Psycho-Oncology

Purpose: The purpose of this study was to determine the frequency of body image and sexual problems in the first months after treatment among women diagnosed with breast cancer at age 50 or younger.

Background: Breast cancer treatment may have severe effects on the bodies of younger women. Surgical treatment may be disfiguring, chemotherapy may cause abrupt menopause, and hormone replacement is not recommended.

Methods: A multi‐ethnic population‐based sample of 549 women aged 22–50 who were married or in a stable unmarried relationship were interviewed within seven months of diagnosis with in situ, local, or regional breast cancer.

Results: Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis. Half of the 546 women experienced two or more body image problems some of the time (33%), or at least one problem much of the time (17%). Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction, hair loss from chemotherapy, concern with weight gain or loss, poorer mental health, lower self‐esteem, and partner's difficulty understanding one's feelings. Among the 360 sexually active women, half (52%) reported having a little problem in two or more areas of sexual functioning (24%), or a definite or serious problem in at least one area (28%). Greater sexual problems were associated with vaginal dryness, poorer mental health, being married, partner's difficulty understanding one's feelings, and more body image problems, and there were significant ethnic differences in reported severity.

Conclusions: Difficulties related to sexuality and sexual functioning were common and occurred soon after surgical and adjuvant treatment. Addressing these problems is essential to improve the quality of life of young women with breast cancer. Copyright © 2005 John Wiley & Sons, Ltd.

An overview is provided of research into the return to work of cancer survivors, examining both the rate of return to work and factors impacting this return. A series of literature searches was conducted on MEDLINE and PSYCLIT databases for the years 1985–1999. Studies had to focus on the patient's perspective and had to include either the percentage of return to work or factors associated with return to work. Case studies and studies of cancer as an occupational disease were excluded. The search identified 14 studies. The mean rate of return to work was 62% (range 30–93%). The following factors were negatively associated with return to work: a non‐supportive work environment, manual labour, and having head and neck cancer. Sociodemographic characteristics were not associated with return to work. For increasing age, associations were mixed. The increased survival rate of cancer patients warrants attention to the problems survivors may encounter upon their return to work. More systematic research is needed to establish more clearly the relative importance of factors associated with return to work of cancer survivors, which, in turn, would contribute to an increase in the labour‐participation of cancer survivors. Copyright © 2002 John Wiley & Sons, Ltd.

Cancer patients' complaints of impaired cognition following chemotherapy are fairly common but poorly documented among adult patients. Neuropsychological testing was used to evaluate current cognitive functioning of 28 stage I and II breast cancer patients (ages 28–54) who had completed 3 to 18 months of adjuvant chemotherapy, from 0.5 to 12 months prior to testing. Effects of drug regimen, length of treatment and level of depression on cognitive functioning were examined. Despite estimated high‐normal pre‐morbid intelligence (mean FSIQ 113) patients scored significantly below age‐, education‐, and gender‐corrected test norms in areas of verbal and visual memory, mental flexibility and speed of processing, attention and concentration, visuospatial ability and motor function. Of patients, 75% scored ‐2SDs (moderate impairment) on one or more test measures. Level of cognitive impairment was unrelated to depression, type of chemotherapy and time since treatment, but was positively related to length of chemotherapy treatment. These preliminary findings suggest that cognitive impairment may follow conventional adjuvant chemotherapy treatment and warrant replication with a controlled and more rigorous longitudinal design.

Cancer patients often have to deal with severe side effects and psychological distress during cancer treatment, which have a substantial impact on their quality of life. Among psychosocial interventions for reducing treatment‐related side effects, relaxation and imagery were most investigated in controlled trials. In this study, meta‐analytic methods were used to synthesize published, randomized intervention–control studies aiming to improve patients' treatment‐related symptoms and emotional adjustment by relaxation training. Mean weighted effect sizes were calculated for 12 categories, treatment‐related symptoms (nausea, pain, blood pressure, pulse rate) and emotional adjustment (anxiety, depression, hostility, tension, fatigue, confusion, vigor, overall mood). Significant positive effects were found for the treatment‐related symptoms. Relaxation training also proved to have a significant effect on the emotional adjustment variables depression, anxiety and hostility. Additionally, two studies point to a significant effect of relaxation on the reduction of tension and amelioration of the overall mood. Intervention features of the relaxation training, the time the professional spent with the patient overall (intervention intensity) and the schedule of the intervention (offered in conjunction with or independent of medical treatment to the cancer patient) were relevant to the effect of relaxation on anxiety. The interventions offered independently of medical treatment proved to be significantly more effective for the outcome variable anxiety. Relaxation seems to be equally effective for patients undergoing different medical procedures (chemotherapy, radiotherapy, bone marrow transplantation, hyperthermia). According to these results relaxation training should be implemented into clinical routine for cancer patients in acute medical treatment. Copyright © 2001 John Wiley & Sons, Ltd.

There is an increasing number of long‐term survivors of cervical and endometrial cancer for whom quality of life is of major importance. We interviewed 20 women (aged 19–64) to explore the dynamics and components of post‐treatment sexual adjustment and its impact on quality of life. Stratification by treatment received (surgery alone, surgery plus external‐beam radiation, surgery plus brachytherapy, and surgery plus external‐beam radiation and brachytherapy) and time since treatment (immediately post treatment, during the next 2 years and thereafter) was undertaken, to ensure representation of all relevant experiences and views, and to allow time for any long‐term side effects to appear. The NUD*IST software (Non‐numerical Unstructured Data by Indexing, Searching and Theorising) was used to assist with the coding of audio‐taped, transcribed interviews and to search for themes and segments. While the data supported findings reported in the literature, important new themes emerged in the course of the qualitative analysis. These included: (a) issues related to being ‘feminine’, (b) the role of intimacy in post‐treatment adjustment and (c) the importance of communication between health professionals, patients and partners. A model is presented that integrates these issues and highlights the need for effective interventions to improve post‐treatment outcomes. The provision of information, support and modification of rehabilitation devices is suggested. Copyright © 2002 John Wiley & Sons, Ltd.

Although working with cancer patients is considered stressful, palliative care staff experience similar levels of psychological distress and lower levels of burnout than staff working in other specialties. There are few empirical studies in palliative care to explain this. Since working in a stressful job does not inevitably lead to psychological distress, the antecedent factors that promote resilience and maintain a sense of well‐being are worthy of study.

This qualitative study used interpretative phenomenological analysis (IPA) to describe hospice nurses' experiences of work. During the analysis, themes emerged relating to the underlying interpersonal factors that influenced the nurses' decisions to begin and continue working in palliative care, and their attitudes towards life and work.

The emergent themes were compared with the theoretical personality constructs of hardiness and sense of coherence, and this comparison highlighted many similarities. The nurses showed high levels of commitment, and imputed a sense of meaning and purpose to their work. An area of divergence was their response to change, and this is discussed in relation to hardiness and sense of coherence. The implications for staff well‐being, and for staff training and support, which, in turn, may impact on the quality of patient care, are discussed. Copyright © 2006 John Wiley & Sons, Ltd.