Survivorship - what helps and what hinders
BCAC supported the visit of the ASB Visiting Professor Annette Stanton in March 2011 when she presented a public lecture entitled "Survivorship in Breast Cancer What helps and hinders women?".
Annette Stanton is Professor of Psychology and Psychiatry/Biobehavioral Sciences at the University of California, Los Angeles, senior research scientist at the UCLA Cousins Center for Psychoneuroimmunology, and a member of the Jonsson Comprehensive Cancer Center.
Her research centers on specifying factors that promote psychological and physical health in individuals who confront health-related adversity. In the area of psychosocial oncology, she conducts both longitudinal research and randomized, controlled intervention trials to understand how psychological factors influence the quality of life and health in women diagnosed with breast cancer or at risk for the disease.
Key points from her talk include:
- According to the United States National Cancer Institute, an individual is a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition.
- Institute of Medicine (2005) found:
Survivorship care is a neglected phase of the cancer care trajectory
Survivors are concerned with cancer recurrence and treatment late effects
Few guidelines on follow-up care, and providers lack education and training
Interventions needed for physical and psychological consequences of cancer and treatment
- Studies have found breast cancer survivors have a greater risk of decline in physical function, social function, emotional function, vitality compared with those who have not had a diagnosis of breast cancer
- However, many women experience benefits from a breast cancer diagnosis including, enhanced relationships, deepened appreciation for life, increased personal strength, valued change in life priorities, greater spirituality and attention to health-promoting behaviours.
- After cancer treatment many women feel "I should be celebrating", "I should feel well", "I should be the 'pre cancer' me", "I shouldn't need support".
- Specific problems can persist after treatment, including fear of recurrence, fatigue, arm problems, sexual problems, cognitive problems.
- Depressed cancer patients use more emergency room and medical inpatient hospital services (Himelhoch et al., 2004)
Depression triples the risk for nonadherence to a variety of medical regimens (DiMatteo et al., 2000)
Elevated depressive symptoms predict lower arm mobility and lower satisfaction with medical care over time in women with breast cancer (Caban et al., 2006; Bui et al., 200
- Risk factors for compromised adjustment (eg depression, fear of recurrence, quality of life etc) include diagnosis at a younger age; history of psychological disorder; other chronic stressors; co-morbid conditions; chemotherapy receipt.
- Protective coping strategies include: having social support; finding benefit; expressing emotions; actively accepting diagnosis; using spiritual coping; engaging in problem focused coping.