Underfifty Women and Breast Cancer: Narrative Markers of Meaning-Making in Traumatic Experience

The Role and Function of Autobiographical Memory Narratives during the Emotional Processing of Breast Cancer Treatment: An Empirically-Derived Memory Coding System

Breast cancer (BC) in younger age is a critical and potentially traumatic experience that can interrupt the continuity of self-narrative during a crucial phase. In the Narrative Identity framework the translation of memories into autobiographical narratives is an internal and external process that plays a key role in meaning-making, social relationships and self-coherence. The aim of this study is to examine the role and function that autobiographical memory narratives (AMN) play in the process of adaptation to BC medical treatment. Seventeen BC women below 50 years received prompts to provide autobiographical memory narratives at four phases during their treatment (pre-hospitalization-T1-post-surgery-T2-chemo-radio therapy-T3-follow-up-T4). The Emotional Processing Scale (EPS) was also administered. In all, 68 AMN were collected. A three step procedure of data analysis was conducted. The first one, an empirically-derived memory coding manual to analyze key dimensions of AMN was developed: Agency; Emotional Regulation and Interpersonal Relations. Findings show a particular vulnerability in narrative identity faced by BC women during the shift from T1-T3. In the second one, an emotional coping profile for each woman focusing on the shift from T1-T3 was created. For the third step, these profiles were compared with the EPS scores. The final results suggest the capacity of the AMNs to differentiate the women's emotional adaptation over the course of the BC treatment. Despite the study's limitations, it supports the use of AMN as clinical device to construct a deeper knowledge and profiling trajectory of how women have internalized and elaborated past encounters with illness and help providers, as well as their prior experience of bodily/psychological health and integrity. This information adds to an understanding of their current efforts at recovery and adaptation. In this way we believe that the recollection of narrative memories, not only at the end of the cancer treatment but also during its process, could help the women to mend the broken continuity of their narrative self, as they seek to maintain a healthy balance of internal resources across their past, present, and projected future.

Cancer Prevention Sense Making and Metaphors in Young Women’s Invented Stories

Despite the proven effectiveness of cancer prevention, the literature highlights numerous obstacles to the adoption of screening, even at a young age. In cancer discourse, the metaphor of war is omnipresent and reflects an imperative demand to win the war against disease. From the psychodynamic perspective, the risk of cancer forecasts an emotionally critical experience for which it is important to study mental representations concerning illness and health care. Through the creation of an invented story that offers a framework for imagination, our aim is to understand what the relationship with preventive practices in oncology means for young women and how this relationship is revealed by their metaphors. A total of 58 young women voluntarily participated in the present research, answering a narrative prompt. The stories written by the participants were analyzed using qualitative methodology to identify construct, themes and metaphors. Our findings identify four constructs: the construction of a defense: youth as protection; the attribution of blame about cancer risk; learning from experience as a prevention activator; and from inaccessibility to access to preventive practices: the creation of engagement. The construction of an invented story allows us to promote a process of prefiguration on the bodily, affective and thought planes invested in preventive practice and brings out the use of metaphors to represent cancer risk and self-care. The results allow us to think about the construction of interventions to promote engagement processes in prevention from an early age.

Early Diagnosis of Melanoma and Breast Cancer in Women: Influence of Body Image Perception

The diagnosis of melanoma and breast cancer may impact many aspects of life with significant reductions in emotional functioning and quality of life. The aim of the study was to analyze the emotional traits of female patients with oncological in early-stage diagnosis, investigating predictors for psychological distress and analyzing body image perception. An observational study was conducted, A sample of 84 female cancer patients (age range 30–55 years) with melanoma (n = 42) and breast cancer diagnosis (n = 42). The examined emotional variables were psychological distress; depression, stress, and anxiety; metacognitions; and body self-perception. Findings showed higher psychological distress in breast cancer than in melanoma patients (p = 0.00), which was related to lower positive self-perception of body image (p = 0.03). Furthermore, psychological distress was negatively correlated with consequences of clinical treatment on body image, and low well-being affected the social interaction and well-being with own body. There was no significant difference between cancer staging and timing from diagnosis. Prevention and therapeutic psychological protocols might be adapted and tailored to the unmet needs of the patients in medical treatments to promote and enhance the Quality of Life in survivorship.

Unveiling beauty: Insight into being tattooed postmastectomy

BACKGROUND

It could be argued that mastectomy tattoos are being considered by some women in contemporary society as an alternative to breast reconstruction.

AIM

To gain insight into the experience of "being" tattooed where breast(s) once occupied space, six women with mastectomy tattoos were interviewed.

METHODOLOGY

The teachings of Gadamer's philosophical hermeneutics were engaged to better understand what it means "to be" tattooed postmastectomy.

RESULTS AND DISCUSSION

Discoveries include feeling sad and damaged postmastectomy, embodying the tattoo as a novel representation of self for women living without breast(s), and reclaiming power, control, and confidence in a way that is symbolically meaningful.

CONCLUSION

Health care providers working with women diagnosed with breast cancer are invited to learn from women with mastectomy tattoos and to consider expanding discourse about care to include options beyond breast reconstruction.

