Women’s Emotions Prior to Their Diagnoses with Breast Cancer

1. Women’s Emotions Prior to Their Diagnoses with Breast Cancer E. Adams, SPT, B. Annis, SPT, A. Hudyncia, SPT, T. Jornov, SPT, A. Klig, SPT, S. Livingston, SPT, A. Zonneville, SPT Advisor: Dr. Lynda J. Dimitroff, PhD, BSN, RN, CHES Purpose Emergent Themes Emergent Themes Conclusions The purpose of this research is to describe women’s emotions prior to their diagnosis with breast cancer Emotions Before Diagnosis: 13/14 Women reported negative emotions, including worry, depression, and stress, prior to their diagnosis. “…terrible sadness, emptiness, depression, very down…” Relationship with Dad (child, teenager, adult): 17/23 Women reported atypical relationship with father throughout their life (no real relationship, not demonstrative father, abusive/poor relationships, abnormal relationships). “I remember being a very young child and feeling intense dislike or I even want to say hatred for him. I didn’t respect him…an amazingly critical man…my dad wasn’t there physically for us.” Resentment in the Past: 18/24 Women reported having resentment in the past, prior to their diagnosis. “I let the resentment build…I never knew how to speak up.” Suppression/Internalization of feelings: 13/14 women reported suppression/internalization of feelings and emotions, especially anger, prior to their diagnosis. “I kept internalizing a lot and held it in…I didn’t want to cause any waves.” Taught about Sexuality Growing Up: The majority of women reported a lack of information/formal education taught about sexuality growing up. “Never learned about sex…grew up with conserved mom who never talked about sex.” Sexuality Before Diagnosis: The majority of women reported low self-esteem prior to their diagnosis. “I didn’t feel good about sex, didn’t feel good about body” “I would do it when I didn’t want to do it…I felt like it didn’t have any meaning to me…I didn’t have the same sexual satisfaction…I played along with it.” Losses: 13/13 Women reported experiencing a significant loss that impacted their lives prior to their diagnosis with breast cancer. 13/13 Women reported a significant loss of a parent or in law due to death or just loss of relationship prior to diagnosis. “”Business closed…marriage broke up, father got ill and died suddenly…left with a handicapped mother…mother in law died of cancer (crying)…father in law died…” Unhealthy Relationships with Spouse- 12/14 Women reported unhealthy relationship with spouse. “He clipped my wings, he made me unsure of myself…I didn’t like myself when I was married to him” Inability to Deal With Significant Amounts of Stress: 14/24 Women reported stress from significant people in their lives including parents, husband, or kids. “You feel you should be at home with your family, and yet you should be there (with her sick father), and you can’t do enough in either place.” Feelings of Worthlessness: 7/14 Women reported some sort of abuse whether sexually, physically, or emotionally. “He punched me in the jaw one time for calling the cops on him when I thought he had thrown my mom out the window because I heard it downstairs, the crash (in relation to her father).” Taking Care of Others: 13/16 Women reported taking care of another family member prior to their diagnosis. “People used to pile things on my desk and I would always take care of everything for everyone.” Giving at My Expense: 19/19 Women reported giving at their expense/putting others needs ahead of their own prior to their diagnosis. Took care of everybody but self, yes always others 1st “I can’t say no.” The majority of women reported negative emotions prior to their diagnosis. The majority of women reported an atypical relationship with their father throughout their life. The majority of women reported suppression/internalization of feelings and emotions as well as feelings of resentment prior to their diagnosis. The majority of women reported a lack of information/formal education about sexuality growing up and having low self-esteem. All women reported experiencing a significant loss that impacted their lives (parent, loved one, career, etc.) prior to their diagnosis. The majority of women reported having an unhealthy relationship with their spouse. Majority of women reported the inability to deal with a significant amount of stress. Half of women reported some sort of abuse prior to their diagnosis. The majority of women reported giving at their expense and taking care of others and putting other’s needs ahead of their own. Background There is a limited amount of evidence exploring the mind/body connection regarding women’s emotions prior their to breast cancer diagnosis. In the 1950’s Leshan and Worthington published several studies addressing this issue; their findings included that the loss of a major relationship, blocked abilities to express hostile feelings, self dislike/distrust, and tension over the relationship with one or both parents may contribute to the onset of breast cancer.1 More recently, there has been evidence suggesting that severe life events and anger repression may be significant risk factors.2 Overall the literature states that there is not enough evidence to determine whether or not depression, coping styles, personality factors and stressful life events play a role in the etiology of breast cancer.3,4,5 There are non-modifiable and modifiable (lifestyle choices) risk factors that are associated with breast cancer. Non-modifiable risk factors include: gender (female), age (>55 years old), genetics (women with BRCA1 and BRCA2 genes have an 80% chance for breast cancer development), family history, personal history, race (Caucasian), dense breast tissue, age at menarche (<12 years old), and lobular carcinoma in situ (increases risk 7-11x). Modifiable risk factors include: age at first live birth (older accounts for increased risk), recent use of birth control pills, post-menopausal hormonal therapy, not breast feeding, alcohol, obesity, and lack of exercise.6 Recommendations Increase education on positive coping styles to deal with stress, loss, and dealing with other negative emotions. Increase awareness regarding the importance of a healthy father-daughter relationship. Providing young females with education regarding sexuality is pivotal in building high self-esteem. Increase awareness emphasizing the importance of addressing one’s own needs rather than giving at their expense. Research Design Qualitative methods with a feminist theory framework. Semi-structured interviews Constant comparative analysis References Participants • Leshan L, Worthington R. Some recurrent life history patterns observed in patients with malignant disease. The Journal of Nervous and Mental Disease. 1956;124 (5): 46-50. • Butow et al. Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer. Journal of Psychosomatic Research. 2000; 40:169-181. • Bleiker E and van der Ploeg H. Psychosocial factors in the etiology of breast cancer: review of a popular link. Patient Education and Counseling. 1999; 37: 201-214. • Dalton et al. Mind and cancer: do psychosocial factors cause cancer? European Journal of Cancer. 2002; 38:1313-1323. • Jacobs J and Bovasso G. Early and chronic stress and their relation to breast cancer. Psychological Medicine. 2000; 30:669-678. • American Cancer Society. What Causes Breast Cancer? September 29, 2009. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_breast_cancer_5.asp. Thirty Caucasian women diagnosed and treated with breast cancer over 18 years old living in western New York will be interviewed.