Sexuality and Breast Cancer - Assignment Example

? Sexuality and Breast Cancer - Annotated Bibliography - Number and Number Number of Words: 2,325 Part I – Bibliographic Information As of 2008, the Office for National Statistics reported that roughly 39,277 or 31% of 126,700 women who were diagnosed with cancer-related diseases had breast cancer (Office for National Statistics, 2011a). In line with this, reported figure in 2008 was 1,633 or 4% higher as compared to the number of breast cancer cases back in 2007 (Office for National Statistics, 2011b). It is a myth to believe that breast cancer occurs only among women. In rare cases, 0.8% of the total patients diagnosed with breast cancer are male (Donovan & Flynn, 2007). Particularly among women more than 50 years of age, breast cancer is one of the major causes of deaths throughout the United Kingdom. Each year, approximately more than 10,000 or 26 out of 100,000 women die due to untreated breast cancer (Office for National Statistics, 2011b). Several studies revealed that there is a close link between sexuality and breast cancer in the sense that most women who has been diagnosed or has received breast cancer treatment experience a decreased sexual performance due to the psychological impact of body image disturbances (Fobair & Spiegel, 2009; Sheppard & Ely, 2008; Burwell et al., 2006; Fobair et al., 2006; Pelusi, 2006). The focus of this annotated bibliography is to examine and identify the link between sexuality and breast cancer. Aside from determining strategic ways that will enable specialist breast care nurses deliver a holistic care to the patients, information gathered in this study will be useful in terms of educating men and women about the psychological impact of having breast cancer on sexuality. Key Words: sexuality, breast cancer, body image, psychological impact, women Part II – Explanatory Paragraphs Pelusi, J. (2006). Sexuality and Body Image. Cancer Nursing. 29(2S): 32-38.ISSN:0162-22OX. This article increases the readers’ knowledge with regards to effective ways in controlling symptoms related to breast cancer treatment. It also emphasized the importance of increasing the nurses’ knowledge concerning the physiological and psychological impact of breast cancer. Aside from considering the cultural background of each patient when treating breast cancer, the author explained how the use of chemotherapy, hormonal therapy, radiation therapy, and mastectomy could create negative effects in patients’ sexual responses, sexual relationship with their partners and disturbance in body image. The author conducted a literature review as a way of examining the impact of breast cancer and breast cancer treatments on body image, sexual roles and relationships, and cultural differences of each patient. In general, qualitative approach in research design examines the relationship between the nature of the subject being examined in its natural setting (Maykut & Morehouse, 1994, p. 68). Through the use of this approach in research design, the researcher can freely describe and interpret the personal opinion of the research respondents with regards to the research questions (Patton, 2002). However, information gathered from pure qualitative research study is highly dependent on the researcher’s analysis and interpretation. Therefore, it would have been better in case the author decided to combine the use of qualitative with quantitative approach in research study design. Aside from the negative psychological impact of mastectomy, aging could make women unhappy about their physical appearance. Therefore, health teaching should be a part of the nurses’ responsibility when delivering holistic care to the patients. To encourage the patients’ partner in giving emotional support to the patient, nurses should communicate and educate the patients’ partner that the side effects of cancer therapies includes hormonal changes, sleep and appetite disturbances, fatigue, nausea and vomiting, malaise, and apathy. In response to vaginal dryness caused by chemotherapy or early menopausal among women, it is necessary to suggest the use water-based vaginal lubricants. To help the couple regain and maintain their sexual relationship, the author suggested the idea to try alternative sex positions. The process of receiving chemotherapy could result to pre-menopausal stage among women with breast cancer. By encouraging the patients to seek for their physician’s advice, nurses can assist the patients in maintaining their hormonal balance. On top of evaluating the effectiveness of the proposed health care intervention, nurses should include issues related to altered body image and sexuality in the nursing diagnosis when preparing the patients’ individual care plan. Donovan, T., & Flynn, M. (2007). What Makes a Man a Man?: The Lived Experience of Male Breast Cancer. Journal of Cancer Nursing. 30(6): 464-470. Representing approximately 0.8% of total breast cancers diagnosed, cases of male breast cancer (MBC) is rare. Since research data concerning its psychosocial impact is limited, the authors sought to understand this condition by adopting a phenomenological framework to inquire about the conscious experiences of MBC patients as lived from the subjective or first person perspective. The qualitative approach to this study was conducted by semi-structured interviews with only 15 participants. Its phenomenological framework focused on descriptive and subjective interpretation of data and therefore lacked scientific rigour. The sample size was too small to draw any valid conclusions, or even determine if the experiences were typical of those experienced by MBC patients. It was difficult to detect any researcher induced bias and the results of the study did not produce generalisable data. Yet, it did provide valuable insight into the lived experience of MBC. Analysis of the findings identified four principle themes, namely that MBC was considered a stigmatising condition due to its feminized