Quality of Life in Women with Breast Cancer Post Mastectomy - Research Paper Example

Quality of Life in Women with Breast Cancer Post Mastectomy Table of Contents Page 3 Introduction Page 4 Justification of the Problem Page 4 Statement of the Problem Page 4 Review of the Literature Page 5 Theoretical Framework Page 7 Purpose of the Study Page 7 Definition of Terms Page 7 Methodology Page 8 Subjects Page 8 Setting Page 8 Procedure Page 8 Data Analysis and Presentation Page References Page Abstract Over 250,000 new breast cancer diagnoses are made each year; and, treatment of the majority of those cases will include a mastectomy. Furthermore, since breast cancer survival rates are also increasing, it is important to help breast cancer survivors have a high quality of life following treatment. The existing research has identified some factors which appear to be related to quality of life among post mastectomy breast cancer patients. However, a good deal more research is needed to fully understand all of the factors which contribute to achieving a high quality of life. This study is intended to add to the existing literature and help to develop a plan to aid patients in achieving their highest possible quality of. life. Data will be collected from post mastectomy breast cancer patients that comprise the study sample, through the use of self-reporting questionnaires as well as focus groups and/or therapeutic sessions. of the data will then be analyzed, presented, and used to help formulate a plan. Introduction Over 250,000 women in the United States are diagnosed with breast cancer every year; and, a large percentage of those women have a mastectomy as a part of their cancer treatment (CDC, 2010). Some women enjoy a very high quality of life post mastectomy, while others do not. Research has identified a variety of factors that contribute to the quality of life that is achieved after treatment. The most significant factor to a high quality of life post mastectomy is having breast reconstruction surgery immediately after the mastectomy surgery (ASPS, 2011; Nissen et al., 2002). Other factors contributing to a post mastec to my patient’s quality of life include personality traits, age, overall physical health and emotional and psychological health among others. However, a good deal more research is needed to identify all of the possible factors, and how they may interact, that would allow all post mastectomy patients to live the highest quality of life possible. Justification of the Problem Since such a large number of mastectomies are performed every year, it is an important issue with regard to women’s health. In order to achieve a full and proper recovery, and go on to live a high quality life post mastectomy, it is essential to identify the combination of factors necessary to achieve it. Statement of the Problem Since survival rates are improving, more attention must be given to the quality of life for breast cancer survivors (ASPS, 2011). A good deal more research is needed to help post mastectomy breast cancer patients achieve the highest quality of life possible. Review of the Literature Even though more research is needed, there is existing research that identifies some of the factors necessary for post mastectomy breast cancer patients to achieve a high quality of life. Some early research seems to suggest that the negative effects of having breast cancer (e.g. sexual well-being) may be lessened by the conservation or reconstruction of the breast (ASPS, 2011; Rowland et al., 2001). Very little research has been done comparing psychosocial outcomes of patients that had a lumpectomy, a mastectomy alone, or a mastectomy with reconstruction (Rowland et al., 2001). The study included a large number of breast cancer survivors (1,957) who filled out a self-report questionnaire that measured health-related quality of life. As found in other research, those who had a mastectomy with reconstruction were more likely to be younger, college educated, affluent and white, than those in the other groups; however, no difference was found among the groups with regard to emotional, social or role function (Id.; Nissen et al., 2002). Body image and feelings of attractiveness are the usual psychosocial impacts found with regard to the surgery; and, nearly all post mastectomy patients report the fear of recurrence to be their greatest emotional challenge (Nissen et al., 2002; Rowland et al., 2001). The study also found that after a year from diagnosis, the quality of life is probably influenced most by the woman’s age or exposure to adjuvant therapy (Rowland et al., 2001). Breast cancer patients who have a mastectomy with reconstruction have been found to enjoy a better quality of life if they have certain personality traits (ASPS, 2011). A doctor in Italy, Dr. Silvio Bellino, gave 57 women, all of whom had a mastectomy followed by immediate reconstruction, a number of psychological tests in order to determine which personality traits improve quality of life after surgery. Dr. Bellino found two personality traits that appear to be related to higher quality of life scores. The first trait is the temperamental characteristic of “harm avoidance”, which Dr. Bellino described as women who were “apprehensive and doubtful” (Id.).. The second trait related to higher quality of life scores is being “vindictive/self-centered” on an interpersonal level; and, Dr. Bellino