Meg, age 50, currently on post-menopausal, was diagnosed with Invasive Ductal Carcinoma (IDC), also known as one of the most common forms of breast cancer (“Invasive Ductal Carcinoma,” n.d.). The first sign of cancer was detected through a mammogram, followed by a physical examination and later confirmed by an ultrasound and biopsy. Three tumours/ lymph nodes were discovered. After surgery, Meg underwent treatments of chemotherapy followed by Taxotere, radiation therapy and hormone therapy.
Side effects of treatments
Chemotherapy & Radiation therapy
The side effects that Meg encountered after chemotherapy and radiation therapy was cognitive changes and fatigue, where she described her problems with concentration; having difficulties retaining information when reading a book, and driving; where she could not maintain proper attention and finding words.
Fatigue, in this case, is not fatigue that most people would experience in their everyday functioning. Cancer-related fatigue (CRF) is a more extreme form of fatigue where it is not relieved by sleep or rest, where up to 80% and 90% of patients treated with chemotherapy and radiation, respectively, reported experiencing fatigue. Moreover, as Meg has stated her difficulties with driving and concentration, a study has revealed the impact of CRF on patients who have gone through chemotherapy where 88% of patients reported it to be interfering with their daily routines, and 91% felt that it hindered them from having a normal life. In addition, approximately 50% and 60% reported to find concentrating on things and social activities, respectively, somewhat more difficult (Hofman, Ryan, Figueroa-Moseley, Jean-Pierre & Morrow, 2007). Hence, these outcomes of CRF that Meg is experiencing are not uncommon for individuals who have received treatments of chemotherapy and radiation.
Closely related to fatigue, the side effect of Cancer Related Cognitive Changes (CRCC) from standard to high dose of chemotherapy is also a very common change for 48%- 95% of breast cancer patients (Ahles & Saykin, 2002). Changes such as the ability to concentrate, maintain focus, fatigue and organising problems, as Meg has also experienced with her reading, driving, and finding words. As these changes require more effort to perform everyday functions, it will result in fatigue and vice versa.
After a year of hormone therapy instead of the suggested ten years, being on Famara, Meg experienced joint pain and weight gain. These are the side effects of menopause although Meg was post-menopausal.
Impact of distressful symptoms on life roles
Symptom distress may generate physical dysfunctional, cognitive and emotional disturbances, particularly typical symptoms with upper-arm problems such as lymphoedema. Lymphoedema is a continual swelling where there are build-ups of protein-rich fluids and has an impact on most women’s lives as well as Meg’s. Impacts such as discomfort in mobility, where the swelling in Meg’s right upper limb has limited the movement in her right shoulder. Other effects include the incapability to carry heavy items such as groceries, exercises that may lead to further symptoms, troubles of appearance in the fit of clothing, and unable to manage occupational responsibilities as returning to work was also a concern for Meg (Armer, 2005).
Body image disturbance
Body image disturbance is another distressful symptom that has also impacted Meg’s life, from trying to cope with the loss of the breast to significant weight gain. As the breast connotes a woman’s sense of femininity and identity, deformities in its appearance will generate negative impacts on a woman’s Quality of Life (QoL) including their physical, cognitive, emotional and socio-economic conditions. Results from a study of 577 women studied by Al-Ghazal, Fallowfield, and Blamey in 2000, revealed the effect of a woman’s psychological well-being and satisfaction are from invasive surgery to the breast, which ultimately may result in the removal of breast (Al-Ghazal et al, as cited in Helms, O’Hea, & Corso, 2008). This will heighten Meg’s emotional stress about her body image, which may lead to anxiety symptoms that will further increase her concern about the recurrence of cancer.
In addition, the range of 50% – 96% of women have reported to gain weight after the diagnosis of breast cancer, with 20% of the range noted to gain over 10 kg (Goodwin et al., as cited in Helms et al., 2008). Like body image disturbance, weight gain can also negatively impact Meg’s self-esteem. Although not specified in the case study of the amount that Meg has gained besides it being “substantial”, weight gain may be another factor besides painful joints and feet, that contributes to her decrease in physical activities.
As a result, all of these can also impact Meg’s QoL and well-being as a whole, such as life satisfaction, family situations, physical health, and economic status. Although Meg has some social support from friends, she may not be satisfied with her life, dealing with the sense of loneliness as she lives alone without any familial support, her father being in a nursing home that is four hours away. Furthermore, despite having support from her employer, Meg’s cognitive and fatigue-related issues combined with painful joints in the neck, back, knees and feet, additionally with the pressure to contribute to her job as a lawyer, all may decrease QoL due to distressed.
Suggestions / Interventions
As Meg has reduced physical activities because finding walking difficult due to painful feet, and experiences breathlessness on exertion, I would recommend her to slowly exercise more, starting with the easiest, for example, yoga. As potential effective interventions for fatigue and cognitive may include Non-Pharmacological Interventions such as exercise. Studies have shown patients receiving chemotherapy or radiation have participated in exercise programs such as aerobics, and revealed to have reduced levels of fatigue (MacVicar & Winningham; Mock et al., as cited in Pinto & Maruyama, 1999). Other interventions include rest, sleep, and psychosocial interventions that involve support groups, individual counselling, coping strategies, and stress management (Mock, 2004). Therefore, I would recommend Meg to take on these interventions if she finds it difficult to express her concerns to her loved ones.
Ligibel, J.A., Basen-Engquist, K., & Bea, J.W. (2019) compiled together a list of studies on different interventions and how breast cancer survivors can manage their activities after the diagnosis. Studies were associated with dietary change, where diets included consumption of Mediterranean and macrobiotic diet, increase intake of vegetables, fruits, fiber and decrease in fat intake. Most studies have shown effective results in declining the risk of the cancer recurring. Hence, I would suggest Meg to take on a healthier diet and maintain a healthy weight at home as it would lower her anxiety levels for the recurrence of cancer.
Home-based multidimensional programmes
Furthermore, other effective recommendations are home-based multidimensional survivorship programmes as aims to emphasise in increasing women’s QoL and the transition to what is considered a ‘normal’ life. The programme is most effective when three factors work in conjunction with one another. Factors include Education, such as advice and information on self-management. Physical comprises of exercise and resistance training, and Psychological where cognitive therapies and counselling are involved, as mentioned above. However, these programs have only shown short-term benefits in reducing anxiety and fatigue at home (Cheng, Lim, Koh, & Tam, 2017).
Overall case reflection
Overall, a majority of cancer patients and survivors, including Meg, experiences a diverse range of challenges from diagnosis, throughout treatment and post-treatment. As a result, these treatments have led to physical changes, where Meg had issues regarding her appearance with the loss of the breast, psychological distress, depression and financial challenges. As Meg still received income protection insurance payments upon all of her sick leave with the support from her employer, financial matters were not as big of a concern for her, nor did she experienced any depression. However, with no emotional and social support except some coming from her friends, the issue of loneliness may be a risk of developing depression.
Moreover, as early detection may save lives, women ages 40-74 who have completed screening every one to two years have reduced their mortality by 40% (Seely & Alhassan, 2018). Although it is not Meg’s fault that she had her first mammogram when she turned 50, but if she were to be screened at an earlier age, it may possibly help reduce the risk of breast cancer or its effects, along with a healthy diet.
To conclude, breast cancer is still one of the most prevalent cancer in women worldwide. Issues such as fatigue and cognitive changes are issues that need to be appropriately managed by health professionals, and should not be avoided.