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THE IMPLICATIONS OF BREAST CANCER ON THE FAMILY
ABSTRACT: (Hide the abstract)
Starting from the basic element, the couple, it can be defined as a biopsychosocial structure, where partners stimulate each other, support each other, growand accomplish themselves as biological individuals, social and affective, one through the other. In this approach, two essential elements are identifiedinvolved in the construction of family life, biological and social side that is in a constant change depending on the psychological dynamics of the relationshipbetween the two partners. They streamline their objectives through the completion of their life events planned or not, having positive or negativeconsequences on the relationship of the couple.In the present study, the emphasis is put on the implications of breast cancer over the life of the couple. In this regard, a study was conducted in theOncology clinic of the Municipal Hospital in Timisoara, on patients diagnosed with breast neoplasm. The study was attended by 200 patients with breastneoplasm who were administered the SF-36 and the Questionnaire for the assessment of Unhappiness.A diagnosis of cancer affects not only the patient but also the family, friends, and community of the individual.
Breast cancer constitutes an important cause of morbidity and mortality, representing the second cause of death in women. According to the World
Health Organization, more than 1.2 million people are diagnosed with breast cancer each year and over 500,000 die because of this affection. Breast cancer mortality rate has decreased since 1990 due to early diagnosis and improve treatment methods.
Constantin Enăchescu said that “any illness, regardless of its nature (somatic, psychological or psychosomatic), is accompanied by a particular state of mind of the patient, which is materialized in the psychology of the patient” [1, 2].
Breast cancer is a complex and traumatic disease, considered to be systemic since its diagnosis.
Women recognize and agree with reducing the risk through the practiced surgical procedures, but thy are thinking about aspects of emotional, social, sexual and marital functioning, about synchronizing with an upcoming surgery, about pregnancy or other family needs and objectives. It is also necessary to encourage the woman to have a discussion with their spouse/
partner, precisely in order to dispel his anxiety and to straighten any uncertainties in terms of evolution, prognosis and the family’s future. Most women consider this aspect as being of utmost importance for them [3, 4].
MEANS AND METHOD
The study is a prospective one, we studied patients with breast neoplasm that presented themselves in the Oncology clinic from the Municipal Hospital of Timişoara in the period 2014-2016. It was aimed at drawing up a batch of patients whose diagnosis would include the phenomenon of breast cancer, from its apparition its development and the treatment applied, with the full range of effects causing physical and mental discomfort. The studied batch consisted of 200 subjects between the ages of 25 and 59 years. Of these 100 subjects consists of women diagnosed with breast neoplasm and a control group consisting of 100 healthy women.
For the realization of this study, the questionnaire for measurement of the quality of life SF-36 was used, of which I highlighted the area of social relationships (personal relationships, social support, sexual activity), personal as well as the questionnaire of unhappiness evaluation. The questionnaire of unhappiness evaluation addresses the following major fields of life: the relationship with the spouse and children, anxiety, emotional suffering, social life, disappointment, loneliness, depression, personal independence and life satisfaction.
Table 1 shows the averages and standard deviations for the scale of social relations, the quality of life in patients with breast cancer and healthy persons, i.e., the age groups, the total scores ranged from 9.30 to 14.30(M=11,83; AS= 1,19).
Of the three ratios F, presented in table 1, only one is statistically significant: F „lot” F (1, 194) = 18,427, p < .001 (M= 11,49 versus M= 12,16).
This means that there are statistically significant differences between patients with breast cancer and healthy individuals, patients have a lower level of quality of life on the level of social relations, compared to healthy individuals, due to the fact that the main effect for batches are submitted as being statistically significant.
The effect of the age variable on the field of social relations of the quality of life variable is statistically insignificant F (2,194)= 0,233, p >.05. This means that there were no significant differences found between the three age groups at the sick subjects (M=11,75 on the group aged between 25-36 years, M=11,44 on the group aged between 37-46 years and M=10,94 on the group aged between 47-59 years), compared with the healthy persons (M=12,09 on the group aged between 25-36 years, M=12,30 on the group aged between 37-46 years şi M=12,53 on the group aged between 47- 59 years).
