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Cognitive emotional and social aspects in breast cancer
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[eng] BACKGROUND: Breast cancer is one of the most prevalent diseases in women. Prevention and treatments have lowered mortality; nevertheless, the impact of diagnosis and treatment continue to affect ali aspects of patients' lives (physical, emotional, cognitive, social, and spiritual). The presence of psychological distress, anxiety and depression are still very prevalent. Cancer treatment often involves surgery, radiotherapy, chemotherapy, or hormonal therapy, treatment options that must be assessed and decided, and where patients have a relevant role. Shared decision-making (SDM) regarding adjuvant systemic therapy is based on both properly conveying information about the prognosis of the disease and the benefits and risks of adjuvant treatment, as well as the patient's ability to understand this information. AIMS: This research has two objectives: 1) Describe breast cancer patient's experiences throughout all the stages of their disease with a journey model, and 2) Examine doctor-patient coincidence with respect to the estimation of relapse with/without adjuvant chemotherapy and regarding the risk of treatment toxicity. METHODS: To meet the first objective, a qualitative study was designed. Twenty-one women with breast cancer or survivors were recruited at 9 large hospitals in Spain and intentional sampling methods were applied. Data were collected using a semi-structured interview that was elaborated with the help of medical oncologists, nur ses, and psycho-oncologists. Data were processed by adopting a thematic analysis approach. To attain the second objective, cross-sectional, multicenter study was conduct ed. lt involved 281 breast cancer patients and 23 oncologists employed at 11 Spanish hospitals. Prognosis (risk of recurrence with and without chemotherapy and risk of severe toxicity with chemotherapy) and SDM questionnaires were completed by oncologists and breast cancer patients. These lastones also filled out the 18-item Brief Symptom lnventory scale (BSl-18). RESULTS: The diagnosis and treatment of breast cancer entails a radical change in patients' day-to-day that linger in the mid-term. Seven stages have been defined that correspond to the different medical processes: diagnosis/unmasking stage, surgery/cleaning out, chemotherapy/loss of identity, radiotherapy/transition to normality, follow-up care/the "new" day-to-day, relapse/starting over, and metastatic/time-limited chronic breast cancer. The most relevant aspects of each of the states are highlighted, as are the various cross-sectional aspects that manifest throughout the patient's journey. The results of the second objective indicate that oncologists' prediction of risk of relapse without and with chemotherapy (30.4 and 13.3%) and risk of severe toxicity (9.8%) were more optimistic than those of breast cancer patients (78.6, 29.6, and 61.0%, respectively). The greater the severity, the higher the risk of relapse according to the oncologists (p = 0.001); not so far the patients. Older physicians and more experienced ones predicted lower risk of relapse with and without chemotherapy and less severe toxicity than younger doctors and those with less experience (p < 0.001). Oncologists' SDM and their prediction of risk of relapsing with chemotherapy correlated negatively with patients' SDM and their prediction of risk of severe toxicity (p < 0.01). There is a positive correlation between psychological distress (BSl-18) and the estimated risk of recurrence with chemotherapy in breast cancer patients (p < 0.001). These results stress the importance of improving doctor-patient communication in SDM. CONCLUSIONS: An in-depth understanding of breast cancer patients' experiences favor patient-centered care , which facilitates a better adjustment of the healthcare professional as well as the detection of risk situations, helping to identify the key moments when more precise information and support should be offered. Similarly, preparing women for the process they have to face and for the sequelae of treatments would contribute to reduce their uncertainty and concern, and improve their quality-of-life. In breast cancer patients undergoing treatment with curative intent, enhancing doctor-patient communication to coincide more the respect to risk of relapse and toxicity would raise expectations of cure, decrease treatment-related anxiety, and achieve a more realistic estimate of the risk of relapse and toxicity.
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CIRIA SUÁREZ, Laura. Cognitive emotional and social aspects in breast cancer. [consulta: 12 de desembre de 2025]. [Disponible a: https://hdl.handle.net/2445/187213]