The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship

Abstract

Background Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty / anxiety about cancer recurrence many years post-treatment. Because breast cancer onset frequently occurs in older women, survivors may have additional age-related illnesses and symptoms yet be uncertain about whether the cause of their symptoms is normal aging, another illness, or breast cancer recurrence. Physiologic responses such as immune alterations may predispose women to exacerbations of these illnesses. The survivor-provider relationship is also influential give the long standing nature of ongoing breast cancer surveillance post active treatment completion. Objective The purpose of this study was to evaluate relationships between emotional distress (uncertainty, anxiety, fear of recurrence), immunity (cytokine levels, lymphocyte counts), and communication events (women’s plans for their visit, the ability to negotiate decision-making roles) immediately before and 24 hours after a regularly scheduled medical oncology surveillance visit. Methods We evaluated relationships between emotional distress (uncertainty, anxiety, fear of recurrence), immunity (cytokine levels, lymphocyte counts), women’s plans for their visit, and their ability negotiate decision-making roles, before and after a medical oncology visit. Results Emotional responses (uncertainty, anxiety, fear of cancer recurrence) to an upcoming medical oncology were associated with change in immune status pre-post visit. Post-visit NK cells increased in 70% of women, and uncertainty/anxiety decreased. Most women had a plan for their oncology visit and 66% successfully negotiated decision-making roles with providers although these factors did not predict emotional or immune outcomes, perhaps due to longstanding relationships previously established with their medical oncology provider. Conclusions breast cancer survivors in this study, as in others, report uncertainty and anxiety related to the fear of cancer recurrence associated with routinely scheduled medical oncology visits. Women also experienced alterations in immune responses to the stress of a routine medical oncology visit. The interaction between women and their oncology providers has the theoretical potential to allay both emotional and physiological responses to this stressor, contributing to the well-being and quality of life for older long-term breast cancer survivors Implications for Practice Because not all women respond in a similar fashion to an upcoming medical oncology surveillance visit there is a need to determine who may be most at risk for more acute alterations in immunity related to the fear of cancer recurrence that is inherent in ongoing surveillance after treatment for breast cancer. When the meaning of symptoms is understood, and existing symptoms are not erroneously attributed to breast cancer recurrence, quality of life is enhanced and women can move forward in their lives without significant emotional distress1. ...

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