Women diagnosed with breast cancer and who have the disease surgically treated by mastectomy experience a health crisis. This thesis focused on the behaviours, feelings and attitudes of women during their breast cancer and mastectomy experiences. The overall purpose was to identify therapeutic factors that can be used by health professionals to improve the psychological and physiological well-being of women with this disease. The conceptual scaffolding for the thesis was drawn from the fields of perceptual psychology and decision-making. The thesis was supported by a study that examined specific areas concerning the breast cancer and mastectomy experience. These areas were self-perceptions, the psychological milieu resulting from a breast cancer diagnosis, and post-mastectomy breast restoration decision-making. The population included: a prosthesis group of 64 women who had mastectomies and wore external breast prostheses, a reconstruction group of 31 women who had mastectomies and underwent breast reconstructions, a control A group of 75 women who had not experienced mastectomy, and a control B group of 65 women who also had not experienced mastectomy. Self-perceptions: The perceptions of the prosthesis, reconstruction and control A groups regarding their body-image, self-concept, total self-image, and self-esteem were compared by using Polivy's (1977) Body-Image Scale and Rosenberg's (1965) Self-Esteem Scale. The body-image, total self-image, and self-esteem mean scores indicated that the prosthesis and reconstruction groups had more positive feelings regarding their bodies than did the control group. There were no significant differences in self-concept among the three groups. These findings challenge a common assumption that mastectomy automatically results in psychiatric morbidity caused by an altered body-image and suggest that health professionals should not make assumptions about how a woman will psychologically respond to mastectomy. Quality of life perceptions were compared among the prosthesis, reconstruction and control B groups using the Ferrans and Powers (1985) Quality of Life Index. The mean scores of the prosthesis and reconstruction groups were higher than the control group's scores, with higher scores indicating more positive quality of life perceptions. The findings suggest that the women in the mastectomy samples had found ways to cope with their health crises. Over time, they learned not to define all existence in terms of a cancer diagnosis and had gained or maintained a positive perspective on life. Post-mastectomy attitudes in the prosthesis and the reconstruction groups were compared. Using the Mastectomy Attitude Scale the results indicated that both groups were satisfied with their bodies, had a positive outlook towards their lives, implied that sexuality entailed more than having breasts, and felt that mastectomy treatment was necessary to save their lives. Neither group concealed that they had a mastectomy, nor were the women prone to discuss their mastectomy experiences. The findings from the study indicate that the women post-mastectomy already had or developed positive attitudes towards themselves and life in general and the method chosen for breast restoration had no apparent impact on these attitudes. The self-perception data indicated that women do adjust and cope with breast cancer surgically treated by mastectomy. These women should be encouraged by health professionals to develop a helping relationship with other women who are newly diagnosed with the disease. This alliance could engender hope in those women who are beginning their journey along a similar road to survival. More hope for these women and less fatalism would decrease their sense of crisis and facilitate their abilities to take an active part in the decision-making processes relating to their treatment. Psychological Milieu: The women in the prosthesis and the reconstruction groups were interviewed about their breast cancer and mastectomy experiences. The findings supported the premise that receiving a diagnosis of breast cancer plunged the women into a health crisis and caused an instant disruption to their lives. The women found that they had to suddenly deal with several complex issues all at the same time, such as what must be done in the immediate future to treat the cancer, as well as the more frightening issues of the meaning of the illness on their ultimate life expectancy. All of this turmoil played havoc with their ability to make informed decisions regarding their breast cancer treatment alternatives. This finding suggests the need for more individualised interventions and support for women when they are making decisions during this stressful period. Health professionals need to keep in mind that simply hearing the word "cancer" often prevents a person from assimilating the complete