Breast Cancer: Coping Strategies, Axillary Dissection, and Arm Morbidity - Essay Example

Breast Cancer: Coping Strategies, Axillary Dissection, and Arm Morbidity By Introduction This essay aims at exploring different aspects that pertain to breast cancer. Breast cancer is ranked among the most common types of cancer today, as it affects many individuals, as compared to the past years. There are different symptoms that characterise breast cancer, and these include among others, a lump thickening in the breast tissue. Early diagnosis of breast cancer allows for early treatment and prevents the spread of cancer to other parts of the body. Breast cancer is divided into two types including non-invasive breast cancer and invasive breast cancer. Non-invasive breast cancer does not have the ability to spread to other parts of the body, while the invasive type can spread to other body parts. There are no major known causes of breast cancer, but the aspects of age and family history among others increase the likelihood of developing it. Treatment of breast cancer employs a combination of surgery, radiotherapy, and chemotherapy. Nonetheless, this essay is divided into three major parts. The first part focuses on the coping strategies of women diagnosed with breast cancer. The second part discusses axillary dissection as an option for invasive cancer and sentinel node metastasis. Finally, the third part focuses on lymphoedema, and seeks to establish whether an individual diagnosed with breast cancer is at risk of arm mortality after breast cancer surgery. This essay draws from different journal articles that address the major issues in the essay. These articles provide knowledge that provides answers to the questions raised in each of the three parts of this essay. Coping with Breast Cancer What coping strategies are used by women when diagnosed with breast cancer? My aim in this section is to describe the paper by Drageset, Lindstrom & Underlid (2010) and consider how this work answers the question. In their work “Coping with breast cancer: between diagnosis and surgery” published in the Journal of Advanced Nursing, Drageset, Lindstrom & Underlid (2010) had the main aim of investigating and reporting on the coping strategies that women use in the period between when they are diagnosed with breast cancer and when they go for surgery. This therefore, includes the experiences of the women, their pain, and quality of life. In order to report on this, the researchers adopted the qualitative descriptive design, and data collection was by individual semi-structured questions. Only 21 Norwegian women newly diagnosed with breast cancer and awaiting surgery were interviewed. The findings of Drageset, Lindstrom & Underlid (2010) revealed different coping strategies. Step-by-step was found to be the most common strategy, and involved taking one day at a time and not worrying. In pushing away, women distance themselves from reality and push away negative thoughts. Business as usual showed that some women carried on with their daily routine, while in enjoying life, women focused on what was important in their life. In dealing with emotions, women either expressed their emotions or kept their emotions at a distance. In preparing for the worst, some women anticipated death and possibilities of metastasis after surgery. Finally, in positive focus, women acknowledged that although there were possibilities of death, they remained optimistic. A different study by Redaniel, Martin, Wade et al (2013) investigated the relationship between waiting times from diagnosis to surgery with survival in women with localised breast cancer. Results showed no evidence of this relationship, as an increase in waiting time did not lead to excess mortality. This confirms that coping strategies are utilized by women. This study was significant, as it established the various coping strategies of the women. However, there are two major limitations of this study. First, the study had only 21 respondents. I consider this sample size to be small. Therefore, it puts a limit on how the study findings can be generalized to a larger population. Second, the data used in this study have been collected from only one ethnic group. The researchers interviewed Norwegian women only, and excluded non-Norwegians. For this reason, it would be difficult to generalize the study findings to non-Norwegian populations. Despite the limitations of study the study by Drageset, Lindstrom & Underlid (2010), the findings provide relevant answers to the study question. The study identified seven coping strategies that women used. These as identified include, step-by-step, pushing away, business as usual, enjoying life, dealing with emotions, preparing for the worst, and positive focus. These findings are important and might be useful in identifying patients in need of particular counselling and support; and can be utilised in evaluating the effects of breast cancer on the psychosocial well-being of women. Nevertheless, considering