Functional Status of Long-Term Breast Cancer Survivors: Demonstrating Chronicity

More than 6 million people alive in the United States today were diagnosed and treated for cancer at some time in their lives (National Cancer Institute, 1990). Many of these people are women who have survived breast cancer. Although extensive psychosocial research has been done with breast cancer patients (Bloom et al., 1987; Dintruff et al., 1978; Ganz et al., 1993; Ganz, Polinsky, Schag, & Heinnick, 1989; Ganz, Schag, Polinsky, Heinrich, & Flack, 1987; Lewis & Bloom, 1978-79; Lindsey, Norbeck, Carrieri, & Perry, 1981; Maguire, 1984; Meyerowitz, 1986; Miller, 1981; Quint, 1963; Taylor et al., 1985; Zemore, Rinholm, Shepel, & Richards, 1989), little information is available about the problems and concerns that persist for breast cancer survivors beyond the initial phases of treatment (Loescher, Welch-McCaffrey, Leigh, Hoffman, & Meyskens, 1989; Welch-McCaffrey, Hoffman, Leigh, Loescher, & Meyskens, 1989). For all cancer survivors what begins as a crisis involving diagnosis and treatment gradually becomes a chronic illness characterized by lifelong follow-up medical care, indelible psychological effects, and changes in social and employment relationships. In general, breast cancer survivorship is characterized by "mild morbidity" (Morris, 1987) and non-life-threatening problems not likely to be mentioned to others (Karydas, Fentiman, Habib, & Hayward, 1986). However, some studies have documented important longer-term effects of breast cancer diagnosis and treatment (Bloom et al., 1987; Maguire et al., 1978; Morris et al., 1977; Polinsky, Fred, & Ganz, 1991). Meyerowitz (1986) found that "even successful treatment for [breast] cancer can continue to have an impact on patients' lives long after the active treatment phase has ended". Elevated levels of distress and disruption have been reported even two years after mastectomy (Holland, 1980; Maguire, 1984; Morris, Greer, & White, 1977), and patients who have received adjuvant chemotherapy for breast cancer have reported long-term effects on general activity level and physical symptoms, as well as iatrogenic effects (Meyerowitz, Watkins, & Sparks, 1983; Silberfarb, Maurer, & Crouthamel, 1980). Nail, Jones, Giuffre, and Johnson (1984) documented the prevalence of various physical discomforts after mastectomy in 218 women who had had their surgery an average of 5.5 years earlier (range one to 25 years). This article reports on a study designed to determine the long-term effects of breast cancer diagnosis and treatment on physical, psychological, and social functioning. Long-term breast cancer survivors were defined as women more than one year from their original surgery for breast cancer. Proper identification of chronic effects can enhance the appropriateness and targeting of social work interventions with cancer survivors. METHODOLOGY Sampling A purposive sample of Reach to Recovery volunteers from five American Cancer Society (ACS) units in southern California was selected as an appropriate study population of breast cancer survivors. Reach to Recovery volunteers are women more than one year from their breast cancer surgery who are trained by the ACS as visitors to act as role models for new breast cancer patients and help new patients adapt functionally and psychologically to the breast surgery and the diagnosis of cancer. The ACS units for the current study were chosen on the basis of their geographical accessibility to the researcher and because their Reach to Recovery programs were about equal in size (50 to 75 volunteers each). Questionnaire booklets were mailed to all of the women. Measurement Demographic and Medical Background Information. Items in the questionnaire booklet included questions about age, marital status, children, income, education, occupational status, religion, ethnicity, medical conditions not related to the breast cancer, date of initial breast cancer surgery, types of surgery and treatments received for breast cancer, recurrence, breast reconstruction, and mental health services received. …