diagnosis, indicated treatments, and possible prognosis. Therefore, care-givers must be prepared to repeat and elaborate upon information previously given to the affected individual and the family. Breast Restoration Decision-Making: To evaluate the prosthesis and the reconstruction groups' abilities to undertake competent breast restoration decision-making, a 5 Stage process was devised, modelled after Janis and Mann's (1977) seven criteria for competent decision-making. Analysis of the data revealed that both groups displayed passive information seeking behaviour in relation to breast restoration alternatives. They had either no knowledge or limited knowledge regarding the alternatives. Their lack of knowledge was due either to (1) anxiety about their disease, or (2) deficiencies in the interpersonal skills of individuals presenting information to them, or (3) the perceptions that they had insufficient time to gather information, or (4) a combination of these factors. Because the prosthesis and the reconstruction groups were under stress they used coping styles to accomplish decision-making. To measure their coping styles five categories were defined, based on Janis and Mann's (1977) conflict model of emergency decisionmaking and Simon's (1957) notion of "bounded rationality". Two styles emerged. The prosthesis group used the "Sideliner" style that allowed the women to make a quick, conflict-free decision. They were not aware of alternative choices resulting in their decision-making experience being uncomplicated and effortless. The reconstruction group used the "Contented" style that also allowed them an uncomplicated and effortless decision-making experience. The women decided that breast reconstruction was their only viable option. Many of them did not even think that they had made a decision about an alternative because of the strong salience towards breast reconstruction. A breast restoration decision-making model has been developed and proposed for women to use when considering their alternatives. This model offers to health professionals and women a realistic and useable decision-making process that can be implemented when individuals are experiencing a health crisis. The model can be modified and used for numerous situations that require decisions regarding treatment alternatives. This inquiry has demonstrated that there is a need for a specific health professional to assist women newly diagnosed with breast cancer. This individual would assume several roles that include one of advocacy for the women, and the important role of ensuring that these individuals have the information and knowledge to make competent decisions regarding their breast cancer treatments.

Bakgrund: Bröstcancer är den vanligaste formen av cancer hoskvinnor i Sverige. Behandling av bröstcancer kan leda till att kvinnan blitvungen att operera bort sitt bröst. Kvinnobröstet har i alla tider varit ensymbol för det absolut feminina. Syfte: Syftetvar att belysa de drabbade kvinnornas upplevelser efter mastektomi. Metod: Studien var en litteraturstudiebaserad på antal kvalitativa vetenskapliga artiklar. Resultat: I resultatet visades att många kvinnor upplevdeförändring av sin kropp. Genom förlust av bröstet förlorade de kvinnlighet,sexualitet och identitet. De upplevde sina kroppar som stympade vilket leddetill sorg. Relationen till partnern påverkades både positivt och negativtberoende om kvinnorna ansåg sig vara sexuellt accepterade eller inte. Ärretsymboliserade både förlust, rädsla för ny cancer och seger över att ha blivitbotad. Slutsats: Det är viktigt attsjuksköterskan har det hälsofrämjande tänkesättet i mötet med kvinnor som hargenomgått mastektomi, för att hjälpa dem att bearbeta sina upplevelser ochuppmuntra dem att uppnå en hög känsla av sammanhang. / Background: Breast cancer is themost common cancer among women in Sweden. Thetreatment of breastcancer may lead to women being forcedto surgery remove her breast. Women’s breasthas always been a symbol of the very feminine. Aim: The aim was to highlight theaffected women's experiences after a mastectomy. Method: The study was a literature review based on qualitative, scientificarticles. Results: The results showed thatmany women experiencechanges in their body.Through the loss ofthe breast, they lost femininity, sexuality and identity.They experienced theirbodies’ mutilated, causing grief. Their relationshipfor their partner was affected, positively or negatively depending on if thewomen considered themselves to besexually accepted or not. The scarsymbolizes both the loss, fear of new cancer and victory to having beencured. Conclusion: It is important that thenurse has the healthpromotion forethought when meeting with women who have undergone a mastectomy.To help themovercome their experiencesand encourage themto achieve a highfeeling of life connection.

