Impact of Breast Disease on the Patient

Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

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The psychosocial problems resulting from breast cancer are far-reaching. Although the loss of an extremity is more disabling in everyday life, the loss of a breast produces intense feelings of loss of the feminine identity. Many women who lose a breast become depressed because they feel their symbol of femininity has been removed. They are afraid that they will no longer be considered ''whole'' women because their bodies have been maimed. They fear that they can no longer be loved normally and that they can no longer experience sexual satisfaction. They fear looking at themselves in a mirror and perceive themselves as ugly. The asymmetry is often described as ''mutilation'' or ''a bomb crater.'' After mastectomy, women often suffer from sexual inhibition and sexual frustration.

Once a woman has discovered a mass in her breast, she becomes intensely fearful. The fear of breast cancer is twofold: It is a cancer, often with a bad prognosis, and it is associated with disfigurement. For these reasons, the patient commonly denies the presence of the mass and delays seeking medical attention. It is not uncommon for a patient to seek medical assistance for the first time with a large tumor mass the size of an orange that has eroded through the skin and has become infected. When asked how long the mass has been present, the woman might answer that she ''discovered it yesterday.''

After a mastectomy, the patient will probably suffer from depression and low self-esteem. The patient should be supported, and counseled if necessary. Open communication and sharing of feelings among the patient, husband, significant other, physician, and family are important factors in the psychologic rehabilitation of the woman.

The patient pictured in Figure 16-8 had inflammatory carcinoma of her left breast, with massive lymphedema of the left arm. The patient had noticed that her arm had been swelling for the past few months, and she now needed support to raise it. She presented to the clinic complaining only about the heaviness of her arm. When examination revealed the breast lesion, she stated that she had noticed the breast changes ''only a few days ago.'' This is another example of denial of illness (see also the patient shown in Fig. 2-1).

Most commonly, women with invasive breast cancer and axillary lymph node involvement require chemotherapy for periods up to 6 or 7 months after mastectomy. Many of the agents used to treat the patient have significant side effects, including nausea, vomiting, and alopecia. There are medicines available to help control the nausea and vomiting, but the alopecia presents another special problem. Although the woman recognizes that she will lose her hair and knows that it will grow back, she suffers further from low self-esteem. In our society, hair is a

Figure 16-8 Inflammatory breast carcinoma.

Figure 16-8 Inflammatory breast carcinoma.

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