association. Living with breast cancer was distressing as it challenged perceptions of masculinity. Men and women with breast cancer have different and sometimes conflicting needs. Health care professionals are often unaware of the specific psychological and informational needs of these patients. MBC constitutes a unique lived experience that is not seen in any other disease profile. It is perceived as an unwelcome and unexpected intrusion into the lives of the individuals affected. Its stigmatising association with femininity is compounded by the results of its treatments, mastectomy scar, hot flushes, erectile dysfunction thereby affecting the core values and legitimacy of masculinity. This paper alluded to significant deficits in the treatment and management of the psychosocial needs of the MBC patient. Breast care nurses and other health care professionals need to recognise that the treatment of these patients result in a profound change in their concept of self and sexuality unparallel to that of their female counterparts. Gender appropriate support and information is needed in order to enable these patients to negotiate the complexity of this confronting disease. Fobair, P., & Spiegel, D. (2009). Concerns about Sexuality after Breast Cancer. Journal Cancer. 15(1): 19-26. The use of chemotherapy could negatively affect the patients’ sexual desire, sexual functioning, and emotional relationship with their partners. Therefore, the authors revealed that patients with breast cancer are most likely to experience sexual problems after receiving breast cancer treatment and follow-up intervention. Since pharmaceutical drugs used in treating breast cancer could cause hot flashes, vaginal dryness and pain, the authors suggest that patients with breast cancer should receive psychological and emotional counselling. The authors invited 360 quantitative research participants between the age of 22 to 50 years old who were able to survive the health and emotional consequences of breast cancer. To gather a more descriptive response to the research questions, the authors re-interviewed a total of 185 research survey participants. This particular research design is better than the chosen research strategy used by Donovan & Flynn (2007) and Pelusi (2006) since pure quantitative approach in research design is insufficient in terms of subjectively describing the personal opinion of the research respondents with regards to the research topic whereas pure qualitative approach does not give the researcher a more generalized research findings concerning the research topic. This article enabled the readers to gain better understanding about the causes and concerns of breast cancer patients on sexuality. Likewise, this article tackled a list of psychological and physiological changes that patients with breast cancer could anticipate. To minimize the psychological distress associated with breast cancer, patients should receive psychotherapeutic intervention. Breast cancer survivors who were able to live their life to the fullest are the ones who can serve as a motivational inspiration to breast cancer patients. Therefore, nurses should encourage breast cancer survivors to actively participate in social organization for breast cancer patients. Because of the inspirational thoughts of the breast cancer survivors, some of the breast cancer patients will be able to easily accept their health situation. This stage is very important in terms of making them able to develop a more positive outlook in life. Fobair, P., Stewart, S., Chang, S., D’Onofrio, C. Banks, P. (2006). Body image and sexual problems in young women with breast cancer. Psycho-oncology. 15: 579-594. This article focused on determining the frequency of sexual problems and body image alterations after the first month of receiving breast cancer treatment. After interviewing a total of 549 women between 22 to 50 years old with situ, local or regional breast cancer, the authors revealed that nurses should assist the patients in dealing with emotional and psychological difficulties associated with reduced sexual functioning and sexual desire after receiving surgical treatment. Seven months after being diagnosed with in situ, local or regional breast cancer, the authors conducted a multi-ethnic population semi-structured interview study on 549 patients. The ethnic and cultural differences of breast cancer patients could significantly affect the patients’ attitude and behaviour towards breast cancer treatment. In line with this, conducting a multi-ethnic population study could prevent the authors from developing bias research study result. This article is useful in terms of identifying specific body image alterations caused by breast cancer treatments. In line with this, the authors revealed that undergoing the surgical process of mastectomy, a significant weight gain or loss, and possible hair loss due to chemotherapy could lead to decreased in self-esteem and poorer mental health which could make them experience a decreased quality of life. Similar to the study recommendations of Fobair & Spiegel (2009), Sheppard & Ely, 2008, and Pelusi (2006), it is necessary for nurses to extend emotional support not only to the patients but also to their family members. Burwell, S., Case, D., Kaelin, C., & Avis, N. (2006). Sexual Problems in Younger Women after Breast Cancer Surgery. Journal of Clinical Oncology. 