Nursing Care And Psychosocial Adjustment to Illness After Breast Cancer

Psychosocial Adjustment to Illness Breast cancer is a chronic illness that imposes significant physical, emotional, and social challenges on patients. As a chronic disease, its effects extend over time, and the demands placed on individuals often vary throughout different phases of their journey. The process of adjustment to a breast cancer diagnosis is multifaceted, involving various dimensions of quality of life, emotional responses, and the impact on family dynamics. Understanding the psychosocial aspects of breast cancer is crucial for healthcare providers, as it allows for comprehensive care that addresses not only the physical but also the emotional and social needs of patients.

Breast Cancer as a Chronic Illness

Breast cancer is classified as a chronic illness, characterized by prolonged duration and a series of stressors that patients must navigate. The initial diagnosis often brings about emotional turmoil, necessitating decisions regarding treatment options, coping with physical changes, and adapting to new lifestyles. According to Loveys and Klaich (1991) and Walker et al. (1996), key ongoing issues include:

  • Acceptance of the Diagnosis: Coming to terms with a breast cancer diagnosis can be an emotionally taxing process, often involving denial, anger, and grief.
  • Treatment Decisions: Patients face a myriad of choices regarding surgical options, chemotherapy, radiation, and hormone therapy, each with its own set of potential side effects and outcomes.
  • Emotional Distress: Many individuals experience anxiety and depression related to the fear of recurrence, changes in body image, and potential loss of autonomy.
  • Need for Information and Support: Patients often seek information about their condition and treatment, as well as emotional support from healthcare providers, family, and peers.

The initial postoperative phase tends to be particularly stressful, as Northouse (1990) found that emotional distress is prevalent during this time. However, issues such as distress from side effects and limitations in role performance may persist long after the initial treatment phase (Hoskins et al., 1996b; Walker et al., 1996).

Response or Adjustment

Adjustment to a breast cancer diagnosis is a complex process that encompasses various dimensions of quality of life. Traditionally, adjustment has been conceptualized as synonymous with quality of life; however, this broad definition can inhibit the identification of specific dimensions and predictors of adjustment.

Research by Dow et al. (1999) highlighted the themes of struggle experienced by cancer survivors, including independence versus dependence, wholeness, life purpose, reclaiming life, and coping with multiple losses. More specifically, Ferrell et al. (1998) noted that adjustment for breast cancer survivors involves demands across four primary domains: physical, psychological, social, and spiritual.

Dimensions of Adjustment

  1. Physical Dimension: Involves the management of symptoms and treatment side effects, which can significantly affect quality of life.
  2. Psychological Dimension: Relates to emotional well-being, coping strategies, and mental health, including issues of depression, anxiety, and body image.
  3. Social Dimension: Encompasses changes in social interactions, support systems, and the impact of the illness on relationships.
  4. Spiritual Dimension: Addresses questions of meaning, purpose, and faith, which can provide comfort or lead to existential crises.

Four Major Multidimensionality Dimensions

Aaronson (1990) identified four major dimensions crucial to understanding quality of life in patients with chronic illnesses:

  1. Functional Status: Refers to the patient’s ability to perform daily activities and roles.
  2. Symptoms Related to the Disease and Treatment: Involves physical symptoms such as pain, fatigue, and side effects from treatment.
  3. Psychological Functioning: Includes emotional health and cognitive function, impacting how patients cope with their diagnosis.
  4. Social Functioning: Focuses on the patient’s social interactions and support systems.

Interrelatedness of Dimensions

These dimensions are interconnected, meaning that a decline in one area can adversely affect others. For example, physical limitations due to treatment may lead to social isolation, which in turn can exacerbate psychological distress.

Process of Adjustment

The adjustment process to breast cancer is not linear; rather, it is characterized by fluctuations in emotional and physical well-being over time. Research indicates that both the patient and their family are affected by the adjustment process, highlighting the importance of a holistic approach to care.

Family Dynamics

The family system often undergoes significant changes when a member is diagnosed with breast cancer. Cooley and Moriarty (1997) and Germino (1998) emphasized that usual roles within the family may be altered, leading to increased interpersonal tension. Emotional distress is not limited to patients; partners and family members also experience significant anxiety and stress.

Longitudinal studies show that emotional and physical adjustment can last for months or even years after the initial diagnosis. For example, Northouse and Swain (1987) found that spouses of newly diagnosed patients exhibited significant emotional distress and mood disturbances lasting up to 18 months post-surgery. Given the intimacy of the relationship, partners face their own struggles, including fears about cancer recurrence and feelings of helplessness in supporting the patient.

Time as a Factor

The duration of the adjustment process varies among individuals, and emotional distress can persist well beyond the initial treatment phase. Research indicates that partners may experience heightened emotional distress compared to patients, sometimes lasting for several years (Given & Given, 1992). As demands on the family escalate, this distress can lead to challenges in marital adjustment and family dynamics (Zahlis & Shands, 1993).

Predictors of Adjustment

Adjustment to breast cancer is influenced by a variety of predictors, which can be broadly categorized into psychological, social, and situational factors:

  1. Life Stress: High levels of life stress prior to diagnosis can impact the ability to cope with the illness.
  2. Age: Younger patients may experience different challenges compared to older patients, influencing their adjustment process (Lehto & Cimprich, 1999).
  3. Stage of Disease: The prognosis and treatment options available at different stages of cancer can significantly affect emotional responses and coping strategies (Zabalegui, 1999).
  4. Time Since Diagnosis: As time passes, patients may adapt to their new reality, but initial emotional responses often linger (Irvine et al., 1991).
  5. Initial Emotional Status: Patients who have pre-existing mental health conditions may face greater challenges in adjusting to a breast cancer diagnosis (Iscoe et al., 1991).
  6. Perceived Support: The level of perceived social support can significantly affect adjustment outcomes (Northouse et al., 1995; Hoskins et al., 1996a, 1996b).
  7. Social Integration: Engagement in social activities and maintaining relationships can facilitate better adjustment (Loveys & Klaich, 1991).
  8. Side Effects and Associated Distress: The physical and emotional toll of treatment can complicate the adjustment process (Wilson & Morse, 1991; Budin, 1998).
  9. Uncertainty: Feelings of uncertainty about the future can heighten anxiety and affect coping strategies (Christman, 1990).

Conclusion

The journey of adjustment to breast cancer is complex, multifaceted, and influenced by a myriad of factors. Understanding the dimensions of psychosocial adjustment—physical, psychological, social, and spiritual—allows healthcare providers to offer more comprehensive care that addresses the holistic needs of breast cancer patients.

As the adjustment process involves not only the patient but also their family, a systemic approach is essential. Factors such as perceived social support, emotional well-being, and the impact of treatment on daily life play crucial roles in how individuals navigate their cancer experience.

Future research should continue to explore these dimensions and predictors of adjustment, providing insights that can inform interventions aimed at improving quality of life for breast cancer survivors and their families. By addressing the psychosocial aspects of breast cancer care, we can facilitate better outcomes and enhance the overall well-being of those affected by this chronic illness.

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