The Network That Unites a Qualitative Study on Clinical Psychological Intervention for Women with a History of Breast Cancer and Chronic Pain

The aim of this qualitative research is to deepen the knowledge in the field of psycho-oncology and the consequences of chronic and persistent pain by listening to patients’ experiences, their emotions and difficulties in facing this hard condition, and assessing their perception of the role of the psychologist in pain management. In this qualitative study, a semistructured interview was used, designed from three research questions: chronic pain and quality of life; chronic pain and psychological well-being; and the role and perception of the psychologist in pain management. The sample consists of 29 women who suffered or have recovered from breast carcinoma, and who currently report having chronic pain due either to the presence of the cancer or as a result of surgery or treatment. Three themes emerged from the thematic analysis: quality of life and psychological well-being, relational well-being, and perception and role of the psychologist. Two subthemes have been identified for each theme: common features of chronic pain and consequences and resilience for the first theme; not feeling understood and willingness to protect loved ones for the second theme; and improvements perceived by users and reasons for not making use of the service for the last theme. In conclusion, the results obtained from the literature and those from the analysis of the interviews are discussed and compared, and reflections are made on possible future implications.

Pre-surgery supportive and goal-oriented strategies are associated with lower post-surgery perceived distress in women diagnosed with breast cancer

BACKGROUND

Psycho-oncology literature pointed out that individual health outcomes may depend on patients' propensity to adopt approach or, conversely, avoidant coping strategies. Nevertheless, coping factors associated with postoperative distress remain unclear, unfolding the lack of tailored procedures to help breast cancer patients manage the psychological burden of scheduled surgery. In view of this, the present study aimed at investigating: 1. pre-/post-surgery distress variations occurring among women diagnosed with breast cancer; 2. the predictivity of approach and avoidant coping strategies and factors in affecting post-surgery perceived distress.

METHODS

N = 150 patients (mean age = 59.37; SD =  ± 13.23) scheduled for breast cancer surgery were administered a screening protocol consisting of the Distress Thermometer (DT) and the Brief-COPE. The DT was used to monitor patients' distress levels before and after surgery (± 7 days), whereas the Brief-COPE was adopted only preoperatively to evaluate patients' coping responses to the forthcoming surgical intervention. Non-parametric tests allowed for the detection of pre-/post-surgery variations in patients' perceived distress. Factor analysis involved the extraction and rotation of principal components derived from the Brief-COPE strategies. The predictivity of such coping factors was investigated through multiple regression (Backward Elimination).

RESULTS

The Wilcoxon Signed-Rank Test yielded a significant variation in DT mean scores (TW = -5,68 < -zα/2 = -1,96; p < .001) indicative of lower perceived distress following surgery. The four coping factors extracted and Varimax-rotated were, respectively: 1. cognitive processing (i.e., planning + acceptance + active coping + positive reframing); 2. support provision (i.e., instrumental + emotional support); 3. emotion-oriented detachment (i.e., self-blame + behavioral disengagement + humor + denial); 4. goal-oriented detachment (i.e., self-distraction). Among these factors, support provision (B = .458; β = - .174; t = - 2.03; p = .045), encompassing two approach coping strategies, and goal-oriented detachment (B = .446; β = - .176; t = - 2.06; p = .042), consisting of one avoidant strategy, were strongly related to post-surgery distress reduction.

CONCLUSION

The present investigation revealed that the pre-surgery adoption of supportive and goal-oriented strategies led to postoperative distress reduction among breast cancer patients. These findings highlight the importance of timely psychosocial screening and proactive interventions in order to improve patients' recovery and prognosis.

Trajectories and predictors of social avoidance in female patients with breast cancer

BACKGROUND

Social avoidance plays an important role in influencing quality of life among patients with breast cancer. Social avoidance behaviors change with treatment periods. However, the trajectory patterns and the predictive factors have not been fully studied.

OBJECTIVE

This study examined the growth trajectory of social avoidance and its predictors in patients with breast cancer.

MATERIALS AND METHODS

A total of 176 patients with breast cancer in a university hospital in Shaanxi Province, China, were followed up four times over 6 months following surgery, and data from the final 144 patients were analyzed. The growth mixed model (GMM) was used to identify the trajectory categories, and the predictive factors of the trajectory types were analyzed by logistic regression.

RESULTS

The best-fit growth mixture modeling revealed three class models: persistent high social avoidance group (Class 1), social avoidance increased first and then decreased group (Class 2), and no social avoidance group (Class 3), accounting for 13.89, 31.94, and 54.17% of patients, respectively. Single-factor analysis showed that family income per capita, residence, and temperament type were related to the social avoidance trajectory. Logistic regression analysis showed that only temperament type was an independent predictor of the social avoidance trajectory, and patients with melancholia were more likely to have persistent high social avoidance.

CONCLUSION

Our study proved the heterogeneity of social avoidance behaviors and the influencing effect of temperament type on the development of social avoidance behaviors in Chinese patients with breast cancer. Health professionals should pay more attention to patients who are at higher risk of developing a persistent social avoidance pattern and provide target interventions.

