Postmastectomy coping strategies and quality of life.

Examined characteristics that might relate to quality of life in postmastectomy patients with operable breast cancer. 113 women who had been treated for breast cancer during 3.5 yrs preceding the study were surveyed. 53 Ss had received mastectomies alone. The remaining 60 Ss, who had shown some spread of disease to the lymph nodes only, received long-term, prophylactic chemotherapy as an adjunct to mastectomy. Analyses indicated that level of cancer-specific denial was the variable most strongly associated with postmastectomy distress. This coping strategy was more important in explaining distress than were availability of social support, treatment group, time since operation, or age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skin-sparing mastectomy. Oncologic and reconstructive considerations

OBJECTIVE: The authors compared skin-sparing mastectomy and traditional mastectomy both followed by immediate reconstruction in the treatment of breast cancer. SUMMARY BACKGROUND DATA: Skin-sparing mastectomy is used increasingly in the treatment of breast cancer to improve the aesthetic results of immediate reconstruction. The oncologic and reconstructive outcomes of this procedure have never been analyzed closely. METHODS: Institutional experience with 435 consecutive patients who underwent total mastectomy and immediate reconstruction from January 1989 through December 1994 was examined. Mastectomies were stratified into skin-sparing (SSM) and non-skin-sparing (non-SSM) types. RESULTS: Three hundred twenty-seven SSMs and 188 non-SSMs were performed. The mean follow-up was 41.3 months (SSM, 37.5 months, non-SSM, 48.2 months). Local recurrences from invasive cancer occurred after 4.8% of SSMs versus 9.5% of non-SSMs. Sixty-five percent of patients who underwent SSMs had nothing performed on the opposite breast versus 45% in the group of patients who underwent non-SSM (p = 0.0002). Native skin flap necrosis occurred in 10.7% of patients who underwent SSMs versus 11.2% of patients who underwent non-SSMs. CONCLUSIONS: Skin-sparing mastectomy facilitates immediate breast reconstruction by reducing remedial surgery on the opposite breast. Native skin flap necrosis is not increased over that seen with non-SSM. Skin-sparing mastectomies can be used in the treatment of invasive cancer without compromising local control.     

Medicolegal issues and fine needle aspiration of the breast. What you can do to decrease your risk of being sued

Carcinoma of the breast is the most litigated cancer in women. This article discusses steps that can be taken to reduce the risk of being sued. Topics covered include laboratory practices, patient contact, informed consent, documentation, record keeping, interpretive problems, triple test, diligence, and reporting results as well as what to do if sued.     

A hermeneutics of exploration: The interpretive turn from binswanger to gadamer.

The interpretive turn in psychology is strongly indebted to the hermeneutic philosophies of Martin Heidegger and Hans-Georg Gadamer. What is less known is the degree to which the interpretive turn is already initiated in the 1920s by the Swiss psychiatrist, Ludwig Binswanger (1881–1965). For Binswanger, the objective of psychology and psychopathology is to understand how the person exists and relates to others in the world—and this can only be achieved through a situated understanding of the person in his or her life-world. Binswanger is one of the first to recognize and work out the contributions of Husserl's and Heidegger's philosophies for psychology. Using an approach that combines elements from phenomenology, hermeneutics and dialogical philosophy, Binswanger views the person not as an object, but as fundamentally immersed in a world of human relating. Yet Binswanger is not a Heideggerian, and does not identify his work as existential. Instead, he develops a dialogical perspective on human experience that parallels important aspects of Gadamer's hermeneutics. Drawing chiefly on untranslated texts, I maintain that Binswanger's hermeneutics of exploration forms an important, if relatively unknown chapter of the interpretive turn in psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate, bilateral transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after mastectomy

