New Study Finds Usual Care Enough to Promote the Well Adjustment to Early Breast Cancer
Women with early stage breast cancer who receive the usual care available in medical centers experience physical, emotional, and social adjustment over time without the additional interventions of standardized educational/supportive videotapes or individualized telephone counseling offered during each of the breast cancer stages.
Deborah Witt Sherman, PhD, CRNP, professor, University of Maryland School of Nursing, led an intervention study that appears in the current issue of the journal Applied Nursing Research, to evaluate the effectiveness of educational and supportive videotapes and/or telephone counseling compared to usual (standard care) on the adjustment of women with early-stage breast cancer during the stages of diagnosis, post-surgery, adjuvant therapy, and ongoing recovery.
The researchers enrolled 249 patients with early stage breast cancer from three major medical centers and one community hospital in New York City. They randomly assigned the patients into four groups. All four received usual care consisting of inpatient care and office visits provided by the medical team, including their physician, and nursing staff.
In addition to the usual care group, another group of women received the standardized educational supportive videotapes specific to the stage of breast cancer they were experiencing. A third group received individualized telephone counseling specific to each stage. A fourth group received both the educational videotapes and telephone counseling.
The videotapes included interviews with women and their family members, as well as interviews with breast surgeons, oncologists, and nurse experts. Consistent with crisis and stress-coping theories that guided the study, the educational videotapes were created to provide information about what the patients can expect physically, emotionally, and socially during each stage of the breast cancer experience.
As the telephone counseling was individualized, each session helped women normalize their experience and offered guidance and counseling to address their specific needs. Sherman says the counseling sessions explored whether breast cancer was viewed as a threat or as a challenge by the patient, as well as what types of support were valued by women.
Can breast cancer be found early?
Screening refers to tests and exams used to find a disease, like cancer, in people who do not have any symptoms. The goal of screening exams, such as mammograms, is to find cancers before they start to cause symptoms. Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast. The size of a breast cancer and how far it has spread are important factors in predicting the prognosis (outlook) for a woman with this disease.
Most doctors feel that early detection tests for breast cancer save many thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests. Following the American Cancer Society’s guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.
Some specific findings of the study include:
• Patients in all groups showed improvement over time in overall health, psychological well-being, and social adjustment.
• There were no significant group differences in physical adjustment, as measured by side effect incidence, severity, or overall health.
• There was poorer emotional adjustment over time in the usual care (control) group as compared to the intervention groups on the measure of side effect distress.
• For the telephone counseling group, there was a marked decline in psychological well-being from the adjuvant therapy phase through the ongoing recovery phase.
As an exception, Sherman reported that women receiving usual care reported greater side effect distress when receiving chemotherapy or radiation than did women who received educational or telephone support. In contrast to expectations, women receiving telephone counseling alone had a marked decline in psychological well-being during the adjuvant therapy through the ongoing recovery phase.
The researchers proposed that although personal discussion regarding the cancer experience may provide an outlet for women to discuss their concerns, it may not allow the opportunity to move health-related concerns into the background. Sherman suggests, “Maybe ongoing conversations about negative experiences keeps opening the wound rather than letting it heal.”
What Are the Symptoms of Breast Cancer?
In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:
- A lump in the breast or underarm that persists after your menstrual cycle; often the first apparent symptom of breast cancer, breast lumps are painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
- Swelling in the armpit.
- Although lumps are usually painless, pain or tenderness in the breast can be a sign of breast cancer.
- A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
- Any change in the size, contour, texture, or temperature of the breast; a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
- A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration; scaling of the nipple is symptomatic of Paget’s disease, a localized cancer.
- Unusual discharge from the nipple that may be clear, bloody, or another color. It’s usually caused by benign conditions but could be due to cancer in some cases.
- A marble-like area under the skin.
- An area that is distinctly different from any other area on either breast.
The researchers learned that adjustment issues continue for women during the ongoing recovery phase when all medical treatments have been completed. A small group of women in the study did not adjust well whether receiving usual care or extra interventions.