that the Journal of Advanced Nursing is a world-leading international peer reviewed journal, the findings of this study can be considered valid. Axillary Dissection Is there definitive and accurate information that could assist in making a decision about whether to have axillary node clearance for a diagnosis of invasive breast cancer and sentinel node metastasis? My aim in this section is to describe the paper by Giuliano, Hunt & Ballman et al (2011) and consider how this work answers the question. Normally, the sentinel lymph node dissection (SLND) aids in the identification of nodal metastasis of early breast cancer. However, there is no clarity whether further nodal dissection has an effect on survival. In their study, “Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis” published in the Journal of American Medical Association, Giuliano, Hunt, Ballman et al (2011), investigated how complete Axillary lymph node dissection (ALND) on patients with sentinel lymph node (SLN) metastasis of breast cancer affected their overall survival. This was a randomized control trial with 856 women with clinical TI-T2 invasive breast cancer with no palpable adenopathy, and 1-2 SLNs containing metastases that were identified histologically. All participants were subjected to lumpectomy and tangential whole-breast irradiation. Participants with SLN metastases identified by sentinel lymph node dissection (SLND) underwent ALND or no further axillary treatment, while those assigned to ALND underwent dissection of at least 10 nodes. Findings of this study showed that the use of SLND alone compared with ALND on patients with limited SLN metastatic breast cancer did not lead to inferior survival. This study has three major limitations. The first regards the data collection process. The study included patients that had no positive nodes. These were 29 (7%) patients in the SLND group and 4 (1.2%) in the ALND group. However, the researchers did not explain why these patients that failed to meet the inclusion criteria were included. Second, a large number of women lost follow-up in the study. These included 21% in the ALND group and 17% in the SLND group. When the number lost to follow-up exceeds 10%, it jeopardizes the validity of the results. Finally, the researchers did not collect all data for clinical and demographic characteristics. For instance, 18% of the patients in the ALND group had no data on the number of positive nodes. This equally compromises the study findings. Despite the limitations, this study has been instrumental in answering the relevant question. In their conclusion, the researchers indicated that ALND may not be justified as the standard practice in this patient population. A different study by Bortolini, Genta, Biacchiardi et al (2011) recommended that ALND should be avoided in cases of micrometastatic SLN and in all positive SLN cases. The researchers found out that more refined selection of patients is necessary when ALND is being considered. This therefore, shows that there is no accurate information that would help to determine whether axillary node clearance for invasive breast cancer and sentinel node metastasis can be conducted. Overall, being published in the Journal of American Medical Association (JAMA) a second-tier journal, in addition to problems in the methodology puts a challenge to the confidence in the study findings. Prediction of arm mortality Is there a real risk of developing lymphoedema following surgical removal of the axillary lymph nodes? My aim in this section is to describe the paper by Hack, Kwan, Thomas-MacLean et al (2010) and consider how this work answers the question. Lymphoedema is a swelling that results from the build-up of lymph fluid in the tissues near the surface of the body. This occurs because of the damage that surgery causes to the lymphatic system specifically lymph nodes the area under the arm. This arm morbidity has become a major concern for some women after undergoing breast cancer surgery. In their paper, “Predictors of arm morbidity following breast cancer surgery” published in the Psycho-Oncology, Hack, Kwan, Thomas-MacLean et al (2010) aimed at examining the characteristics of the chronic arm morbidity after breast cancer surgery. This study employed a sample of 316 women with a non-metastatic diagnosis of breast cancer. These were subjected to clinical assessment and measures of arm morbidity 6-12 months after they had breast cancer surgery. The results of this study showed that there was a risk of experiencing arm morbidity post-breast cancer surgery. The women studied who were 6-12 months post breast cancer surgery exhibited arm morbidity. These experienced pain, lymphoedema, and functional disability of the arm and shoulder, which are all related to arm morbidity. This study has revealed that there is a likelihood of experiencing arm morbidity after breast cancer surgery, hence making a significant contribution to this area of research. However, there is one major