Although breast reconstruction has been shown to provide psychological benefits in mastectomy patients, there is reluctance to perform immediate, bilateral TRAM flap reconstruction because of concerns regarding magnitude of the procedure, length of hospitalization, potential complications, and long-term recovery. Between June, 1990 and March 1992, 15 patients underwent immediate, bilateral TRAM flap reconstruction following bilateral mastectomy at the University of Michigan Hospitals. Diagnoses included lobular carcinoma in situ (nine patients), strong family history of breast cancer (five), or bilateral breast cancer (one). Invasive breast cancer was present in three patients. Three modified radical mastectomies and 27 simple mastectomies were performed. Bilateral pedicle TRAM flap reconstruction was carried out at the same time in all patients (30 flaps total). Marginal loss occurred in one flap (3%). Additional complications included marginal necrosis of the abdominal donor site wound (one), wound infection (two), and abdominal donor site hernia (one). Median hospital stay was 7 days. Median follow-up was 13 months (range 4-25 months). All patients have resumed their accustomed pre-operative activity patterns. These findings demonstrate that immediate, bilateral TRAM flap reconstruction is a safe and effective option for breast reconstruction after mastectomy.     

Primary vitrectomy for bullous rhegmatogenous retinal detachments due to complex breaks

Sixty-five patients who underwent modified radical mastectomy were compared with 55 breast conservation patients, all of whom were in stage I, II or III of breast cancer and were under treatment at an oncology clinic in northern Israel. The main findings indicate no differences between the groups in physical, psychosocial, marital or medical interaction, according to the CARE scale. These findings reflect the results of similar comparative studies conducted during the 1980s and 1990s as documented in the literature. Sexual interaction showed statistical differences favoring the women who had undergone mastectomies.     

Breast cancer care in older women: sources of information, social support, and emotional health outcomes

BACKGROUND: The authors studied older women with breast cancer and asked: 1) where do older women get information regarding breast cancer care and how helpful do they perceive each of these sources to be? and 2) what aspects of social support are associated with older women's general and breast cancer specific emotional health outcomes? METHODS: To be eligible, women had to be at least 55 years of age and newly diagnosed with TNM Stage I or II breast cancer. Data were collected from women's surgical records and a 35-minute, computer-assisted telephone interview. RESULTS: Nearly all women rated information that was provided by their breast cancer physicians as very or somewhat helpful. Written materials provided by breast cancer physicians also were frequently rated as very or somewhat helpful. Women's marital status, religious service attendance, ratings of their physicians' technical and interpersonal care, and perceptions of their own abilities to communicate with their physicians were significantly associated with both general and breast cancer specific emotional health outcomes (all P < 0.05). CONCLUSIONS: Although older women obtained information regarding breast cancer from a variety of sources, they relied heavily on their physicians for information. To care most effectively for this group of patients, an increased understanding of the relation between the processes and outcomes of breast cancer care is needed Identifying older women with breast cancer at risk for poor emotional health outcomes and developing methods to enhance physician-patient communication in this setting may improve these outcomes.     

Review of Entering the circle: Hermeneutic investigation in psychology.

Reviews the book, Entering the circle: Hermeneutic investigation in psychology edited by R.B. Addison and M.J. Packer (1989). Entering the Circle is highly recommended, if only to familiarize us with (or remind us of) the penetrating critique and contribution that hermeneutic thought offers psychology. In addition this book should be recommended because it contains, perhaps more so then other books of this genre, a diverse group of essays (dealing with developmental, clinical, social and educational psychology) that grapple with methodological and practical issues of hermeneutic psychology by reporting on research that is grounded, to a greater or lesser extent, in a hermeneutic approach. Also, another distinctive aspect of this book is that it is almost entirely devoted to the concerns of hermeneutics (the catchword "interpretive," often used in this book, I take to be interchangeable with "hermeneutic"), and thereby distinguishes itself from what has come to be known as existential or phenomenological psychologies—a distinction that for many purposes is unnecessary but may prove to be helpful in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Bodies in treatment: The unspoken dimension.