Attributions of survival and methods of coping of long-term ovarian cancer survivors: a qualitative study

Background

Only 8–23% of advanced epithelial ovarian cancer patients survive for 10 years or longer. Given the need for targeted interventions to improve survival, we interviewed this relatively rare survivor population to gain personalized insights into the reasons for their survival. The aim of this study was to characterize subjective attributions of survival and specific coping mechanisms long-term survivors of ovarian cancer.

Methods

Twenty-two semi-structured, qualitative interviews assessing survival attributions and coping strategies were conducted from April to November 2014. Data were analyzed in a multistep process using ATLAS.ti.8: codes were identified during review of the transcripts and refined with literature review; the frequency of codes and code co-occurrence was calculated, and codes were grouped into themes. Resulting themes were checked by a national leader of an ovarian cancer advocacy organization and compared against available literature.

Results

Thematic analysis found that participants credited their long-term survival to a variety of factors including medical, social, religious/spiritual, and lifestyle/personal characteristics. Some participants rejected these same attributions, concluding that the reason for survival was due to luck or unknowable. Several of Carver et al.’s theoretical dimensions of coping were evident in our sample: planning, positive reinterpretation, social support, religion and acceptance whereas three relatively new strategies were uncovered: conserving emotional energy, value-based activity coping, and self-care.

Conclusions

Long-term survivors’ perspectives were largely consistent with those of newly diagnosed ovarian cancer patients and ovarian cancer survivors of shorter duration. However, the long-term survivors were also willing to reject conventional attributions for survival and recognized the importance of disciplined self-preservational coping strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01476-1.

A review of psychological impact of breast cancer in women below 50 years old

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

Lived experiences of women suffering from breast cancer in Kashmir: a phenomenological study

Using a phenomenological approach, this study aimed to gain an in-depth understanding of the lived experiences of Kashmiri women suffering from breast cancer within the context of their day-to-day lives. Snowball sampling and theoretical sampling techniques were employed for recruiting participants. Data collection was primarily based on the principles of data saturation. Data saturation occurred after 12 women with breast cancer were interviewed. Data was collected using face-to-face in-depth individual interviews. The interview guide consisted of open-ended questions. To attain the utmost variation, sumptuousness and profundity of responses, interviewer asked probing, specific, and interpreting questions during interviews. Data analysis of the transcripts was based on Graneheim and Lundman’s (Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 2004;24:105–12) procedures for taking out themes in qualitative data. Two main themes emerged that explained the lived experiences of women with breast cancer: (i) challenges encountered (altered body image, embarrassment, perceived worries, financial constraints, dealing with negative attitudes and stigma) and (ii) coping strategies (reliance on religion and spirituality, social support, living as usual, optimistic attitude and will to recover, and venting out). The findings revealed that breast cancer diagnosis influences women significantly as they acknowledged that it wasthe most traumatic experience of their life; however, with time, they started to accept the reality and made use of various methods to cope with their illness.

Engaging Patients and Families to Help Research Inform and Advance Patient and Family-Centered Care in Critical Care Medicine

Intensive care unit (ICU) patient, and family member engagement is evolving in both critical care medicine practice and research. The results of two qualitative critical care research projects led by ICU survivors and family members show how patient-partner research training can inform the critical care community of meaningful priorities in the traumatic ICU context. The resulting creation of a prioritized list of critical care research topics builds further on the construct of patient-centered care.

Narratives of Self-Harm at School: Identifying Trajectories of Intervention in Educational Contexts

Recent studies have shown that self-harming behaviour is increasingly widespread among adolescents, in particular at school. However, educational institutions perceive themselves unable to cope with the phenomenon, searching for protocols and guidelines to improve its management. Considering schools as useful contexts for intercepting the young malaise, this study aims at exploring the main meanings of self-harming behaviours made within the educational cultural contexts starting from the student’s narrations, in order to understand the possible trajectories of practice. In two high schools we have collected 96 narratives of self-harm written by adolescents (mean age 14; 74% females), who have been engaged in non-suicidal self-injury once in their life. The analysis of the narratives, produced with the help of a software for the automatic qualitative analysis of texts, has allowed to identify four prevalent themes organized into three sense vectors. The findings highlighted significant gender differences in the representation of the experience of self-harm between males and females, as well as the importance of meaningful relationships developed in familiar and educational contexts, which may allow the help seeking process. The emerging of culturally-shared meanings among adolescents within the investigated contexts may allow to think about possible protocols of preventive and clinical practices in schools.

A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions

Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory.

Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis.

Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness.

Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.

Psychological Aspects of Breast Reconstruction after Breast Cancer

Even though breast cancer mortality is declining, the diagnosis still poses a huge threat for the affected woman and her close family. Breast cancer surgery, which often includes reconstructive procedures, can help restoring a satisfactory body image. The decision on the type of surgery should always be made together with the patient and should focus on her psychosocial needs. This review describes the psychological aspects of breast cancer for the patient and her social environment and offers ideas for a patient-oriented treatment plan.

Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed.