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THE PSYCHOSOCIAL IMPACT OF THE BREAST CANCER PATIENTS POST-MASTECTOMY

n this theoretical work, my subject is the psychosocial impact of the breast cancer patients, especially in the

moment of the post-mastectomy. The breast cancer can be defined as an overgrowth of breast cells. This type of

cancer can grow in the cells that line the ducts or in the cells that line the lobules. The lobule is the gland where

occur the milk production and the duct does the connexion between the lobule and the nipple. Breast cancer can start in

other tissues, but this is more uncommon.

All tumours can be classified in benign or malign. In benign tumours, there are a growth abnormally of the cells and

the formation of the lump. This type of tumour doesn't grow up uncontrollably and doesn't metastasize to other parts of the

body. The fibro adenoma is the most common benign breast tumour; it can be treatable through the simple surgery that

removes the lump. In malign tumours, the cancer cells can be able to spread beyond the breast. For example, a simple one

cancer cell can grow up and develop another cancer cells. After this, they invade surrounding tissues and can spread through

the lymph nodes, and metastasize to other sites of the body, and the probability of forming other tumour is highest.

The breast cancer can be classified in two types, according to its origin: ductal carcinoma and lobular carcinoma.

Another way to classify the breast cancer is through the potential of invasion or not. For example, the ductal carcinoma can

be divided in ductal carcinoma in situ or invasive ductal carcinoma. In ductal carcinoma in situ, there are the growth of cancer

cells inside of the duct, while in the invasive ductal carcinoma, these cancer cells can invade the surrounding tissues of the

duct, and provoke the metastasis of the tumour. The same happens in the lobular carcinomas. There are another types of

breast cancer, but they are more uncommon.

The worldwide incidence of the female breast cancer has been increasing over the years. The countries with the

highest rate of this type of cancer are United States of America, Australia and New Zealand. In Europe, the first three

countries with the highest rate of female breast cancer are Belgium, Denmark and France, with more than 120 cases per

100.000 women.

There are many risk factors that increase the probability of the female breast cancer. The most common are: the

gender, the most significant risk factor for developing breast cancer is being a woman; the age, the probability to have a

diagnosis of breast cancer increases exponentially with the age, especially after the 50 years old; hormonal factors, such as

exposure to the oestrogen and progesterone hormones for long and uninterrupted periods, nulliparity, first pregnancy after

the age 30, not having breastfed or breastfeeding, early menstruation (before age 12) and late menopause (after age 50);

previous breast conditions, such as background of the breast tumours; family history, especially in the first and second-

degree relatives, in clinical backgrounds of the mother, sister or aunt; and non-reproductive lifestyles factors, such as

overweight or obesity, diet rich in fats, sedentary life, addictions, like drugs, tobacco or alcohol consumption, shift work and

radiation exposure, for example in medical exams like X-rays.

The treatment of the breast cancer can be done in different ways, such as the surgery, the chemotherapy, the

radiotherapy and the hormonal therapy. There are many types of surgery, according to the stage of the breast cancer, but

the most common are the mastectomy and the lumpectomy. In the mastectomy, occurs the removal of the breast and the

lymph nodes. The procedure of the mastectomy can be done in different ways, according with the stage of the breast

cancer. Therefore, if the lymph nodes aren't metastasized, the surgeon just removes the breast. In lumpectomy, it's just

removed the lump and surrounding tissues. This surgery is done through the little incision in the lump area.

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All process of the breast cancer doesn't affect just the physical side; it provokes a great psychosocial impact in these

women, and they experience many feelings and emotional changes. The most common feelings that they experience are

the stress, the anxiety and the fear. They can have many reasons for the fear, such as: the treatment and the consequences

of that; the impact that this condition can provoke in their life; the pain; the recurrence, to other words, the probability the

live this experience again; and the death. In many cases of female breast cancers, these feelings provoke mental diseases,

like depression.

The adaptation to a new body image is the big challenge to these women. Many women may feel differently about

their body post-mastectomy. And this aspect have the great psychosocial impact because, in many cultures, the breast

symbolize the femininity, for it sexual and attractive meaning, and the reproduction, through the meaning of life, the

experience of the motherhood and the area where is done the procedure of the breastfeeding. With the loss of the breast,

they may feel too the loss of their identity as a woman.

The reintegration in family life and the rehabilitation work are two other challenges in women' life. During the

experience of the breast cancer, they loss their individual's roles. The marital role is one of the most significant changes.

Breast cancer's treatments have many physical consequences, such as the loss of breast, the loss of hair, with the use of the

chemotherapy, and the increase of the weight, consequence too the decrease of the physical activity. Women feel

uncomfortable with their self image, and, consequently, it can provoke conflicts in the couple. It is common the decrease of

the sexual satisfaction and the loss of the sexual attraction. In some cases, husbands don't want touch in the woman's

breast. In other cases, the women don't want to be touched in this area. Other individual's roles have challenges, such as the

familiar role, with less presence with the family during this transition; professional role, with the loss of the job; and social

role.

The way that they lead with this condition is through the coping strategies. The coping strategies are ways that

people use to solve their problems and manage their stress. In breast cancer condition, the most typically coping strategies

are the negation, the revolt, the isolation, the depression, and, at the end, the acceptance of their condition. The most of

these coping strategies have a wrong use by the women. Therefore, all of the psychosocial impact, with the using of wrong

coping strategies, provokes a destruction of quality of life, being urgent an adequate nursing care.

The nursing role is very important in the care of the women with breast cancer. The goals of nursing intervention

must be: the encouragement of the women changes their psychosocial aspects, the upgrade of the current lifestyle and the

improvement of the quality of life. Nurses should provide an atmosphere of acceptance, openness and availability as well as

privacy for patient. The promotion of the calm and quiet environment is very important too. Nurses must explore with these

women previous methods of dealing with life problems and encourage to identify their own strengths and abilities. The

nurses should also encourage the women with breast cancer to communicate, specifically to talk about their feelings and

fears. Nurses must arrange social support, involving the husband, family and friends in the care. And, at the end, nurses

should encourage the participation in breast cancer support groups.

To finish, women with breast cancer suffer, besides of the physical side, a great psychosocial impact, that can be

solved for the better way with the support of the multidisciplinary team, including the nursing care, that will arrange

strategies to the patient have a better quality of life.

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Compas, B.; Luecken, L. Psychosocial Adjustment to Breast Cancer. American Psychological Society.

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Dahl, C.; Reinersten, K.; Nesvold, I. A Study of Body Image in Long-Term Breast Cancer Survivors. Journal

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Fallbjork, U.; Rasmussen, B.; Karlsson, S.; Salander, P. Aspects of body image after mastectomy due to

breast cancer e A two-year follow-up study. European Journal of Oncology Nursing. 2012;

Gumus, A.; Çam, O. Effects of Emotional Support-Focused Nursing Interventions on the Psychosocial

Adjustment of Breast Cancer Patients. Asian Pacific Journal of Cancer Prevention, Vol. 9, 2008;

National Cancer Institute. What you need to know about breast cancer. National Institutes of Health. 2012;

Paiva, L.; Dantas, D; Silva, F. [et. al]. Body image and sexuality of women who underwent a radical

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Shoma, A. [et. al]. Body image disturbance and surgical decision making in Egyptian post menopausal

breast cancer patients. World Journal of Surgical Oncology, 2009.

Name: Mónica Soares Pinto Roque

Date: Wednesday, 13th November 2013