Reviews the book, Bodies in treatment: The unspoken dimension by Frances Sommer Anderson (see record 2007-07946-000). In this book, the author aims to move talk and body therapists closer to one another, so that each appreciates the narrative and the visceral and so that, together, they can care for patients as wholly as possible. Body therapists consider the body to be a rich source of information, with the potential to facilitate regulation and reorganization of emotional states, explains William Cornell, in his chapter “Self in Action: The Bodily Basis of Self-Organization.” Specifically, body therapists ask patients to verbalize their physical sensations, to notice and to change their breathing, to adjust their posture. Sometimes body therapists touch patients to better sense and to reconfigure troubled parts of the body. These techniques aim to heed, deepen, and even change experiences at the level of the body. Despite this book’s imperfect cohesion and inconsistent strength (both common in edited books), it succeeds strongly in bringing needed attention to a dimension of treatment that has been largely ignored, and sometimes exploited, by therapists. This book will be of particular interest to clinicians (from graduate students in the field to seasoned analysts) who treat patients with eating disorders and/or trauma histories, patients who somatize, and patients who suffer from chronic illnesses. Francis Sommer Anderson is brave to have written about the ways her own profession of talk therapy failed to touch and heal some aspects of her patients, and some aspects of herself. The authors of her volume all contribute—most, very creatively and innovatively; some, eccentrically—to Anderson’s aim of including bodies in treatment and of healing patients as completely as possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Now tell me, what is your orientation to religion?"--Therapeutic attitude and management as an expression of religious faith

The essence of the therapeutic process is the relationship: the client experiences that the therapist is prepared "to be there" and to remain with him/her on the journey unconditionally. A possible goal of personal life, as well as of a therapeutic process, is to become oneself. This is described in the biblical symbol of Exodus: the motivation of the way and all existential experience of being on the way are a possibility to interpret my human existence and to fit it into the wider horizon of religious understanding; to know and experience a liberator-God (a God who sets me free) as the very basis of my development. To what extent therapy--as part of the way the therapist and the client go together--always also touches a religious dimension is shown by giving examples of some attitudes and consequent actions.     

Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer

PURPOSE: Clinical reports suggest that many breast cancer patients experience persistent fatigue as a long-term side effect of adjuvant chemotherapy treatment. To investigate this issue further, we examined the characteristics and correlates of fatigue in women who had completed adjuvant chemotherapy for breast cancer and in a comparison group of women with no history of cancer. PATIENTS AND METHODS: Participants were 61 women with breast cancer who had completed chemotherapy an average of 471 days previously and 59 women with no history of cancer. All participants completed standardized self-report measures of fatigue, sleep quality, menopausal symptoms, and coping and were administered a structured clinical interview to identify current and past psychiatric disorder. RESULTS: Compared with women with no history of cancer, former adjuvant chemotherapy patients reported more severe fatigue (P < .01) and worse quality of life because of fatigue (P < .05). More severe fatigue among patients was significantly (P < .05) related to poorer sleep quality, more menopausal symptoms, greater use of catastrophizing as a coping strategy, and current presence of a psychiatric disorder. CONCLUSION: These findings support the view that many breast cancer patients experienced heightened fatigue after completion of adjuvant chemotherapy treatment. Results yield a profile of women who are at increased risk for heightened fatigue after chemotherapy and suggest ways to intervene clinically to prevent or reduce fatigue in this patient population.     

Gamma-probe-guided resection of the sentinel lymph node in breast cancer

Regional lymph node metastases in patients with breast cancer have fundamental staging, prognostic, and treatment implications. Classically, axillary lymph node sampling requires a dissection under general anesthesia. The concept that a primary, or sentinel, lymph node is the first node to receive drainage from a tumor has been established in patients with malignant melanomas using radiolabeled tracers and vital dyes. This study proposed two hypotheses: (1) radiolabeled sentinel lymph nodes can be identified in most patients with breast cancer, and (2) radiolabeled sentinel lymph node biopsy accurately predicts axillary lymph node metastases in those patients. Patients with operable breast cancer had Tc-99 sulphur colloid injected around their breast tumors 1-6 hours preoperatively. Patients underwent gamma probe identification of sentinel lymph nodes that were biopsied. All patients underwent axillary lymphadenectomy in conjunction with lumpectomy or mastectomy. Fifty female patients ages 26 to 90 years underwent lumpectomies with axillary dissections (40 patients) or modified radical mastectomies (10 patients). Sentinel lymph nodes were identified in 42 of 50 patients (84%). Eight patients (16%) had metastases to the axillary lymph nodes. In 7 patients, sentinel lymph nodes correctly predicted the status of the axillary nodes. There was one false negative result. A total of 550 lymph nodes were resected for an average of 11.2 nodes per patient. Sentinel lymph node scintigraphy and biopsy accurately predicted the axillary lymph node status in 41 of 42 patients (98%). Scintigraphy can identify sentinel lymph nodes in a large majority of patients. Sentinel lymph node biopsy is an accurate predictor of axillary lymphatic metastases.     

