Abstract PL03: Psychosocial, survivorship issues: Are we doing better?
Authors: Fallowfield LJ 
Published: August 2014

Abstract
Extraordinary advances have been made in the past 3 decades in breast cancer treatment. More women have greater prospects of cure or lengthier, good quality survival. Advances include:- improved diagnostic and staging procedures, sophisticated onco-plastic surgery, enhanced radiotherapy techniques and targeted systemic therapies. Much more attention has also been paid to cancer care delivery and access to specialist nurses, counsellors, support groups and services provided by breast cancer charities. It is questionable whether or not these considerable improvements in treatment delivery and outcomes have led to comparable, measurable changes in patients’ psychosocial, functional and sexual well-being. Data are mixed – some reports suggest that psychological morbidity remains high and unremitting whilst others have found a decline over time and little difference from that of age-matched controls without breast cancer. Other research has explored the pre-existing psychosocial factors associated with poor adjustment such as a history of psychological problems and social isolation. Determining healthy long-term adjustment is more than just assessment of psychological morbidity; the impact that non-life threatening, iatrogenic harms of otherwise efficacious anti-cancer treatments has is often over-looked. A concentration on clinician reported safety data in trials rather than patient reported outcomes has hampered research into ameliorative interventions. Systematic monitoring of quality of life-threatening side-effects would permit early implementation of effective interventions and enhance long-term survivorship.
We have known for some time that inadequate communication by health-carers affects adjustment. Communication has arguably become even more difficult given the increasing complexity of modern breast cancer treatment, and the number of therapeutic options available. Just as gross disparities exist in outcomes such as survival between patients in different socio-economic groups, those in lower groups have less time with healthcare professionals, are not confident asking for explanations about care plans and are unlikely to access on-line informational sources or support services.
Nevertheless women's reactions to breast cancer and its treatment vary enormously irrespective of culture or class divides. For some the diagnosis is a catastrophe, irreparably threatening their physical, functional, social, psychological, sexual and occupational well-being. For others it represents yet one more of life's hurdles to overcome together with other social, educational and financial iniquities they face. Consequently, just as with the exciting advent of personalised and targeted medicine, we need similar endeavours producing more individualised psychosocial care; communication should be flexible, adapted to the varying needs of individuals, appropriate screening should enable resources, be that counselling, relaxation therapy, yoga, exercise or mindfulness training to be focussed on those at most risk of the unremitting psychosocial dysfunction that compromises healthy survivorship. Spreading scarce supportive services thinly for all irrespective of their risk of poor adjustment, makes as much sense as administering hormone treatment or trastuzumab without information about receptor status.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PL03.