (January): 93-100. http://www.sciencedirect.com/science/article/pii/S1748681508009716
• Fobair, Pat, Susan L. Stewart, Subo Chang, Carol D’Onofrio, Priscilla J. Banks and Joan R. Bloom. “Body Image and Sexual Problems in Young Women with Breast Cancer.” Psycho-Oncology 15 no. 7 (July): 579-594. http://onlinelibrary.wiley.com/doi/10.1002/pon.991/full
• Froude, Cameron, Sandra Rigazio-DiGilio, Laura Donorfio, and Keith Bellizzi. 2017. “Contextualizing the Young Adult Female Breast Cancer Experience: Developmental, Psychosocial, and Interpersonal Influences.” The Qualitative Report 22(6): 1488-1510. http://nsuworks.nova.edu/tqr/vol22/iss6/1
• Ganz, Patricia A., Katherine A. Desmond, Thomas R. Belin, Beth E. Meyerowitz and Julia H. Rowland. 1999. “Predictors of Sexual Health in Women After a Breast Cancer Diagnosis.” Journal of Clinical Oncology 17 no. 8 (August): 2371–2380. http://ascopubs.org/doi/10.1200/JCO.1922.214.171.1241
• Hall, Daniel L., Merle H. Mishel and Barbara B. Germino. 2014. “Living with Cancer-Related Uncertainty: Associations with Fatigue, Insomnia, and Affect in Younger Breast Cancer Survivors.” Supportive Care in Cancer 22 no. 9 (September): 2489-2495. https://link.springer.com/article/10.1007/s00520-014-2243-y
• Hughes, Spenser, Lisa M. Jaremka, Catherine M. Alfano, Ronald Glaser, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, William B. Malarkey and Janice K. Kiecolt-Glaser. 2014. “Social Support Predicts Inflammation, Pain and Depressive Symptoms: Longitudinal Relationships Among Breast Cancer Survivors.” Psychoneuroendocrinology 42 (April): 38-44.
• Kroenke, Candyce H., Laura D. Kubzansky, Eva S. Schernhammer, Michelle D. Holmes and Ichiro Kawachi. 2006. “Social Networks, Social Support, and Survival After Breast Cancer Diagnosis.” Journal of Clinical Oncology 24 no. 7 (March): 1105-1101. http://ascopubs.org/doi/abs/10.1200/jco.2005.04.2846
• Kroenke, Candyce H., Marilyn L. Kwan, Alfred I. Neugut, Isaac J. Ergas, Jaime D. Wright, Bette J. Caan, Dawn Hershman and Lawrence H. Kushi. 2013. “Social Networks, Social Support Mechanisms, and Quality of Life After Breast Cancer Diagnosis.” Breast Cancer Research and Treatment 139 no. 2 (June): 515-527. https://link.springer.com/article/10.1007%2Fs10549-013-2477-2
• Liang, Wenchi, Caroline B. Burnett, Julia H. Rowland, Neal J. Meropol, Lynne Eggert, Yi-Ting Hwang, Rebecca A. Silliman, Jane C. Weeks and Jeanne S. Mandelblatt. 2002. “Communication Between Physicians and Older Women with Localized Breast Cancer: Implications for Treatment and Patient Satisfaction.” Journal of Clinical Oncology 20 no. 4 (February), 1008-1016.
• Metcalfe, Drew B., Claire S. Duggal, Allen Gabriel, Maurice Y. Nahabedian, Grant W. Carlson and Albert Losken. 2014. “Prevalence of Body Dysmorphic Disorder Among Patients Seeking Breast Reconstruction.” Aesthetic Surgery Journal 34 no. 5 (July): 733-737.
• Pikler, Vanessa and Carrie Winterowd. 2003. “Racial and Body Image Differences in Coping for Women Diagnosed with Breast Cancer.” Health Psychology 22 no. 6 (November) 632–637. http://psycnet.apa.org/doiLanding?doi=10.1037%2F0278-6126.96.36.1992
• Przezdziecki, Astrid, Kerry A. Sherman, Andrew Baillie, Alan Taylor, Elizabeth Foley and Kellie Stalgis-Bilinski. 2013. “My Changed Body: Breast Cancer, Body Image, Distress and Self Compassion.” Psycho-Oncology 22: 1872-1879. http://onlinelibrary.wiley.com/doi/10.1002/pon.3230/full
• Schover, Leslie R. 1991. “The Impact of Breast Cancer on Sexuality, Body Image, and Intimate Relationships.” CA: A Cancer Journal for Clinicians 41, no. 2 (March/April): 112-120. http://onlinelibrary.wiley.com/doi/10.3322/canjclin.41.2.112/epdf
• White, Craig A. 2000. “Body Image Dimensions and Cancer: A Heuristic Cognitive Behavioral Model.” Psycho-Oncology 9 no. 3 (May-June): 183–192.
About the Author
Dana Greenstein is an eleventh grader at Marlboro High School in New Jersey. She is a passionate individual who loves to learn more about recent developments in the field of psychology and breast cancer. Outside of school Dana took several classes in psychology and biotechnology. In her free time, she enjoys reading, painting and volunteering at the animal rescue organization.