Impact of breast cancer on Asian American and Anglo American women

This pilot study constitutes the first exploration of the impact of breast cancer on Asian American women. Three hypotheses guided this study: (1) Asian American women would choose breast conserving therapy and breast reconstruction at a lower rate than the Anglo American women due to cultural differences in body image, (2) Asian American women with breast cancer would express psychological distress somatically and Anglo American women would express distress emotionally, and acculturation levels of the Asian American women would modify the expressions of distress such that women with high acculturation will express distress more emotionally and less acculturated women would express distress more somatically, and (3) Asian American women would seek assistance for psychosocial problems at a significantly lower rate than Anglo women. Ethnicity, age, and levels of acculturation were found to be significant variables that had to be considered simultaneously. The three hypotheses were only partially supported: (1) Asian American women chose breast conserving therapy and adjuvant therapy at a significantly lower rate than the Anglo American women, (2) Contrary to the hypothesis, somatization did not appear to be a dominant form of symptom presentation for Asian American women regardless of level of acculturation, and (3) Asian American women sought professional assistance for psychosocial problems at a significantly lower rate than Anglo women. Asian American women reported using different modes of help-seeking behavior for emotional concerns and receiving different sources of social support than the Anglo American women. Cultural interpretations of the findings are offered to explain the differences in the physical, emotional, and social responses to the breast cancer experience of Asian American women compared with the Anglo Americans, and notably between the Chinese- and Japanese Americans as well. The findings of this study warrant more refined exploration in order to improve the medical, psychological and social outcomes for Asian American women with breast cancer.     

Influence of stressors on breast cancer incidence in the Women's Health Initiative.

Objective: To examine associations among life events stress, social support, and breast cancer incidence in a cohort of postmenopausal women. Design and main outcome measure: Women's Health Initiative observational study participants, breast cancer free at entry, who provided assessment of stressful life events, social support, and breast cancer risk factors, were prospectively followed for breast cancer incidence (n = 84,334). Results: During an average of 7.6 years of follow-up, 2,481 invasive breast cancers were diagnosed. In age-adjusted proportional hazards models, 1 stressful life event was associated with increased risk, but risk decreased with each additional stressful life event. After adjustment for confounders the decreasing risk was not significant. Stressful life events and social support appeared to interact in relation to breast cancer risk such that women who had greater number of stressful life events and low social support had a decreased risk of breast cancer. Conclusions: This study found no independent association between stressful life events and breast cancer risk. The results are compatible with a more complex model of psychosocial factors interacting in relation to breast cancer risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions, vulnerability, and psychological adjustment: The case of breast cancer.

Hypothesized that psychological adjustment would be positively associated with breast cancer victims' perceptions of invulnerability to a recurrence of cancer and that victims' causal attributions for cancer (e.g., self-blame, birth control pills, sexually demanding husband) would influence adjustment to the extent that the attributions contributed to or detracted from perceived invulnerability. A path model was developed based on the proposed association between invulnerability and adjustment, and attributions were tested for whether they directly or indirectly influenced adjustment. Responses from intensive interviews of 42 breast cancer victims (aged 23–81 yrs) who had undergone mastectomies within 2 yrs prior to being interviewed were used to test the path model. Ss were also administered the Beck Depression Inventory and another measure to assess emotional response to breast cancer at Ss' present stage of adjustment. Results support the hypothesized positive association between perceived invulnerability and adjustment and show that the relationships between specific attributions and adjustment were mediated by vulnerability beliefs. Follow-up data may be useful in ascertaining the role played by cognitions in the biological progression of cancer. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)