Volume: 2: Issue-1: Jan-Mar -2011

ISSN 0976-4550

EFFECTS OF !E"ST C"NCE! ON #$%SIO&O'IC"& "N( #S%C$O&O'IC"& $E"&T$ OF #"TIENTS 1 Ghazala Shaheen*, 2Muhammad Arshad, 1Tahira Shamim, 1Shafia Arshad, 3 Muhammad Akram, 4Zareena Yasmeen
1

College of conventional medicine,The Islamia University of Bahawalpur. Pkaistan Cholistan Institute of !esert "tudies,The Islamia University of Bahawalpur. Pkaistan # "hifa ul $ulk $emorial %ospital, %amdard University, &arachi, Pkaistan ' !epartment of (ducation, The Islamia University of Bahawalpur. Pkaistan ABSTRACT O)*e+,-.es:-The )reast cancer has great impact on physiological and psychological health of patients. This study was designed to investigate the psychological and physical effects of )reast cancer. #a,-en,s an/ me,0o/s:-*ne hundred +1,,- patients were included in the study sample. .ll the patients were evaluated with the help of a /uestionnaire which developed with the help of psychologists. !esul,s:-The results showed that the patient had high distress level at the time of diagnosis and during treatment.0,1 of patients reported that they do not get enough support )y their hus)ands. 2esults also showed that treatment of )reast cancer severely affects the fertility and no pregnancy was recorded during the treatment of )reast cancer. Con+lus-ons:-The results of the present study showed that the patients involved in C. )reast undergo several psychological 3 physiological changes. !uring the treatment patient4s psychological treatment is must to )oost the self esteem 3 to courage the patient to fight against the disease. !e" #$rds %Breast cancer, psychological changes, self esteem, and support, %us)ands, Chemotherapy.

&'TR()*CT&('
Psychiatric disorders occur more fre/uently in patients with advance cancer than in general population +Block, ,,,- and ,5#, 1 of patients with advance cancer will have a formal psychiatric diagnosis, the most common )eing depression +%optof et al., ,, -.In early cancer it has )een found that factors related to patients rather than the disease increases the risk of depression.+%arrison 3 $aguire., 166'Physical symptoms are more likely to correlate with depressive symptoms when they remain uncontrolled, have high severity and numerous, thus adding to patient )urden +$artin 3 7ackson., 1666-. Breast cancer survivors most fre/uently report e8periencing emotional distress +e.g., depression and an8iety symptoms- and intrusion and avoidance +e.g., intrusive thoughts, feelings, and imagery9 num)ing of responsiveness and avoidance of feelings, situations, or ideas- in relation to cancer and its treatment. Cancer and its treatment may provoke severe physical and psychological complaints. Breast cancer seems to )e more stressful )ecause this disease and its medical treatment can afflict the sense of femininity, perceived se8uality, and fertility of its victims +Irvine et al., 1661-. This study is carried out to determine the impact of diagnosis and treatment of )reast cancer on patient, her hus)and and her family.

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M+T,() S,u/4 (es-3n Breast cancer patients referred to BI:* were eligi)le to take part in the study. Base line demographic information was o)tained on age, diagnosis9 length of time since diagnosis and effects of treatment on physical and psychological health .Patient was asked to complete a /uestionnaire with ; items. #ro+e/ure:.ll patients were re/uired to give written consent prior to participating and full ethical approval for this study was o)tained. Patients were also informed of the nature of the study and were told they can participate or leave the study. .ll the /uestionnaires were completed )y daily visiting the BI:* and )y personal contacts to the patients in a duration of one year. S,a,s,-+al "nal4s-s:<ith the consultation of statisticians the data collected on all parameters was organi=ed in ta)ulated form and enter in a statistical software i5e5"P"" for further analysis. !escriptive analysis was done and histograms regarding each parameter were prepared. R+S*-TS Rea./i$n $f /he 0a/ien/ $n dia1n$sis
To record the reaction of the patients on the diagnosis of )reast cancer, hundred patients were asked that what their reaction was when they came to know that they were suffering from )reast cancer. *ut of 1,,, 0, patients responded that they )ecame very depressed, 1> patients replied that they felt that their death was very near, # patients responded that on hearing this news they )ecame upset for a while )ut decided to fight against the disease, only one patient said that she remained normal on hearing this news +?igure 1-.

