Breast Cancer Global Research: Coping, Social Support and Health of Women With Breast Cancer

Purpose:

Breast cancer is a stressful experience for women worldwide. National and international studies report poor quality of life, increased emotional distress among women with breast cancer. (Mayer, et al., 2010; Mukwato, et al., 2010; Yusuf, et al., 2013). Factors which can impact health after breast cancer include coping and social support (Doumit, et al., 2010; Drageset, et al., 2010; Kim, et al., 2010; Taleghani et al., 2006; Till, 2003). The purpose of this presentation is to discuss: global research findings on coping and social support and their impact on health of women with breast cancer; and implications of global research findings on coping and social support for nursing practice, advocacy and policy for women with breast cancer.

Breast cancer is the most common disease of women worldwide and it contributes to 23% of all newly diagnosed cases of cancer (Mukwato et al., 2010). Breast cancer is the most common cause of cancer death among women in developing countries including Cambodia, Nepal, Rwanda, Malaysia (Yusuf et al., 2013) and the second cause of cancer mortality among women in developed countries including the United States, England, Australia (Breast Cancer Global Statistics, 2015). The United States, India and China account for almost one third of global breast cancer cases. Factors contributing to reduction of breast cancer include better screening, early detection, increased awareness and improving treatment options.

Drageset, Lindstrom & Underlid (2010) studied coping with breast cancer in Norwegian women between diagnosis and surgery and found women coped by taking things step by step; pushing away; doing business as usual; enjoying life; dealing with emotions; preparing for the worst and positive focus. Women were aware of death but at the same time hopeful and optimistic. Themes related to social support were: available support; needing information, advice, care; having confidants; balancing distance and closeness with their social support network. Social networks both gave support and needed support. Other themes were feeling healthy, adapting to disease, waiting, uncertainty, informing others about breast cancer. Mukwato et al. (2010) found four predominate coping mechanisms for women with breast cancer and their family, namely, seeking social support; reliance on God; positive suggestion/attitude, and acquisition of information and education.  Distress in significant others is prevalent with a breast cancer diagnosis. Neris & Yokoyama dos Anjos (2014) studied spouses of women with breast cancer who were from Brazil, Canada, USA and Iran. Spouses worried that they will not be able to support and care for their wife. Breast cancer led to changes in the marital relationship, either it became more positive or increased conflict occurred. Research indicates social support may reduce anxiety, improves ability to cope with stress, reduces emotional distress, depression, fatigue, and pain and increase feelings of control (Denewer, et al., 2011; Mayer et al., 2010 ; Sammarco, 2001).  Study Purpose: To investigate coping, social support, and health of women with early stage breast cancer, and describe women’s perceptions of support received from husbands/significant others.

Methods: Lazarus and Folkman’s stress-appraisal-coping theoretical framework guided the study. Women aged 29 to 80(n=47) having mastectomy (n=33) or lumpectomy (n=14) surgery were referred by surgeons and nurse interviewed before surgery. Instruments: Ways of Coping Revised, Resources/Social Support Scale, Profile of Mood States.

Results: African-American women had more beneficial-positive appraisals than Caucasian women (t=2.80, p=.008). Ways of coping used quite a bit/great deal: concentrated on what to do; prayed; accepted sympathy; talked; let out feelings; got professional help; analyzed problem, changed or grew. African-American women used more distancing than Caucasians (t =2.27, p=.029). Hispanic women waited, slept, drank alcohol. Helpful resources were: social supports; American Cancer Society/New Life; religion/church; cultural practices; grieving; finances; good relationships; belief in control over future. Informational and emotional support were used more often than tangible support. Most husbands/significant others were supportive. Women reported men need education on how to help them through the breast cancer experience. Lumpectomy and mastectomy patients used the same types of social support to cope, namely, informational, emotional, tangible, and integration support. Women needing chemotherapy required more emotional support than women receiving hormonal or radiation therapy. African-American women had less tension-anxiety (t =-2.56, p=.014), less confusion (t =-2.27, p=.028), more vigor (t=4.47, p<.001), less mood disturbance (t=-3.22, p=.002) than Caucasians. Hispanic women reported uncertainty/fatigue.

Conclusion:

Women use a variety coping strategies/resources and support to reduce stress. African-American women use more distancing coping, had better emotional health than Caucasians. Implications focus on educating women on  helpful coping strategies/resources and support since these factors can affect health. Men need support and guidance to help women through their breast cancer diagnosis and treatment. Global research findings have implications for advancing practice, advocacy and policy for prevention and treatment of breast cancer in women.