Psychosocial adjustment among women with breast cancer stages I and II: six-year follow-up of consecutive patients.

PURPOSE: To evaluate, in a long-term follow-up study of consecutive patients (N = 99), the impact of surgery--breast-conserving treatment (BCT) versus mastectomy (MT)--on psychosocial adjustment among women with breast cancer, pTNM stage I/II. PATIENTS AND METHODS: Semistructured interviews were conducted at a median of 6 years (range, 5.8 to 8.1) after primary surgery. Sixty-six women were available for the long-term follow-up study. Twenty-six women had been treated with BCT and 40 with MT. RESULTS: No statistically significant differences were found between the two groups concerning psychosocial adjustment, as measured by the Social adjustment Scale (SAS). In general, the levels of maladjustment were lower than at 13 months postoperatively, but 10% still showed maladjustment. Sixty percent of the women were unwilling to show themselves naked, and 22% felt that they had become less attractive because of the surgical treatment. In an explorative part of the interview, 68% of the women complained about how they had been informed of the diagnosis. A tendency toward a significant difference was found in the relation between previous maladjustment and a negative experience at the time of diagnosis (P = .07). CONCLUSION: Few data are available on long-term follow-up results with regard to psychosocial adjustment among women after breast cancer surgery. This study provides the important information that there are no differences in patient psychosocial adjustment that can be ascribed to the type of surgery at 6-year follow-up evaluation.

Psychosocial adjustment among husbands of women treated for breast cancer; mastectomy vs. breast-conserving surgery.

Psychosocial adjustment was measured among 56 spouses of women operated for breast cancer. Of 69 eligible husbands, 56 participated. Twenty women underwent breast-conserving surgery (BCT) and 36 had a mastectomy (MT). An interview was conducted with each woman and her husband separately, 4 and 13 months after surgery. Two instruments were used; SBAS (Social Behaviour Assessment Schedule) and a scale (TB) constructed specifically for the study. The husbands of the women in the MT group were significantly more depressed after 4 months and reported complaints related to their wive's disease more often than did those in the BCT group. After 4 months, the marital relation was assessed as more positive in the MT group. A total of 48% of the husbands in the sample expressed some emotional distress during the investigation period, which is similar to levels seen among breast cancer-operated women themselves. Overall, only marginally better scores were seen for husbands married to women who had undergone breast-conserving surgery. Few researchers have studied psychosocial reactions in the breast cancer patient's family. Since patterns of social support empirically influence the rehabilitation of the cancer patient, this field of investigation is important.

Determinants of the psycho-social outcome after operation for breast cancer. Results of a prospective comparative interview study following mastectomy and breast conservation.

In a prospective interview study, designed to compare the psycho-social outcome after a breast-conserving vs. a mastectomy operation, we analysed possible predictors of the psycho-social adjustment. 99 women with breast cancer histopathological TNM stages I and II were consecutively admitted to the study. Half-structured interviews, based on the Social Adjustment Scale and a scale by P. Maguire, were performed 4 and 13 months after the operation. Living together with the spouse seems to protect women from developing psycho-social problems postoperatively. Women who were gainfully employed or who were given radiotherapy had a higher risk of poor adjustment after 4 months. At 13 months, the scorings indicate that radiotherapy has a reassuring effect. Type of surgery was controlled for in the analysis and showed that, of the risk factors studied, the most consistent trend for an overall better outcome was in the breast-conserved group except for sexual disturbances.

Voluntary associations for cancer patients in Sweden: supportive activities.

Our aim was to describe voluntary associations for patients with cancer in Sweden (n=108) and their activities, type and extent of member support, and the associations' collaboration with the health care system. A specially constructed questionnaire with structured and open questions was used for the investigation. The frequency of answers was 89%. The results show in the broadest sense that the associations have two missions. The direct patient-related mission concerns providing patients with support in the form of close proximity, approachability and through distribution of knowledge together with financial and practical support; the indirect patient-related mission deals with activities aimed at improving conditions for patients in general within the health care system and by influencing authorities as well as supporting family members and significant others and providing financing. The associations collaborate with the health care system, although they face difficulties in becoming 'sanctioned' and in establishing positive relationships with the health care community. The associations display a positive attitude towards their cause and the personal gratification that the voluntary work brings. In general, the findings indicate that the associations have a potential to help patients live and cope with their cancer disease.

Psychosocial adjustment after mastectomy and breast-conserving treatment.

The possible advantages of breast-conserving surgery over mastectomy with respect to psychosocial adjustment were assessed in an interview study. Consecutive patients 40 to 80 years of age with invasive breast cancer of Stages I and II were eligible for the study. Of 161 women, 99 agreed to participate; 37 received breast-conserving treatment and 62 received a modified radical mastectomy. The study method consisted of a semistructured interview at 4 and 13 months after primary treatment based on the Social Adjustment Scale (SAS) and two scales for the estimation of anxiety, depression, and adjustment to a sexual relationship. The women's ratings in the SAS inventory for adjustment to work, social life, marriage, sexual relationship, and parental role showed no statistically significant differences between the two groups. In the interviewer's global rating in the SAS protocol of the overall adjustment after 13 months, 22.0% of the women in the mastectomy group versus 5.4% of those with a preserved breast were rated as having significant disturbances. A statistically nonsignificant tendency (P greater than 0.05) emerged for the other ratings in the interviewer's assessment in SAS and in the estimation of anxiety, depression, and adjustment to sexual relationships. The consistent tendency indicates that there might be clinically important differences in the psychosocial adjustment after the two treatment methods. Larger trials focused more sensitively on the problems after breast loss versus breast preservation in breast cancer surgery are needed to further explore this field.