62 52 42 32 42 32 22 12 2
8er" de0ressed '$rmal 9el/ dea/h 8er" )e.ided /$ fi1h/ near a1ains/ disaese

$f /he 0a/ien/s $n dia1n$sis 9i1ure 1: Rea./i$n $f /he Rea./i$n 0a/ien/s u0$n dia1n$sis $f CA Breas/:

Rea./i$n $f /he 0a/ien/;s hus7and $n dia1n$sis

2eaction of the hus)and depends upon his education and awareness a)out the disease. The response of 1,, patients who were asked that what was the reaction of their hus)ands when they came to know that their wives are suffering from life threatening disease, Breast Cancer. *ut of 1,,, '' patients replied that on hearing this news their hus)ands )ecame upset and showed no cooperation, # patients responded that their hus)ands showed cooperation, patients said that their hus)ands has divorced them and only one patient replied that her hus)and showed full cooperation and encouraged her to fight against the disease +?igure -.

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C$$0era/i<e '$ne .$$0era/i<e Re=e./i$n Gi<e .$ura1e *nmarried /$ fi1 h/ disea se

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'um7er $f 0a/ien/s

Re a./i$n $f 0a/i en/>s h us7and $n dia1n$sis

9i1ure 2: Rea./i$n $f /he 0a/ien/;s hus7and u0$n dia1n$sis $f 7reas/ .an.er

&m0a./ $f disease $n s$.ial life $f /he 0a/ien/

$an )eing a social animal prefers to live in social environment. But after the diagnosis of )reast cancer some patients withdraw themselves from social activities and restrict themselves to within. In this regard 1,, patients were asked that what was the impact of )reast cancer on their social life. *ut of 1,,, @ patients replied that their social life was totally distur)ed and 16 patients said they were totally cut5off from the society. *nly 6 patients replied that the diagnosis of )reast cancer imposed no impact on their social life +?igure #-.

'um7er $f 0a/ien/s

62 52 42 32 42 32 22 12 2

)is/ur7ed '$rmal

C u/$ff fr$m s$.ie /"

&m0a./ $f disease $n s$.ial 9i1ure 3: &m0a./ $f /he 7reas/ .an.er $nlife 0a/ien/;s s$.ial life

+ffe./s $n married life $f /he 0a/ien/

$arried life of many patients gets distur)ed after the diagnosis of )reast cancer due to pro)a)le procedures of treatment of the disease such as mastectomy which causes the distortion in )ody image. .long with this e8pense of treatment, )ehavioral changes and depression further worsen the relations. In present study, 1,, patients were asked the effects of )reast cancer on their married life. *ut of 1,,, 0, patients replied that this disease had distur)ed their married life, 16 patients said that this disease has no effect on their married life, while one patient was unmarried +?igure ' -.

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?2 62 52 42 32 42 32 22 12 2

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)is/ur7ed

( /he r

+ffe ./s $n marrie d life 9i1ure 4 +ffe./s $f 7reas/ .an.er $n 0a/ien/;s married life:

Beha<i$r $f 0e$0le #i/h /he 0a/ien/ af/er dia1n$sis

.fter diagnosis of )reast cancer )ehavior of the people with the patient is changed and mostly people took sympathy for the patient. In present study, 1,, patients were asked a)out the )ehavior of people with patient after diagnosis of the )reast cancer. *ut of 1,,, 6# patients replied that the )ehavior of people with them after diagnosis )ecame sympathetic, ; patients said that the )ehavior of people with them was cooperative and only patients replied that the )ehavior of the people with them was reAected type +?igure ;-.
122 ?2 62 52 42 32 42 32 22 12 2

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C $$0e ra/i<e

Be ha<i$r $f 0e$0le #i/h /he 0a/ie n/ af/er dia1n$sis

9i1ure 3: Beha<i$r $f /he 0e$0le #i/h CA 7reas/ 0a/ien/ af/er dia1n$sis:

+ffe./ $f disease $n 0a/ien/;s slee0

.fter the diagnosis of )reast cancer the sleep duration of a person is usually affected. To record these information hundred patients were asked a)out their sleep after diagnosis of )reast cancer. *ut of 1,,, 0; patients replied that their sleep was totally distur)ed and decreased, patients said that their sleep was increased and 1 patients replied that they sleep normally +?igure >-.

