In step with the burgeoning area of women’s health, clinicians and researchers at Princess Margaret Hospital’s Psychosocial Oncology and Palliative Care program have launched a series of clinical studies and initiatives to address psychosocial issues unique to women.
Several of their efforts are directed towards women with breast cancer, given the high prevalence of the disease and its psychosocial implications. With improved screening, women with breast cancer live longer, but body image concerns, fear of recurrence, lymphedema, pain, premature menopause, and cognitive changes may persist. Thus, social workers Maureen Jackman and Terry Cheng led a multidisciplinary Task Force that developed a very useful and comprehensive patient education booklet. Using non-medical terms, Getting Back on Track: Life after Treatment offers information and resources on a wide range of topics, from dealing with fatigue, finances and faith, to the social and emotional needs of patients as they strive to return to everyday life. It is available at www.uhn.ca/patient/health_info/references/breastcancer_booklet.asp?nav=2;5.2
Building on the success of the information booklet, T.Cheng, M. Jackman and their colleagues, Dr. Jennifer Jones and Dr. Mary Jane Esplen are developing a randomized clinical trial to assess the impact of a brief psychoeducation group to prepare women with breast cancer for their survivorship recovery.
Despite the effectiveness of support groups and individual interventions for women with breast cancer to improve coping, enhance quality of life and psychosocial functioning, a significant proportion of survivors experience persistent difficulties with body image and sexual functioning. In response to this concern, Dr. Mary Jane Esplen and her colleagues have received approval from the Canadian Breast Cancer Research Institute (CBCRI) to develop a grant proposal to test a new intervention to address body image and sexual functioning among survivors up to several years post treatment. This new program is being pilot tested clinically and incorporates group support, education and guided imagery exercises to facilitate coping with shifts in identity, psychosexual functioning, intimacy and body image adjustment. These groups will involve over 200 women with breast cancer treated either with mastectomy or lumpectomy.
It is also recognized that cancer, including breast cancer, affects all family members. Intimate partners play a crucial role in helping women to cope and manage their treatment demands. Thus, T.Cheng, M. Jackman, M. McQuestion and Dr. M. Fitch are studying the experiences of male partners of newly diagnosed women with breast cancer. The results from the study will help guide future development of psychosocial interventions to meet the needs of male partners, thereby strengthening the family and affected woman.
It is now possible to identify women who are genetically susceptible to familial breast and ovarian cancer. However, this knowledge requires affected women and their relatives to not only integrate this emotionally sensitive information, but also to make important decisions regarding potential prevention, which often includes bilateral mastectomy, and how to inform their children. Dr. Mary Jane Esplen, Head, Program of Psychosocial and Psychotherapy Research in Cancer Genetics, is working with an international multidisciplinary group of colleagues. Dr. Esplen is leading a series of studies regarding affected women. The researchers found that supportive-expressive group therapy lowered levels of anxiety and depression, facilitated decision-making concerning preventive bilateral mastectomy and enhanced breast screening among women with the BRCa1/2 gene mutation. This study was published in the journal Cancer. The support groups continue to be offered at University Health Network in Toronto. Along with colleagues in Australia, the U.S.A., and Canada, Dr. Esplen is now planning a randomized controlled trial with colleagues to compare the efficacy of these groups with standard treatment.
As well, the CBCRI has funded Dr. Esplen to carry out a study focusing on how parents (e.g. mothers who carry BRCA1/2 mutations) inform daughters about genetic susceptibility. She will assess what determines disclosure, at what age it occurs, and will then follow daughters aged 13 years to adulthood. Dr. Esplen will use interviews and quantitative measures to examine the impact of knowledge about genetic susceptibility on areas such as psychosocial functioning, knowledge, perceptions of health, body image, sexuality and relational functioning.
Attention has also been paid to those with gynaecologic cancers. Although it has long been recognized that psychosexual changes accompany the illness and its treatment, interventions had not yet included partners. Collaborating with Drs. A. Fyles and D. DePetrillo, from gynaecologic oncology at University Health Network, Drs. de Groot, Devins and Mah, and Susan Winton, SW and Sarah Greenwood, RN found that women with cervical cancer and their partners had similar illness and treatment related concerns. Their highest levels of concern were in the areas of prognosis, sexuality and communication with the treatment team. This emphasized the importance of including partners in the provision of information and in the development of psychosocial interventions. Partnered women with gynaecologic cancers have also been found to have greater psychosexual concerns than single women, suggesting that sensitivity to these differences must be considered with psychosocial interventions.
Future directions in research and psychosocial interventions in women’s health and potential gender differences in cancer care will include considerations of how age and cultural variations influence psychosocial responses.