Psychosocial Issues on Patients with Breast Disorders
Raymund Lirag; Anna Lizza Lopez; Joel Macatula; Samuel Maghuyop; Sidney Manahan; Antonio Mangubat; Jon Marquez; Elenore Meca; Diane Mercado; Novette Morales; Alex Noche; Anna Ocampo; Ivan Oligario; Barbara Ong; Michael Ong; Joy Pabellon UPCM Class 2002 (Year Level II, 1999) Reynaldo O. Joson, M.D. (Facilitator) 1999
Content
I. Case Scenario
I.V. is a 30-year-old female from Cagayan Valley. She is the wife of U.V., a farmer who works at a hacienda for minimum wage (Php 150/day). They have 5 children, with age range of 2-12 years, 3 of which are in grade school. She was referred to you from a local hospital in Cagayan Valley for a hard non-movable (fixated) mass, 6 cm at its greatest diameter, non-tender, solid, with ill-defined borders on the upper outer quadrant of the right breast. Initial diagnostic procedues by mammography and excision biopsy revealed a Stage IIIA breast carcinoma (T3N1M0).
II. Identification of psychosocial or behavioral issues
A. Factors promoting disease
The different factors affecting the psychosocial or behavioral issues can be divided into three major categories, namely: personality, hormonal and immunological, and stress and life events.
1. Personality factors
There is limited empirical proof of any causal relationship between cancer and personality traits. However, Galen, as early as 2 A.D., recorded that melancholic females were more prone to develop masses than sanguine females. In 1975, Greer and Morris observed that women with abnormal expression of emotions such as emotional inhibition or extreme expressions had high incidence of cancer. Other factors that contribute to cancer are self-sacrifice and negative mood states.
2. Hormonal and immunological factors
Psychological stress may lead to immunosuppression, which predisposes to cancer. This is supported by the findings of Kiecolt-Glaser et al in 1984, which revealed depressed NK-cell activity during anxiety-laden situations. Immune cells have receptors for insulin, vasopressin, and other similar hormones released during stressful events leading to an immunocompromised state.
3. Stress and life events
In 1870, Sir James Paget stipulated that deep anxiety, deferred hope, and disappointment preceded the growth and progression of cancer. Furthermore, the loss of a major emotional relationship, such as the death of a loved one, has been reported to be the most common psychosocial factor hastening neoplastic growth (Le Shan, 1956). In a collaborated study by Regan (1997), emotional factors were established to have a causal role in initiating and promoting malignant processes, and accelerating cancer dissemination.
B. Factors affecting recovery
1. Compliance
In the case presented, the treatment plan for the patient is chemotherapy along with radiotherapy. Compliance is the key to her speedy and hopefully full recovery.
2. Psychosocial mindset of the patient (reaction to the illness)
3. Positive outlook
A patient with a positive outlook will have a greater chance of recovering from the illness since this can lead to boosting of her immune response.
4. Negative outlook
This is manifested as fear, denial, depression, anxiety, helplessness, or hopelessness. As was discussed previously, lymphocyte function during emotional inhibition is generally depressed as supported by studies done by Barthrop et al in 1977.
5. Presence of life stressors
The experience of stress can produce an endocrine response that may impair the immune systeme which can be translated to an increased tumor growth. In 1893, Herbert Snow noted that out of 200 women with either breast or uterine cancers, 156 had complications due to stressors such as the loss of a loved one.
6. Presence of support group
It is essential to have a support group who will bestow care and support so as to give the patient peace of mind and self-worth inspite of great comfort. This will be helpful for her to realize that she is not alone in her predicament.
III. The effect of psychosocial or behavioral issues on health, disease and recovery
A. Awareness and educational attainment
These promote early detection and provide the person an idea regarding the severity of the disease. By knowing the treatment options, implications and/or consequences, and by understanding the risks and benefits of every option, the patient is also allowed to participate in the management of his/her condition.
B. Culture
This accords importance and value to health as an aspect in one's life. For instance, in a certain region, job may be prioritized over health, consequently delaying the acquisition of treatment for one's condition until one's capacity to function normally is significantly impaired. It also dictates one's affective behavior regarding the management of the condition (i.e., mastectomy) and one's compliance toward the treatment plan. Some beliefs and practices may also alter the course of the management, as when a pregnant woman initially consults a hilot or albularyo and later a physician, but only after treatment failure.
C. Socioeconomic state
One's status in the society and community is another major determinant of one's health condition. It proportionately enables one to afford health care, such as diagnostics and treatment, and provides access to information and health services. In other words, it can either contribute to the attainment of an optimal health condition or hinder one with stress and a depressed quality of life. This factor also dictates one's lifestyle which can be a source of risks for developing breast cancer. For instance, obesity can be acquired from a sedentary lifestyle for not being forced to do household chores or go to work to earn a living.
IV. Behavioral modifications or psychological issues on the prevention of disease and promotion of health and recovery
A. The following are recommended for the promotion of health and recovery for individuals diagnosed with breast cancer:
B. The following are suggested for the prevention of disease for those without breast cancer (or those not yet diagnosed with the disease):
V. References
Comments or Questions?
Title: Full Name:Email: Comments or Questions:
Psychosocial Issues Folder HIISE-Guidelines and Format GS I TeleBreast Program Development Status
GS I email: gs1pgh@mail.upm.edu.ph RJoson email: rjoson@pacific.net.ph