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)e.reased &n.reased Same as 0re<i$us (/her

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+ffe ./ $f dise ase $n 0a/ie n/>s e 0 7reas/ .an.er 0a/ien/: 9i1ure 4 +ffe./ $f /he CA 7reas/ $n slee0 sle $f /he

+ffe./s $n mem$r"
Breast cancer treatments including chemotherapy and radiotherapy have )ad effects on the memory of the patient. It has )een o)served that in maAority of the cases patients with )reast cancer get pro)lems in their short term memory. In present study, 1,, patients were asked a)out the effects of treatment on their memory. *ut of 1,,, 0@ patients replied that treatment affected their short term memory, ; patients said that treatment affected their long term memory while 0 patients said that treatment had no effects on their memory +?igure @-.
?2 62 52 42 32 42 32 22 12 2
'$ ef f e./s +f f e./s $n +f f e./s $n l$n1 /erm sh$r/ /erm mem$r" mem$r"

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+ffe./s $n mem$r" $f /he 0a/ien/: 9i1ure 5: +ffe./s $f /he /rea/men/ mem$r" $f CA 7reas/ .an.er 0a/ien/s:

+ffe./s $n 0re1nan." if 0re1nan/ durin1 /rea/men/

Breast cancer has so many )ad effects on female4s se8ual life. It has )een o)served in most of the cases that there is no pregnancy after )reast cancer. *ne reason for this might )e that due to the treatment and distur)ance in her married life. In present study, 1,, patients were asked a)out the effects of treatment on pregnancy. .ll the +1,,- patients replied that they have no pregnancy during the treatment of )reast cancer.

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Baldness is the most common side effect of the chemotherapy, that4s why mostly patients get afraid to get chemotherapy treatment. It has )een o)served that all the patients getting chemotherapy treatment have history of )aldness. In present study, 1,, patients were asked a)out the history of )aldness during the treatment. *ut of 1,,, >> patients replied that their hairs were lost while #' patients replied that they have no history of )aldness during the treatment +?igure 052 'um7er $f 0a/ien/s 42 32 42 32 22 12 2 Ye s '$

,is/$r" $f 7aldness 9i1ure 6 ,is/$r" $f 7aldness in 7reas/ .an.er 0a/ien/s:

)&SC*SS&('
$any studies have indicated that post surgical )reast cancer patients are facing serious psychological, physical, se8ual and interpersonal pro)lems +Irvine et al., 166 -.Conse/uently, most )reast cancer patients e8perience difficulties in their a)ility to perform normal daily social activities, and a considera)le fraction of these patients + ,5'>1- seem to suffer from moderate to severe emotional mor)idity +Irvine et al., 166 9 $orris et al., 166@9 Plum) et al., 166@-. $any patients of )reast cancer reported heightened levels of an8iety and illness related worries and reduction of energy and a)ility to do physical activities +"chag et al., 166#-. In present study it was o)served that all the )reast cancer patients have high level of an8iety at the diagnosis of )reast cancer. $any of them said that diagnosis of the )reast cancer was a death sentence for them. The patients were worried a)out the fate of the disease. They were very depressed in thinking that what will happen with their children after their death. The patients )elonging to poor families were worried a)out themselves and a)out the treatment e8penses )ecause they were una)le to )ear high e8penses of treatment of the )reast cancer. In present study 0,1 patients reported that their a)ilities to do physical activities were reduced after the treatment of )reast cancer. They felt loss of energy, fatigue and weakness. <omen diagnosed with )reast cancer may e8perience great emotional distress and develop a variety of psychological pro)lems including insomnia, loss of appetite, e8cessive alcohol consumption, and suicidal thoughts +"imoneton et al., 16@@-. The results of the present study revealed that after the diagnosis of the )reast cancer in maAority of the patients significant decrease in their sleep was reported. This distur)ance in sleep might )e due their intrusive thoughts a)out the disease and treatment of the disease as there are several side effects of the )reast cancer treatments.