24(18): 2815-2821. Aside from identifying the socio-demographic, medical and psychosocial factors that could lead to sexual problems, the main purpose of this article is to examine the sexual problems that young women encounters after being diagnosed with breast cancer. Upon examining the sexual problems of young women with breast cancer a year after receiving surgery, Burwell et al. (2006) revealed that more than half or 56% of women with breast cancer received chemotherapy whereas majority with 64% of women who had lumpectomy and mastectomy. The feeling of lowered sexual attractiveness is strongly associated with more sexual problems. To overcome the feeling of lower sexual attractiveness caused by lumpectomy and mastectomy, 2/3 of women who received lumpectomy and mastectomy had to go through a reconstructive surgery. Only 28% of the research participants had hormonal therapy. Chemotherapy could lead to vaginal dryness. In line with this, Burwell et al. (2006) revealed the women close to menopausal age who received chemotherapy are the ones who experience more sexual problems (P = 0.015). Young women could experience early menopause after receiving chemotherapy. Vaginal dryness can be treated with the use of vaginal rings1. Considering the research findings of Burwell et al. (2006), there is a need to counsel women with regards to the necessary remedies for vaginal dryness on top of bringing back their sense of feeling sexually attractive through reconstructive surgery and psychological motivation. The authors invited a total of 323 research participants who were less than 50 years of age to participate in research survey study. The survey questionnaire includes the use of 4-point and 7-point likert scale in determining the patients’ Medical Outcomes Study, quality of life, marital satisfaction, partner relationship, and Sexual Functioning Scale 6 weeks after the surgery (baseline), 12 weeks after the surgery, and 6 months after the surgery. Having a baseline record is necessary to enable the researchers determines any improvements in the research participants’ health and sexual condition after going through surgery. With regards to the research survey procedure, it is an ethically accepted practice that the authors directly seek permission from the patients before releasing their personal information to the New England Research Institute. Even though only 301 research participants were highly qualified to participate in the study and that only 268 women were able to complete the baseline interview, this figure is more than enough to avoid gathering bias quantitative study result. Specialist breast care nurses should provide holistic care when dealing with the patients who received breast cancer surgery. After learning that chemotherapy could cause vaginal dryness and early menopausal for some women, nurses could conduct health teaching that focuses on treating vaginal dryness. For example: The nurse can suggest the use of water-based vaginal lubricant in the case of premenopausal woman who is having sexual problem with the husband. In case sexual problem is caused by poor body image as a result of 10mastectomy, the nurse could exert extra effort in making the patient feel beautiful by making her feel good through positive praises. Sheppard, L., & Ely, S. (2008). Breast Cancer and Sexuality. Journal of Breast Cancer. 14(2): 176-181. The inability of the spouses to accept altered body image could make the patients feel that their partner does not provide them with emotional support (35%), lead to relationship problems (25%), and separation (12%)” (Sheppard & Ely, 2008, p. 3). Since breast cancer could negatively affect women’s body image and sexual feelings after mastectomy, providing health care support to patients and their partner could help improve their long-term sexual relationship. Similar to the research design of Donovan & Flynn (2007), the authors conducted an in-depth interview with three research interviewees which include the patients’ spouses concerning matters related to sexuality and body image. The idea of interviewing the patients’ spouses is good in terms of coming up with a descriptive response to the research topic. However, the use of pure qualitative research method is not effective in terms of generating a more generalized research finding concerning this matter. Several studies revealed that one of the most common problems that women with breast cancer are facing is due to the inability of their partners to understand their emotional concerns (Fobair & Spiegel, 2009; Fobair et al., 2006; Pelusi, 2006). Similar to the research findings of Pelusi (2006), the research findings of Sheppard & Ely (2008) strong supports the idea that each of the specialized breast care nurse should encourage the patients’ partners to actively participate in health teaching process so they will have better understanding about their wife’s emotional and psychological challenges. *** End *** Appendix I – Incidence of Major Cancers in England back in 2008 Source: Office for National Statistics, 2011a Appendix II – Incidence and Mortality Rates of Breast Cancer in England Source: Office for National Statistics, 2011b References Burwell, S., Case, D., Kaelin, C., & Avis, N. (2006). Sexual problems in younger women after breast cancer surgery. Journal of Clinical Oncology , 24(18): 2815-2821. Donovan, T., & Flynn, M. (2007). What makes a man a man?:The lived experience of male breast cancer. Journal of Cancer Nursing , 30(6): 464-470. Fobair, P., & Spiegel, D. (2009). Concerns about sexuality after breast cancer. Journal Cancer , 15(1): 19-26. Fobair, P., Stewart, S., Chang, S., D'Onofrio, C., & Banks, P. (2006). Body image and sexual problems in young women with breast cancer. Psycho-Oncology , 15: 579-594. Maykut, P., & Morehouse, R. (1994). Beginning qualitative research: a philosophic and practical guide. Taylor & Francis Group. Office for National Statistics. (2011). Retrieved January 27, 2011, from Cancer. One in four people die from cancer: http://www.statistics.gov.uk/cci/nugget.asp?id=915 Office for National Statistics. (2011b). Retrieved January 27, 2011, from Breast Cancer. Incidence rates rise, mortality rates fall: http://www.statistics.gov.uk/CCI/nugget.asp?ID=575 Patton, M. (2002). Qualitative research and evaluation methods. 3rd Edition. Sage Publications. Pelusi, J. (2006). Sexuality and body image. Cancer Nursing , 29(2S): 32-38. Sheppard, L., & Ely, S. (2008). Breast cancer and sexuality. Journal of Breast Cancer , 14(2):176-181. 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