described these women as “resentful and aggressive” (Id.) None of the other personality traits appeared to be significantly related to better quality of life. Dr. Bellino found that having reconstruction immediately following mastectomy, perhaps by lessening the psychological impact of the treatment (Id.). Based on these findings, a preoperative personality assessment would be useful in order to identify factors which are predictive of a better subjective quality of life following surgery (Id.). Roth et al. (2007) conducted a study to examine the contribution of psychological factors in predicting patient satisfaction with post mastectomy breast reconstruction surgery. In this study, patients were given a pre-reconstruction psychological inventory which measured affective distress, depressive symptoms, anxiety, somatization and somatic preoccupation (Roth et al., 2007). At both one- and two-year follow-ups, patients were asked to rate their satisfaction with the general and aesthetic results of the surgery (Id.). Results of the study found both affective distress and somatic preoccupation negatively influenced patient satisfaction with both general and aesthetic outcomes (Id.). The results of this study indicate that pre-surgical psychological screening and counseling would help to enhance patient satisfaction with reconstruction surgery. Another research study that was conducted aimed to discover patient expectations about post mastectomy reconstruction and the factors affecting quality of life after reconstruction (Nissen et al., 2002). All of the study participants were breast cancer patients that had a mastectomy with immediate reconstruction between 1.4 and 5 years prior to the study. The patients attended focus groups with semi-structured, open-ended questions about patient perceptions of preparation, experience and satisfaction with their post mastectomy reconstruction surgery. Results of the study revealed high satisfaction ratings despite some concerns about cosmetic outcomes and a persistent anxiety about recurrence (Id.). A majority of patients reported that reconstruction surgery let them feel more comfortable in clothes, but that recovery from the surgery was difficult (Id.) Finally, the study showed that even reconstruction surgery did not get rid of the biggest emotional challenge related to breast cancer, which is fear of recurrence. Theoretical Framework The current proposed study will be based on the theoretical framework developed by Rogers (1970). According to Rogers’ theory, the goal, with regard to nursing, is to help clients/patients achieve a maximal level of wellness (Potter & Perry, 1991; Rogers, 1970).. Purpose of the Study The purpose of this study is to add to the body of knowledge that explores all of the factors which can assist post mastectomy breast cancer patients achieve the highest possible quality of life. Definition of Terms mastectomy –surgery to remove a breast as part of breast cancer treatment. fotal masatectomy – removal of breast, tissue and nippl.e modified radical – remove breast, lymph nodes and limimg of chest muscle lumpectomy – remove tumor and small amount of tissue around it reconstruction – surgery to rebuikd a breast after mastectomy Methodology Subjects All study participants will be women that have undergone a mastectomy as a part of breast cancer treatment. The mastectomy must have been performed between two and five years prior to the commencement of the study. Setting Currently, the exact setting for the study has not been determined. Procedure The procedure for the study involves first obtaining a baseline ).Study participants will be interviewed and all responses will be recorded. Next, the participants will then complete sa series of self-reporting . The questionnaires will be on various subjects, including psychological health, physical and emotional health, overall satisfacdtion and happiness, among others. Data Analysis and Presentation Once all of the data is gathered, it will be analyzed and presented so that my see the/ significance of certain relationships which help to achieve a high quality of laundery References American Society of Plastic Surgeons (ASPS)(2011).Personality factors affect quality of life after breast reconstruction, according to ASPS study. Women who want ‘revenge on cancer’ may have better psychological responses.Plastic and Reconstructive Surgerty, January 4, 2011. Arlington Heights, IL. Centers for Disease Control and Prevention (CDC) (2010). United States Cancer Statistics: 1999-2007 Incidence and Mortality Web-based Report. Atlanta, GA: Department of Health and Human Services, CDC, and National Cancer Institute. Available at http://www.cdc.gov/uscs. Retrieved on March 23, 2011. Nissen, M.J.,Swenen, K.K.,& Kind, E.A. (2002). Quality of life after postmastectomy breast reconstruction. OncologyNursing Forum 29(3), 547-553. Potter, P.A. & Perry, A.G. (1991). Basic nursing theory and practice, 2nd edition.St. Loui: MO. Mosby – Year Book, Inc Roth, R.S., Lowery, J.C., Davis, J. & Wilkins, E.G. (2007). Psychological factors predict ;patient satisfaction with post mastectomy breast reconstruction. Plastic and Reconstructive Surgery119(7), 2008-2015. Rowland, J.H., Desmond, K.A., Meyerowitz, B.E., Belin, T.R., Wyatt, G.E. & Ganz, P.A. (2001). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. Journal of the National Cancer Institute 93(1), 68. Read More