The purpose of this study was to assess the prognostic significance and clinical correlations of cyclooxgenase-2 expression (COX) in a cohort of patients treated with radiation (RT) for post-mastectomy chest wall relapse (PMCWR). Between 1975 and 1999, 113 patients were treated for isolated PMCWR. All patients were treated with biopsy and/or excision of the CWR followed by RT. Median follow-up was 10 years. All clinical data including demographics, pathology, staging, receptor status, HER-2/neu status, and adjuvant therapy were entered into a computerized database. Paraffin-embedded CWR specimens were retrieved from 42 patients, of which 38 were evaluated, created into a tissue microarray, stained by immunohistochemical methods for COX, and graded 0-3+. A score of 2-3+ was considered positive. Overall survival from original diagnosis for the entire cohort was 44% at 10 years. Survival rate after chest wall recurrence was 28% at 10 years. The distant metastasis-free survival rate after CWR was 40% at 10 years. Local-regional control of disease was achieved in 79% at 10 years after CWR. COX was considered positive in 13 of 38 cases. COX was inversely correlated with ER (p= .045) and PR (p = .028), and positively correlated with HER-2/neu (p =.003). COX was also associated with a shorter time to PMCWR. The distant metastasis-free rate for COX negative patients was 70% at 10 years, compared with 31% at 10 years for COX-2 positive patients (p = 0.029). COX positive had a poorer local-regional progression-free rate of 19% at 10 years, compared with 81% at 10 years for COX negative (p = 0.003). Outcome following RT for PMCWR is relatively poor. Positive COX correlated with other markers of poor outcome including a shorter time to local relapse, negative ER/PR and positive Her-2/neu status. Positive COX correlated with higher distant metastasis and lower local-regional control of disease. If confirmed with larger studies, these data have implications with respect to the concurrent use of COX-2 inhibitors and radiation for PMCWR.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Bakgrund: Bröstcancer är den vanligaste formen av cancer hos kvinnor både i Sverige och internationellt. Kirurgi är en vanlig behandlingsmetod som innebär att man avlägsnar del av bröstet eller hela bröstet, så kallad mastektomi. Mastektomerade kvinnor rapporterar att de upplever ett sämre välbefinnande. Författarna vill uppmärksamma mastektomerade kvinnors upplevelser. Syfte: Syftet var att beskriva kvinnors upplevelser av att vara mastektomerade. Metod: En litteraturöversikt baserad på tio kvalitativa artiklar som var relevanta för syftet. Artiklarnas resultat granskades och likheter samt skillnader kunde urskiljas. Dessa analyserades och sammanställdes i teman. Resultat: Resultatet presenteras i fyra huvudteman och fem underteman. De fyra huvudtemana är: En förändrad kropp, Ett förändrat jag, Intima relationen med partnern och Acceptera den nya kroppen. Kvinnorna upplevde inte bara att kroppen förändrats men även de själva som personer. Kroppen upplevdes stympad och asymmetrisk. De var obekväma inför sin partner vilket medförde en negativ påverkan på sexlivet. De upplevde att människor tittade på dem vilket gjorde att de drog sig undan från det sociala livet. Vissa kvinnor upplevde skuldkänslor över att de inte var tacksamma över att ha överlevt utan istället fokuserade på hur fula de kände sig. Diskussion: I resultatdiskussionen användes livsvärldsteori som teoretisk utgångspunkt då syftet var att beskriva kvinnors upplevelser av att vara mastektomerade. Kroppen är livsvärldens mittpunkt och med vilken vi upplever allt med. När kroppen förändras så påverkas vår livsvärld. De anhöriga ingår i vår livsvärld och stödet från dem var viktigt för att hjälpa kvinnorna att acceptera sin förändrade livsvärld. / Background: Breast cancer is the most common form of cancer for women both in Sweden and international. The most common treatment is surgery and in many cases it implies mastectomy which means that the whole breast/breasts is being removed. The mastectomized women experience a deteriorated well-being. The authors wanted to emphasize the experiences of mastectomized women. Aim: The aim was to describe women’s experiences of being mastectomized. Method: A literature review based on ten qualitative articles which were relevant for the aim. The result of the articles were viewed and similarities and differences could be distinguished. These were analyzed and compiled into themes. Results: The result is presented in four main themes and five sub themes. The four main themes are: A changed body, A changed self, Intimate relationship with the partner and Accepting the new body. The women did not only experience that the body had changed but also that they changed as a person. The body felt mutilated and asymmetrical. They felt uncomfortable with their partner which induced a negative impact on the sex life. They felt that people looked at them which made them withdraw from the social life. Some women experienced feelings of guilt because they were not thankful over the fact that they survived but instead focused on how ugly they felt. Discussion: Life-world theory was used as a theoretical framework in the discussion of the result because the aim was to describe women´s experiences of being mastectomized. The body is the center of the life-world and with which we experience everything. Our life-world is affected when the body changes. The relatives is a part of our life-world and the support from them is important in helping the women accept their changed life-world.

