Psychosocial needs of women with breast cancer: how can social workers make a difference?

In 2001 it was estimated that 233,000 new cases of breast cancer would be diagnosed among women in the United States (American Cancer Society, 2001). The diagnosis and treatment of breast cancer can result in a range of psychological and emotional challenges. Studies estimate that between 20 percent and 66 percent of cancer patients suffer long-term psychological distress (Breitbart, 1995; Rieker, Fitzgerald, Kalish, & Robertshaw, 1989). Although the exact number of women with breast cancer experiencing long-term or severe psychological distress is unclear, it appears to be considerably greater than that of women in the general population. For example, Fallowfield and colleagues (1990) found that 29 percent of women suffered depression after a mastectomy and 22 percent after conservative therapy, and that 21 percent of both groups suffered depression 12 months later. Similarly, Dean (1987) reported that 20 percent of women undergoing adjuvant therapy for breast cancer experienced minor depression and 10 percent were regarded as psychiatrically ill. Estimates of the proportion of women experiencing sexual problems after diagnosis and treatment of breast cancer ranged from 10 percent to 50 percent (Hughson, Cooper, McArdle, & Smith, 1988; Maguire et al., 1978; Schain, d'Angelo, Lichter, & Pierce, 1994). Research shows that women who had a mastectomy before age 50 were twice as likely as women over age 50 to experience sexual difficulties (Hughson et al.). The experience of breast cancer may affect some women emotionally long after their diagnosis. Residual concern about recurrence and fear of checkups may last for many years after the original diagnosis, with up to 50 percent of women experiencing psychiatric disorders (Hall, Fallowfield, & A'Hern, 1996; Jenkins, May, & Hughes, 1991). The recurrence of disease has been shown to have a significant effect on the family (Carlson, Bultz, Speca, & St. Pierre, 2000; Christ et al., 1993; Lewis & Deal, 1995). BENEFITS OF PSYCHOSOCIAL INTERVENTIONS FOR WOMEN WITH BREAST CANCER Evidence demonstrates that cancer patients benefit from psychosocial interventions (Fawzy, Fawzy, & Canada, 2000; Owen, Klapow, Hicken, & Tucker, 2001). In a meta-analysis of 45 randomized controlled trials with adult cancer patients, those receiving psychological therapies had on average a significant improvement of 12 percent in emotional adjustment, 10 percent in social functioning, 14 percent in treatment- and disease-related symptoms, and 14 percent in overall quality of life compared with those not receiving psychological therapies (Meyer & Mark, 1995). A meta-analysis of 116 intervention studies showed that cancer patients receiving psychoeducational or psychosocial interventions had significantly lower rates of anxiety, depression, mood disturbances, nausea, vomiting, and pain and significantly greater knowledge about disease and treatment relative to nointervention controls (Devine & Westlake, 1995). There is less evidence to indicate the best model of therapy for particular clinical settings, but many therapies have much in common (Tapper, 1999). For example, evidence from meta-analyses of randomized controlled trials indicates the efficacy of supportive and cognitive--behavioral therapies in the treatment of depressive disorders in women with breast cancer (Devine & Westlake, 1995; Sheard & Maguire, 1996) and the efficacy of individual and group therapies (Sheard & Maguire). It may be that the features of therapy common to all psychological interventions, such as an empathic manner, listening, affirmation, reassurance, and support, generate the observed outcome. Some women are more comfortable with the privacy of individual counseling; other women benefit from group counseling, where they share the commonality of their experience with group members (Fawzy & Fawzy, 1998). The evidence supporting the provision of psychosocial care to women with breast cancer is clear. …