Nursing Care And Psychosocial Adjustment to Illness After Breast Cancer

Breast Cancer and Psycho Social Adjustment

Breast Cancer As Chronic Illness, Response Or Adjustment, Four Major Multidimensionality Dimensions, Process Of Adjustment, Predictors Variety Adjustment

 Breast Cancer As Chronic Illness 

    Classified as a chronic disease, the demands of breast cancer extend over time, with some phases characterized by more demands and stress than others. Acceptance of the diagnosis, treatment decisions, emotional distress related to physical change and loss, alterations in lifestyle, uncertainty, and need for information and support are ongoing issues (Loveys & Klaich , 1991; Walker, Nail, Larsen, Magill, & Schwartz, nineteen ninety six). 

    Although the diagnostic and immediate postoperative phases are particularly stressful (Northouse, 1990), emotional distress (Hoskins et al., 1996b), distress from side effects (Walker et al., 1996), and limitations in role performance and sense of control may last longer.

Response Or Adjustment  

    Although adjustment has been commonly conceptualized as quality of life, the breadth of the broad conceptualization inhibits definitive studies of its dimensions and predictors. 

    Adjustment has, however, been conceptualized in many ways, including role performance ( Derogatis , 1983), sexual function ( Lasry , 1991), emotional symptoms (Hoskins et al., 1996b; Passacreta , 1997), cognitive function ( Cimprich , 1995) , self-esteem, and body image. 

    To address the issue of multiple interpretations and dimensions, Dow, Ferrell, Haberman, and Eaton (1999) conducted a qualitative study of 687 survivors of various kinds of cancer and identified themes of struggle among independence-dependence, wholeness, life purpose, reclaiming life. , multiple losses, control, and surviving cancer from a family perspective. 

    Narrowing the focus of quality of life to breast cancer survivors, Ferrell, Grant, Funk, Otis-Green, and Garcia (1998) concluded that adjustment involves demands across the physical, psychological, social, and spiritual domains.

Four Major Multidimensionality Dimensions

    Similarly, Aaronson (1990) recognized the multidimensionality of quality of life and proposed the four major dimensions of functional status, symptoms related to the disease and treatment, psychological functioning, and social functioning. 

    In general, it is agreed that the broad domains of adjustment to breast cancer may be conceptualized as psychological (Walker, Nail, & Croyle , 1999), physical (Given & Given, 1992; Cohen, Kahn, & Steeves, 1998; Wyatt & Friedman, 1998), and social ( Tulman & Fawcett, 1990; Northouse, Dorris , & Charron-Moore, 1995).

Process Of Adjustment 

    The adjustment process has a strong effect on the family as a system (Cooley & Moriarty, 1997; Germino , 1998). Usual roles are altered with resulting interpersonal tension in both patients and partners (Lewis & Hammond, 1996). 

    The factor of time is reflected in longitudinal studies of emotional and physical adjustment in both patients and partners. In their seminal study of 50 newly diagnosed breast cancer patients and spouses, North house and Swain (1987) noted that the emotional distress and mood disturbance among the spouses at 3-days post-surgery differed significantly from population norms. 

    The distress and disturbance continued to 18 months. Higher emotional distress and lower adjustment among spouses (Given & Given, 1992), as compared to patients, may continue for as long as 3 years. As the person most intimately involved in the events related to the patient's illness and treatment, the partner struggles with fear of cancer, demands placed on personal life ( Samms , 1999), and feelings of being ineffective. 

    As demands escalate, increased depression among partners affects marital adjustment ( Zahlis & Shands , 1993). Studies in which the partner, identified by the patient as the person most intimately involved in the breast cancer experience are rare and require further resources.

Predictors Variety Adjustment 

    Finally, the wide variety of predictors of adjustment include life stress, age ( Lehto & Cimprich , 1999), stage of disease ( Zabalegui , 1999), time since diagnosis (Irvine, Brown, Crooks, Roberts, & Browne, 1991), initial emotional status ( Iscoe , Williams, & Osoba , 1991).

    Previous diagnosis of cancer (Northouse, Laten, & Reddy, 1995), perceived support (Northouse, Dorris , & Charron-Moore, 1995; Hoskins et al., 1996a , 1996b), social integration (Loveys & Klaich , 1991), side effects and associated distress (Wilson & Morse, 1991; Budin , 1998), and uncertainty ( Christman , 1990).