Recurrence of Cancer Psychosocial Impact

Recurrence of Cancer

Psychosocial impact of recurrent cancer: A nurse's perspective.

A diagnosis of cancer is devastating enough -- and the diagnosis of a chronic condition like recurrent cancer even more so. However, because of the physical difficulties in treating the condition, many healthcare providers can forget the profound psychological and social toll cancer (and cancer treatment) can take upon a patient's mental condition. A nurse, as noted by nursing theorists such as Betty Neuman, must treat the whole person, and the entire social and psychological constellation of conditions faced by the patient and the patient's family. "The two major components in the [Neuman] model are stress reactions and systemic feedback loops. Client reacts to stress with lines of defense and resistance. Continuous feedback loops fine-tune the lines of defense and resistance so as to achieve maximal level of stability. The client is in continuous and dynamic interaction with the environment" (Heyman & Wolfe 2001). The cancer nurse must introduce positive feedback to increase the sense of patient connectedness and resilience, and work against the stress the illness and treatment place upon the patient's body and mind.

As might be expected, generalized psychological distress and diagnosable full-blown medical conditions are common in cancer patients. In general, the more severe and debilitating the symptoms are to daily functioning, the greater the risk of depression. One study found that "in particular... The recurrent phase of breast cancer is an extremely difficult time...Those who had a major depressive episode after the onset of breast cancer are considered to have a higher risk of repeated psychiatric disorders" (Okamura 2005, pp. 303; 307). The cancer nurse must be aware of the fact reoccurrence can be equally if not more devastating than the initial diagnosis, and monitor the patient for signs of such mental illnesses, as well as be prepared to assure the patient that feelings of depression and distress are normal.

There is a cultural emphasis on 'beating' cancer, as embodied in the Lance Armstrong 'Live Strong' Foundation and the Susan G. Komen Foundation, for example, which associates survival with strength, and by implication in the eyes of some patients, recurrence of the cancer with weakness. A recurrent cancer patient may feel like a moral and physical failure. "I think it is part of the American spirit...There's this idea that you can succeed and conquer anything, even illness, on the basis of your character" observed one doctor (Baker 2008). A person with recurrent cancer may also be more apt to seek out alternative therapies out of desperation, but because these therapies associate the empowerment of beating cancer with the power of positive thinking or improved nutrition, a cancer patient may feel as if her or she is not 'working hard enough' if the cancer comes back (Quinlin 2001).

Feelings of depression and worthlessness can actually make some patients less apt to take proactive action during their treatment -- breast cancer patients were often reluctant to undergo the advised chemotherapy post-surgery, given their frustration with the side-effects of treatment and psychological state (Shavin 1982). They felt that the pain of treatment often went unacknowledged, and this type of 'what is the point' questioning must be dealt with by the nurse in a realistic and practical fashion, so the patient does not have a black and white view of his or her prognosis. The nurse must balance the need to foster empowerment and a sense of control over one's health while working against messages in the culture or within the patient's psyche that associate moral weakness with recurrence.

A study of women newly diagnosed with recurrent or metastatic breast cancer found that the greatest psychological difficulties they coped with as cancer patients were difficulties in communicating with doctors, perceived delay in diagnosis, the emotional impact of the initial diagnosis, concerns about the family's ability to cope with the cancer, feelings about why the cancer developed, other life stress and trauma, and being able to discuss with their doctors complementary use of non-prescribed treatments. Nurses can provide a sounding board to help the patient deal with such frustrations, as well as information about how to negotiate the medical system (Turney et al. 2005, p.396).

Patients may feel guilty about what they are 'putting their families through,' although interestingly, a study of children of recurrent cancer survivors only found a weak link between impaired functioning and distress on the part of the offspring and severity of parent's illness. There was no relationship between the psychosocial functioning of the ill mother and any aspect of her offspring's adjustment (Strauss 1992). Nurses must not make assumptions about the family's functionality or lack thereof, although helping children find an opportunity to just 'be kids' may be welcome (Belluck 2009). Having a good sense of the family's state of mental health can assist a nurse in gaining a sense of the patient's state of mental wellness, even though the two are not synonymous.

Although every individual is different, nurses should be aware that different communities may be affected differently by cancer in term of psychosocial effects. For example, African-American women with breast cancer have often found to have particularly high rates of social disconnection from fellow sufferers (Breast Cancer: Social disconnection in African-American women with breast cancer, 2009, Women's Health Law Weekly). Making sure that the patient's family understands the lifestyle and psychological implications of the illness, and connecting the patient to outside sources of community support is vital in such cases. African-American women and other non-white patients also show a lower rate of acceptance of psychosocial support and a willingness to view cancer as a psychological as well as a physically draining illness. While some ethnic groups may be generally less accepting of the idea that it is normal to feel depressed and that depression is not a sign of weakness, recurrent and advanced-stage cancer patients also show lower rates of acceptance of support across all ethnic lines.