Introduktion Bröstcancer är den vanligaste cancersjukdom hos kvinnor i den svenska befolkningen. Vid icke spridd cancer är behandlingen alltid operation där en del eller hela bröstet opereras bort. Det kan vara mycket svårt för många kvinnor att acceptera bröstförlust och mastektomi upplevs ofta av kvinnor som ett trauma och ger en försämrad kroppsuppfattning.   Syfte Syftet var att beskriva kvinnornas livskvalitet och psykosociala tillstånd efter mastektomi.   Metod En systematisk litteraturstudie baserades på granskning av 14 kvantitativa artiklar och en kvalitativ artikel. Artiklarna kvalitetsgranskades, analyserades och diskuterades och sammanställde resultatet med olika tema.   Resultat Analysen resulterade i två huvudkategorier: Livskvalité och psykosociala konsekvenser. De psykosociala konsekvenserna efter genomförd mastektomi bestod av tre subkategorier nämligen: sämre kroppsuppfattning, minskad sexuell lust samt ångest och depression vilket i sin tur ledde till försämrad livskvalitet.   Slutsats     Försämrad livskvalitet, dålig kroppsuppfattning och psykisk ohälsa såsom depression, ångest samt försämrat sexualliv påvisades hos majoriteten av kvinnor som genomgick mastektomi. Det är därför viktigt att vårdpersonal ökar sina kunskaper och förståelse för individens behov för att kunna ge rätt stöd och erbjuda olika anpassade insatser i syftet att minska den psykiska påverkan och öka kvinnornas livskvalité. / Introduction Breast cancer is the most common cancer among women in Sweden. For non- metastasized cancer, the treatment is always surgery where part or the entire breast is surgically removed combined with radiation therapy, hormonal and chemotherapy. It can be very difficult for women to accept breast loss and mastectomy is often experienced by women as a trauma and gives a diminished body image.   Aim Purpose was to describe women's quality of life and psychosocial condition after mastectomy. Ethical considerations have been made.   Method Method vas a systematic literature study based on 14 quantitative articles and one qualitative article. The articles were reviewed for quality, analyzed and discussed and the results summarized in different themes.   Results The analysis resulted in two main categories: Quality of life and psychosocial consequences. The psychosocial consequences after the mastectomy was described in three sub-categories namely: poor body image, decreased sexual desire, as well as anxiety and depression, which in turn led to reduced quality of life.   Conclusion Reduced quality of life, poor body image and psychological problems such as depression, anxiety and impaired sexual life was found in the majority of women who underwent mastectomy. It is therefore important that health professionals look to the individual's needs and increase their knowledge and understanding to provide the right support and offer various proper services with the aim to reduce psychological stress and increase quality of life.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (doctoral)--Universiteit van Amsterdam, 1982. / Vita. "Stellingen" (3 p. inserted) and summary in Dutch. Includes bibliographical references (p. 99-103).

Thesis (doctoral)--Universiteit van Amsterdam, 1982. / Vita. "Stellingen" (3 p. inserted) and summary in Dutch. Includes bibliographical references (p. 99-103).