Also, the interaction effect of age group and the field of social relations of the quality of life is statistically insignificant, F (2,194)= 2,929, p >.05 .
A low score of social relations means interference also marked as frequent with normal social activities due to physical or emotional problems, and a low score of emotional role translates into the existence of problems with work or other daily activities because of emotional problems.
Social factors play a particularly important role in maintaining health, and the neoplasm through its consequences affects the patient suffering from the disease not only physically but also on a social plan .
The personal relationships side investigates how the person id receiving his or hers entourage and the need for intimate relations. The ability and possibility to love and be loved are followed as well as the ability to share joy, happiness or sadness.All kinds of personal relationships are investigated (about the couple, of friendship, marriage), as well as positive or negative experience. The obtained results reveal significant differences between the two groups in terms of personal relationships with an impairment to the sexual activity.
The social support explores the way the person feels the support, engagement, encouraging from family and friends. The questions are centered on the degree to which the entourage supports the person and share the responsibilities. It also included the negative role that family and friends may have over the person, the fact that she does not receive encouragement, that she is rejected, neglected, does not receive the support she certainly needs. The benefits and the importance of social support over the other, and in particular upon the person in an unfortunate situation are well known.
The character of the disease, its evolution, affect not only the patient’s life but also the lives of her family, for this reason the scores obtained report significant differences between the two groups studied [7, 8].
Sexual activity evaluates the desire and sexual appetite, the extent to which a person may normally express their satisfaction and sexual need. The questions from this side target sexual energy, expressing and sexual satisfaction. Sexual orientation is not taken into account only the impact of sexual activity on the quality of life.
Sexual activity is in close connection with the side of self-esteem, body image and negative feelings, all of which are affected in the case of patients with breast neoplasm.
Self-esteem refers to feelings towards one’s self. Self-esteem reflects how the person is considered to be efficient and self-satisfied. Items aimed at education, the ability to acquire new skills, interact with people, self-acceptance, family relationships, work capacity .
Decreased self-esteem and a sense of unfulfillment, may be due to a lack of social relations, but also reduced participation in other activities.
Body image and appearance refer to the positive or negative way to perceive one’s own body, the degree to which body changes are perceived. Body image is also influenced by the attitudes of others towards a person’s appearance.
Body image may be altered as a result of breast neoplasm with negative effects on quality of life.
Total or partial mastectomy distorts the body image which could be the cause of timidity and embarrassment, feelings of inferiority and a decline in self-confidence.
Negative feelings are targeting the sadness, the despair, the anxiety and nervousness. The questions are investigating psychological changes such as depression, mania, panic attacks, without evaluating their severity [7, 8].
The increased incidence of complications related to the disease and treatment, poor social integration and the lack of social relations are the consequences of the various psychological disturbances in oncological patients .
Regarding the questionnaire for measuring the unhappiness, among the lot studied significant differences were obtained between the two lots on all measured variables (the relationship with the husband and children, anxiety, emotional suffering, social life, disappointment, loneliness, depression, personal independence and life satisfaction (Table 2).
Breast cancer is the most common malignant tumor encountered in women. The life-long risk of developing breast cancer is 1 in 8, and the life-long risk of dying because of breast cancer is 1 in 28. In Romania, there are annually around 50000 cases of breast neoplasm.
A diagnosis of cancer affects not only the patient but also the family, friends, and community of the individual.
It is often the partner of a patient with cancer that is affected most significantly of all the family members. Both the patient and their partner may experience strong emotions about the condition, such as sadness, anxiety, or anger, which can affect the relationship.
Cancer can also have an impact on sexuality and the intimacy of couples. Many treatments for cancer may cause side effects such as low libido, vaginal dryness, or depression, which may interfere with intercourse and sexuality. This can contribute to anxiety and tension between the couple, which may be difficult to discuss and work through.
Additionally, continued involvement in social and other community activities should be encouraged for family members. While it is acceptable to cancel activities when feeling emotionally or physically tired, an outlet outside of the direct family can often help to reduce stress levels.