A Comparison of Risk Perception and Psychological Morbidity in Women with Ductal Carcinoma in situ and Early Invasive Breast Cancer

Rakovitch, Eileen; Franssen, Edmée; Kim, John; Ackerman, Ida; Pignol, Jean-Philippe; Paszat, Lawrence; Pritchard, Kathleen I.; Ho, Cindy Wei Li; Redelmeier, Donald A.

doi:10.1023/a:1021853302033

Cited by 156 publications

(137 citation statements)

References 23 publications

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“…In spite of the relatively good prognosis, women's accounts reveal that for some, the experience is distressing and the implications are long-term, resulting in personal difficulties 'moving on' from the experience. The findings support the growing evidence that DCIS patients do not face 'less' distress (Rakovitch et al, 2003) but encounter different stress and emotions compared with those diagnosed with invasive breast cancer (Wellisch, 1997). This study identified a number of key issues which should be recognised and could inform future care and support in order to help DCIS patients adjust following the diagnosis and treatment.…”

Section: Discussion and Implications For Nursingsupporting

confidence: 81%

“…Anecdotal reports propose that the favourable prognosis should result in lower levels of psychosocial concerns (Hoffman, 1997). However, Rakovitch et al (2003) found that despite the generally positive outlook, DCIS patients expressed serious concerns and similar psychological morbidity to patients with invasive breast cancer. Research also suggests that women are confused about DCIS (De Morgan et al, 2002), have deficient knowledge about the condition and worry about their future cancer risk (Bluman et al, 2001).…”

Section: Introductionmentioning

confidence: 97%

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The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS)

Kennedy¹,

Harcourt²,

Rumsey³

2008

European Journal of Oncology Nursing

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Following the introduction of the National Health Service Breast Screening Programme (NHSBSP) in the UK increasing numbers of women are diagnosed with ductal carcinoma in situ (DCIS). In DCIS, the cancer cells are confined to the ducts of the breast but considerable uncertainty surrounds the condition. Patients are often reassured that it is non-invasive and not life-threatening but they are recommended similar treatments to patients with invasive breast cancer. Little research has investigated the psychosocial impact of DCIS; therefore the aim of this qualitative study was to explore women's experiences of the condition. Semi-structured interviews were conducted with a purposive sample of 16 women previously diagnosed and treated for DCIS. Thematic analysis identified six key themes: 1) Invisibility of DCIS, 2) Uncertainty, 3)Perceptions of DCIS, 4) Acceptance of Treatment, 5) Social Support and 6) Moving On.The results highlight the substantial challenges faced by women diagnosed with DCIS.These findings have clear significance for healthcare professionals, especially specialist nurses, who work closely with DCIS patients.

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Section: Discussion and Implications For Nursingsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 97%

The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS)

Kennedy¹,

Harcourt²,

Rumsey³

2008

European Journal of Oncology Nursing

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“…Anxiety, fear, depression and uncertainty are prevalent at diagnosis (Northouse, 1992;Spiegel, 1996Spiegel, , 1997Stark and House, 2000;Witek-Janusek, et al, 2007) and distress typically intensifies with treatment burden (Berger, 1998;Berger, et al, 2007;Maraste et al, 1992;Nail and Winningham, 1995;Schreier and Williams, 2004;Theobald, 2004). The emotional response to breast cancer is independent of disease stage, as women diagnosed with non-invasive breast cancers also experience powerful emotions (Witek-Janusek, et al, 2007;Northouse, 1992;Rakovitch, et al, 2003). The emotional impact of a cancer diagnosis and the rigors of cancer treatment adversely affect quality of life (QOL) and this may persist beyond treatment (Longman, et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer

Witek-Janusek

Albuquerque

Chroniak

et al. 2008

Brain, Behavior, and Immunity

397

324

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This investigation used a non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping in women recently diagnosed with breast cancer. Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSR program or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, as well as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-weeks post MBSR completion. Women with breast cancer enrolled in the control group (Non-MBSR) were assessed at similar times. At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity (NKCA) and IFN gamma production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients. Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN gamma production with increased IL-4, IL-6, and IL-10 production. Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping effectiveness compared to the Non-MBSR group. In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence of beneficial effects of MBSR on immune function, QOL, and coping effectiveness.

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“…A Canadian study reported similar levels of anxiety and depression in women with early-stage invasive breast cancer and those with DCIS. No differences were found between the two groups regarding perceptions of the risk of developing local recurrence, distant recurrence, or breast cancer death [15]. In a Dutch study, HRQoL was compared between women with DCIS and those with early-stage invasive breast cancer [16].…”

Section: Introductionmentioning

confidence: 99%

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

Sackey

Sandelin

Frisell

et al. 2010

European Journal of Surgical Oncology (EJSO)

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in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image. EJSO -European Journal of Surgical Oncology, WB Saunders, 2010, 36 (8) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. To investigate and compare long-term health-related quality of life (HRQoL), body image, and emotional reactions in women with ductal carcinoma in situ of the breast (DCIS) treated with different surgical methods. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Patients and Methods:A total of 162 women were included in the study (47 had mastectomy and immediate breast reconstruction (IBR), 51sector resection alone and 64 sector resection and postoperative radiotherapy). All women included in the study were asked to complete three questionnaires 4-15 years after surgery: the SF-36 for HRQoL, the Hospital Anxiety and Depression (HAD) scale, and the Body Image Scale (BIS). The response rate was 81%. Results:Women in all three study groups had, overall, a very satisfactory HRQoL in the long term, similar to women in the general population. Women who underwent mastectomy and IBR scored significantly higher on physical functioning and bodily pain than the other two study groups as well as their age-adjusted norm groups. The addition of radiotherapy to breast-conserving therapy did not seem to have any negative impact on long-term HRQoL. Our results show significant differences between the three study groups for six of ten BIS items, with a greater proportion of women in the mastectomy and IBR group reporting problems. Conclusions:Women treated for DCIS have a very satisfactory long-term HRQoL. However, body image appeared to be negatively affected in mastectomy and IBR patients. Our results indicate that these women need more preoperative information about what changes in body image to expect after surgery.

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A Comparison of Risk Perception and Psychological Morbidity in Women with Ductal Carcinoma in situ and Early Invasive Breast Cancer

Abstract: Despite the excellent prognosis, women with DCIS express serious concerns and report similar psychological morbidity as women with invasive cancer.

Cited by 156 publications

References 23 publications

The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS)

The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS)

Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

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