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Treatment for cancer has profound impact on patient4s appearance and )ody image +2unsey and %arcourt ,,>-. Chemotherapy is recogni=ed as having a range of side effects including nausea, fatigue, hair loss, ulcers, which make patient feel ill in a way that actual disease does not + ?all5 !ickson and 2ose 1666-. .lopecia or hair loss often rated as one of the most common, feared and traumatic aspect of the chemotherapy +?all5 !ickson and 2ose 1666-. In present study maAority of the patients reported the side effects of their hairs loss, particularly those patients, who received the chemotherapy treatment. It was also noted that most of the )reast cancer patients were in severe depression due to loss of their hairs. To summari=e, the findings regarding the association )etween psychosocial factors and progression of )reast cancer are still controversial. *pposite conclusions can arise from differences in the design and analysis of the studies +Boodkin et al 166#-. The importance of controlling for clinicopathological prognostic varia)les such as tumor stage, histopathologic grading and receptor status has )een stressed many times )y several authors + ?o8 B 160,-.Intervening )ehavioral varia)les, such as diet, smoking and use of alcohol, may also )e responsi)le for the inconsistencies in findings across studies +%olland B 166,-. In addition, patients may vary in immune system status, which also seems to have value in predicting the course of )reast cancer +%er)eman 2 1606,$ohanty et al 1661. Therefore, to o)tain insights into the association )etween psychosocial factors and survival in )reast cancer patients, it seems reasona)le to focus on psycho)iologic mechanisms that could mediate such relationships. The findings of present study it has )een o)served that the patients involved in C. )reast cancer undergo several psychological effects. !uring the treatment of C. )reast cancer patients psychological treatment is must to )oost the self esteem and courage of the patient to fight against the disease.

C$n.lusi$n
Physiological and psychological changes were recorded in patients with )reast cancer. *ur study suggests that further work is re/uired to determine how psychological effects can )e )etter elicited )y early reorgani=ation and treatment i5e psychotherapy. "upport from the hus)and, family and society play a very important role to courage the will power of the patients to fight against the disease. "uch kind of awareness is of great significance for decreasing the mortality rate and )etter prognosis of this disease.

R+9+R+'C+S
Block ", ..ssesing and managing depression in the terminally ill patient. .nnals of Internal $edicine ,,,9# C ,65 10. !ickson ?, 2ose D, Caring for patients who e8perience chemotherapy5induced side effectsCthe meaning for oncology nurses.*ncology :ursing ?orum 1666 9 >C6,156,@. ?o8 B. Psychosocial factors and the immune system in human cancer. InC Psychoneuroimmunology . :ew EorkC .cademic Press. 160, Boodkin &. .ntoni $, "evin ., . partially testa)le predictive model of psychosocial factors in the etiology of cervical cancer. II. Bioimmunological, psychoneuroimmunological, and socioimmunological aspects, criti/ue and prospective integration. Psychooncology 166#9 C 651 1. %arrison 7, $aguire P, Pridictors of psychiatric mor)idity in cancer patients. British 7ournal of Psychiatry 166'91>;C;6#5;60. %elgeson F", "nyder P, "eltman %, Psychological and physical adAustment to )reast cancer over ' yearsC Identifying distinct traAectories of change. %ealth Psychol ,,'9 #C#G1;.

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%er)erman 2. Influence of the host on tumor development. !ordrechtC &luwer .cademic Pu)lishers 1606. %optopf $, Chidgey 7, .ddington5%all 7, Dan D, !ipression in advance diseaseC a systemic review.Part 1CPrevalance and case finding. Palliative $edicine ,, 9 1>C0156@. Irvine !, B. Brown , !. Crooks, 7. 2o)erts ,B. Browne. Psychosocial adAustment in women with )reast cancer. Cancer, 16619>@C1,6@5111@. Dawrie I., Dloyd5<illiams $., Taylor ?.,. %ow do palliative medicine physicians asses and manage depression.Palliatve $edicine ,,' 910C #'5 #0. $artin , . ., 7ackson, &.. !epression in palliative Care patients. 7ournal of pharmaceutical care in Pain and "ymptom Control 16669@C@1506. $ohanty I, $. :ayak , B. :anda . Cell mediated immune status in )reast carcinoma. Ind 7 Pathol $icro)ial, 16619 #'C 15>. Plum) $., 7. %olland . Comparative studies of psychological function in patients with advanced cancer. "elf reported depressive symptoms. Psychosom $ed , 16@@9#6C >'5 @>. 2unsey,:., !. %arcourt. The psychology of appearance.*pen University Press,Bukingham. ,,> "alee)a .&., $... <eit=ner, C... $eyers. "u)clinical psychological distress in long5term survivors of )reast cancerC . preliminary communication. 7 Psychosoc *ncol 166>91'C0#G6#. "chag C, P. Ban= , $. Polinsky, C. ?red, &. %irAe, D. Petersen. Characteristics of women at risk for psychosocial distress in the year after )reast cancer. 7 Clin *ncol 166#911C @0#5@6#. "imoneton, *.C., 7. .chter)erg, ?.B. Dawlis, ". $atthews. Psychological factors and )lood chemistries as disease outcome predictors for cancer patients. $ultivariate (8p Clin 2es 166@9 # C1,@G1 .

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