Psychological Capabilities and Comfort for Patients With Breast Cancer
Psychological capabilities not only give comfort to patients, but it also puts the patient in a better scenario to take effective decisions in the management of their conditions (Iqbal, 2016).
The physical condition and the treatment caused a lot of financial difficulty in patients who are from a rural background belonging to low socioeconomic strata. During treatment, the patient experienced physical and financial losses. It leads to a lot of emotional distresses. The patients who stay out of the home have a severely disturbing family life (Sharma, 2016). Breast cancer in mothers can also influence the marriage prospects of their daughters. In such cases, unmarried children in the family also found to affect the emotional well-being of patients (Deshpande et al. 2013). Studies say that Indian culture also plays an important role to trigger the psychosocial issues in breast cancer patients. For most women, their disease made them more self-centered and driven by personal goals that incite their concerns about their relationship in particular with their husbands. Besides, some patients feel worthless, which intensifies the need for support from family and friends (Banning and Tanzeen, 2014).
A study was conducted among breast cancer patients enrolled in the Department of General Surgery, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India by Srivastava (2016). A total of 200 patients were interviewed using the questionnaires of Hospital Anxiety and Depression Scale (HADS). The associated factors investigated concerned socio demographics, socioeconomic background and the cancer stage. They found the Prevalence of anxiety and depression among the breast cancer patients was 37.0% (n = 74) and 28.0% (n = 56) respectively. They found strong association of anxiety with age group (p = 0.014), educational level (p = 0.034), monthly income (p = 0.001) and financial support (p = 0.041). However, marital status (p = 0.014), monthly income (p = 0.017), accompanying person (p = 0.005) and financial support (p = 0.002) were significantly associated with depression. Binary logistic regression analysis showed age younger than 50 years, those who earned less income, illiterate or low level of education, being single and receiving less financial support are more likely to have anxiety. For depression, those who earned less income, being single and receiving less financial support are more likely to have depression. Study clearly shows that younger age group, low monthly income, having less financial support, low education level and being single were associated with anxiety and depression.
Saxena (2018) in his study identified that the time at diagnosis of breast cancer as the most stressful phase in breast cancer patients in Gujarat. The patients had a strong fear of being rejected by spouse and separation from the family. One of the intense fears amongst survivors is that of relapse which causing anticipatory waiting for next check-up. The combination of all these factors leads to feeling of helplessness with mental stress. Amongst psychosocial factors, the study found factors relating to patient’s environment such as social support and family functions, and problem solving or coping styles were highly associated to anxiety and depressive disorders. A study conducted on prevalence of depression and anxiety in cancer patients by Dutt (2019), it found that Breast cancer patients had the highest prevalence of anxiety and depression. In breast cancer patients, the importance of body image and the influence of mastectomy on it, self-image and its effect on sex drive, can justify the higher frequency of anxiety and depression.
Baqutayan (2012), ‘Most of the breast cancer patients defined anxiety as “a mental condition.” Worry, tension, fear, and stress are interrelated to the anxiety and depression among them. Patients are differing in the way they perceive their problem as well as the way they cope with the anxiety associate with it. Interviewing some breast cancer patients reported that their anxiety is characterized by a number of typical symptoms and signs such as shivering or tremor. They found that their feelings of anxiety increase or decrease at different times. They may become more anxious as cancer spreads or treatment becomes more intense. The level of anxiety experienced by one person may differ from the level of anxiety experienced by another. Anxiety in breast cancer patients is associated with death anxiety, fear of death as a result of their symptoms’.
The presence of depression and anxiety in breast cancer patients is common (Das, 2019). A study conducted of 30 women diagnosed with breast cancer and some of them in the three stages of breast cancer, that is, initial, middle and advanced stages. The study has compared women in these different stages of breast cancer with respect to the presence of psychological distress such as depression, anxiety and trauma and quality of life in the Indian context. Das found that the three breast cancer stages did not differ with respect to psychological distress and symptoms. Although more than half of the participants showed symptoms of depression, anxiety and trauma as a result of cancer diagnosis. The factors which causes psychological distress at all stages of breast cancer are the loss of one’s breast, which is a vital part of a woman’s being, interferes with the patient’s role as a mother, wife and partner, the diagnosis of disease, fear and concerns regarding death, disturbed body image and alternation of femininity, and sexuality and attractiveness. Moreover, the cancer diagnosis not only changes the patient’s perception of herself but also changes others perception of her. Thus not only psychological and physical but social functioning is also affected having an impact on the patient’s over all wellbeing.
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