limitation of this research. This research has failed to examine the prevalence, severity, and predictors of arm morbidity following surgery in a longitudinal manner. Since there are various reports that show that it is possible to develop lymphoedema after years after breast cancer surgery. Therefore, 6-12 months post-breast cancer surgery is such a short time. There is a likelihood that those that did not exhibit arm morbidity could experience that after a number of years. Therefore, this study ought to have adopted a wider context, in that data should have been collected frequently over some years, in order to allow the full determination of the risk factors of lymphoedema. Despite the limitation, this study has provided findings that can be used to answer the question of whether there is a real risk of developing lymphoedema post-breast cancer surgery. The findings suggest that indeed there is this risk for all women that have undergone breast cancer surgery. The study focused on women 6-12 months post-breast cancer surgery and these were shown to exhibit arm morbidity. However, the researchers note that there is evidence that proves that a woman might experience arm morbidity years after their breast cancer surgery. A different study by Kopec, Colangelo, Land et al (2013) on this topic showed that about a third of the participants experienced arm mobility restrictions six months after breast cancer surgery. The consistent results of these studies therefore, confirm the risk of arm morbidity post-breast cancer surgery. Conclusion This essay has provided important information on different aspects of breast cancer, including coping strategies, axillary dissection, and risk of arm mortality. This was achieved through the reviewing and comparison of different journal articles. With regard to coping strategies that women diagnosed with breast cancer adopt, this essay has identified seven major coping strategies. This therefore, proves that life changes for women diagnosed with breast cancer, hence they are forced to adopt strategies that will enhance their survival in their new health status. On the other hand, with regard to axillary dissection, this essay has shown, basing on different journal articles, that there is no definitive and accurate information that could assist in making a decision about whether to have axillary node clearance for a diagnosis of invasive breast cancer and sentinel node metastasis. This is mainly because the different journal articles reviewed did not show enough consistency in their findings and conclusions. This essay has also established important information with regard to whether individuals are exposed to a risk of arm mortality after their breast cancer surgery. From the journal articles reviewed, there was significant consistency in study findings. Therefore, a conclusion reached was that there is a real risk of developing lymphoedema and arm morbidity after breast cancer surgery. Nevertheless, important knowledge generated in this essay include knowledge on the vulnerability of women diagnosed with breast cancer, hence their need to cope. The fact that women are at risk of arm mortality post breast cancer surgery, this calls for effective assessment of patients after surgery for lymphoedema, and right medical attention if they test positive for the condition. This essay has identified axillary dissection as an area that requires more research in order to enhance clarity and understanding of the issue. Nonetheless, this essay has contributed significantly to the knowledge on breast cancer. Works Cited Bortolini, M., Genta, f., Biacchiardi, C., Zanon, E., Camanni, M & Deltetto, F 2011, “Axillary dissection in breast cancer patients with metastatic sentinel node: To do or not to do? Suggestions from our series.” International Scholarly Research Network, Oncology, Article ID 527904. Drageset, S., Lindstrom, T & Underlid, K 2010, “Coping with breast cancer: between diagnosis and surgery.” Journal of Advanced Nursing, 66(1): 149-158. Giuliano, A., Hunt, K., Ballman, K., Beitsch, P., Whitworth, P., Blumencranz, P., Leitch, M., Saha, S., McCall, L & Morrow, M 2011, “Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis.” Journal of American Medical Association, 305(6): 569-575. Hack, T., Kwan, W., Thomas-MacLean, R., Towers, A., Miedema, B., Tilley, A & Chateau, D 2010, “Predictors of arm morbidity following breast cancer surgery,” Psycho-Oncology 19: 1205-1212. Kopec, J., Colangelo, L., Land, S., Julian, T., Brown, A., Anderson, S., Krag, D., Ashikaga, T., Costatino, J., Wolmark, N & Ganz, P 2013, “Relationship between arm morbidity and patient-reported outcomes following surgery in women with node-negative breast cancer: NSABP protocol B-32,” Journal of Supportive Oncology, 11: 22-30. Redaniel, M., Martin, R., Wade, J & Jeffreys, M 2013, “The association of waiting times from diagnosis to surgery with survival in women with localised breast cancer in England.” British Journal of Cancer, 20(3): 42-49. Read More