Cleora S. Roberts

Breast cancer patients' personality style, age, and treatment decision making

Previous studies have shown that whereas nearly all cancer patients want information, far fewer wish to make treatment decisions. Although breast cancer patients who were given a choice of lumpectomy versus mastectomy and were encouraged to make the decision were believed to do better psychologically, a 1994 study refuted this. Some authors suggest that patient personality style is an important consideration in decisional preference.

Use of Complementary Therapies Among Breast and Prostate Cancer Patients During Treatment: A Multisite Study

Purpose: The purpose of this study was to compare the use of complementary therapies (CT) among breast and prostate cancer patients during active cancer treatment. The authors compared use and beliefs about the role of CT in cancer recovery. Methods: A self-report survey was completed by 126 breast cancer patients and 82 prostate cancer patients as part of a multisite research project. The self-report questionnaire inquired about the use of various CTs, sources of information about CT, reasons for using CT, beliefs about the benefits and risks of CT, demographic characteristics, and cancer treatment history. Results: Most of the respondents were older than 50 years, Caucasian, married, had attended or completed college, and were less than 1 year postdiagnosis. Prostate cancer patients were significantly older than the breast cancer patients ( P < .001). Several differences emerged between the groups. Compared to the prostate cancer patients, significantly more of the breast cancer patients reported using CT because they wanted to reduce the risk of recurrence ( P < .01), play a more active role in recovery ( P < .01), help manage stress ( P < .01), take a more holistic approach ( P < .01), or boost the immune system ( P < .01). More of the prostate cancer patients reported using CT to have more control of their recovery ( P < .05). The 2 groups also differed significantly ( P < .01) on several beliefs about the potential benefits and risks of using CT. Conclusions: Most of the patients in this study had used some form of CT since the time of their diagnosis. Differences among breast and prostate cancer patients with regard to their use of CT during cancer treatment should be considered by oncology professionals who are discussing this topic with their patients.

Comparison of psychological symptoms of women requesting removal of breast implants with those of breast cancer patients and healthy controls.

&NA; Concern about the safety of silicone breast implants has led many women with numerous physical and psychological symptoms to seek breast implant removal. This retrospective group comparison study describes the psychological profile of women requesting breast implant removal compared with two control groups. The Brief Symptom Inventory was used to compare psychological symptoms of three groups of women: a preoperative breast implant group requesting removal of implants (n = 78), a postoperative breast cancer group without breast implants (n = 64), and a control group with no known breast disease and unknown breast implant status (n = 68). Scores were compared on the Global Severity Index of the Brief Symptom Inventory as well as on nine subscales: somatization, obsessive‐compulsiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The breast implant group had significantly elevated Global Severity Index scores, as well as somatization, obsessive‐compulsiveness, depression, hostility, and anxiety subscale scores, when compared with the other groups. Post hoc data analysis revealed that women who had implants after subcutaneous mastectomy as prophylaxis for breast cancer (n = 18) had a significantly different symptom profile and higher Global Severity Index scores than women who had cosmetic augmentation (n = 53). Additionally, women who had subcutaneous mastectomy and implants had significantly higher subscales of interpersonal sensitivity, phobic anxiety, paranoid ideation, and psychoticism than the cosmetic implant subjects. Women requesting removal of silicone breast implants had greater psychological distress than women who were recently diagnosed with breast cancer or controls with no known breast disease and unknown implant status. Within the implant group, however, women who had subcutaneous mastectomy showed greater psychological disturbance than those who had augmentation mammaplasty. (Plast. Reconstr. Surg. 99: 680, 1997.)

Psychological and rheumatic symptoms of women requesting silicone breast implant removal.

In this case series, we describe the psychological and rheumatic symptoms of 52 women requesting breast implant removal. Main outcome measures include psychological evaluation with the Brief Symptom Inventory and the Beck Depression Inventory. Clinical evaluation was performed using a rheumatic symptom survey. Results noted elevation of all Brief Symptom Inventory subscales (highest in Somatization and Obsessive-Compulsive), and the Beck Depression Inventory showed mild depression. Rheumatic survey noted a mean of 12 of 23 symptoms. In conclusion, psychological distress and mild depression are noted in this group, who also may experience rheumatic symptoms of connective tissue disease. There was a moderate positive correlation between rheumatic symptoms and psychological distress.

Toward Understanding Women Who Request Removal of Silicone Breast Implants

▪ Abstract: Fifty‐five women were surveyed prior to explantation of their silicone breast implants regarding their reasons for having implants and their reasons for wanting them removed. Open‐ended questions were used and content analysis was done to identify themes in their responses. Most of the women had implants for cosmetic reasons, with 28% having them for breast reconstruction after mastectomy. About one‐third were actively or passively encouraged by their male partners, while nearly the same number reported they were influenced primarily by female friends or relatives. Regarding reasons for removal, the most commonly cited reasons were breast health problems (implants ruptured, painful or uncomfortable) cited by 59%, general health problems (48%), diagnosed with connective tissue disease (25%), and concern about long‐term effects of silicone (18%). Some women blamed a broad array of health problems on the implants, and a few were angry about being given bland reassurances about the safety of the devices. However, the majority were uncertain about the role of silicone in their overall health but were hopeful that removal would restore their health and end their worries about long‐term effects. The average subject was 34 years old when she had the implants to feel more attractive. Now she is 44 and more concerned about her health and her family than her physical appearance. ▪

Outcome study of the psychological changes after silicone breast implant removal

Introduction: The purpose of this longitudinal study is to determine if there are changes in psychological well‐being after breast implant removal. Methods: Thirty‐seven women underwent breast implant removal and completed a preoperative baseline, early postoperative (4 to 9 months), and late postoperative (>10 months) Brief Symptom Inventory, a measure of psychological distress. Results: After breast implant removal the mean Global Severity Scores on the Brief Symptom Inventory of women undergoing implant removal increased over the three time periods, indicating increasing psychological distress. When the group was divided into those who had breast reconstruction after implant removal (implant replacement with saline‐filled implants or TRAM flaps) and those who did not have reconstruction, both groups had increasing psychological distress, but the women who had reconstruction had slightly higher scores. Women with a history of psychiatric treatment showed the greatest increase in psychological symptoms. Conclusion: Breast implant removal did not have psychological benefits in this group of women. Breast reconstruction after removal did not appear to be psychologically beneficial to this cohort. (Plast. Reconstr. Surg. 100: 595, 1997.)

When the Care Giver Needs Care

Abstract Case studies are used to illustrate family dysfunction that can occur when the wife and/or mother who has assumed the role of primary care giver is diagnosed and treated for cancer. These women were treated by the liaison psychiatrist and social workers at a large cancer center. The cases are discussed from a framework of family systems theory. Treatment implications for social workers in health care are also presented.