BOX 3-4
Psychosocial Issues Related to Transition Points in Treatment

“After my very last radiation treatment for breast cancer, I lay on a cold steel table hairless, half-dressed, and astonished by the tears streaming down my face. I thought I would feel happy about finally reaching the end of treatment, but instead, I was sobbing. At the time, I wasn’t sure what emotions I was feeling. Looking back, I think I cried because this body had so bravely made it through 18 months of surgery, chemotherapy, and radiation. Ironically, I also cried because I would not be coming back to that familiar table where I had been comforted and encouraged. Instead of joyous, I felt lonely, abandoned, and terrified. This was the rocky beginning of cancer survivorship for me.”

SOURCE: McKinley (2000).

women who are relatively young, have a history of preexisting depression or psychological distress, have other serious comorbid conditions, and have inadequate social support (Maunsell et al., 1992; Ganz et al., 1992, 1993; Schag et al., 1993; Mor et al., 1994; Schover, 1994; Maunsell et al., 1995; Wenzel et al., 1999; Leedham and Ganz, 1999; Shimozuma et al., 1999). The specific type of breast cancer surgery or taking tamoxifen does not influence the level of distress (Maunsell et al., 1989; Ganz et al., 1992, 1993, 1998a,b; Omne-Ponten et al., 1994; Schover et al., 1995; Day et al., 1999, 2001; Rowland et al., 2000; Fallowfield et al., 2001).

Functional status, sense of well-being, and self-perceived health reported by disease-free breast cancer survivors were found to be similar or more positive than those from healthy women of comparable ages in a large cross-sectional study (Figure 3-2) (Ganz et al., 1998a). This and other studies have shown that marital relationships are generally maintained and are often reported to have strengthened following breast cancer treatment (Kornblith and Ligibel, 2003; Schover, 2004; Dorval et al., 2005). Assessing the factors that contribute to resilience, effective coping with cancer, and positive psychological outcomes associated with the cancer experience is of increasing interest to researchers (Petrie et al., 1999; Justice, 1999; Cordova et al., 2001; Brennan, 2001; Tomich and Helgeson, 2002).

For a minority of women, however, a diagnosis of breast cancer contributes to significant psychosocial distress that can interfere with functioning and well-being (Massie and Holland, 1991). In a review of the literature on depression in patients with cancer, Massie found breast cancer to be among the sites that had especially high prevalence, ranging from 2 to 46 percent, in the studies reviewed (Massie, 2004). This range of estimates is in part due to variation in assessment procedures (Trask, 2004). In terms of



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