Amy is a fictional name given to the patient in this case study to maintain anonymity.
Amy is a 28-year-old lady referred by her GP to the Triple Assessment Breast Clinic with a palpable right breast lump. Amy had a clinical examination which scored her an E3, the consultant requested a mammogram, ultrasound +/_ biopsy. Amy had all examinations completed and was asked to come back the following week for results. The mammogram reported cystic changes and microcalcifications noted throughout the right breast, left breast of normal appearance. 6 core biopsy samples were obtained. The pathology report concluded grade 2, intra ductal carcinoma plus associated nuclear grade DCIS, ER+, PR+, HER2+. 4 further sites were biopsied. After MDT discussion it was decided that Amy would have neoadjuvant chemotherapy and mastectomy.
Amy: ‘I was prepared to be single for the rest of my life, no hair and a wonky breast how attractive!’.
In addition to coping with the loss of a breast, young women often experience a plethora of negative physical, psychological and psychosocial side effects including substantial scarring, hair loss, weight loss/gain, reduced sexual functioning and satisfaction, depression and poor body image (Kurowecki & Fergus 2014).
Physical attraction is important to the formation of a new romantic relationship. It’s the physical attraction that makes you initiate conversation with someone, it’s what makes you swipe right or left on dating apps (Sharratt et al 2018).
Attractiveness can be dictated by societal appearance ideals, to which visible difference do not conform. There are numerous bald men in society which is acceptable, and many women find it attractive/’turn-on’, however Amy’s baldness is perceived as a sign of a cancer patient on chemotherapy (Brower 2017) as opposed to attractive.
Dating is crucial to the formation of a new romantic relationship but can be challenging and anxiety provoking (Shaw et al 2017). Klitzman & Sweeney (2011) define it as ‘the first step to establishing a lifelong supportive partnership with another individual, with the possibility of starting a family’.
Many young breast cancer survivors like Amy consider dating a key priority (Kurowecki & Fergus 2013), but approximately 50 % of them believe that their image concerns, lack of confidence and fear of rejection impact on their ability to enter a new relationship (Uscher et al 2014) which can lead to further distress and worry (Hoskins et al 2008).
Amy: ‘Oh the questions are multiple, if I did start dating someone nice, how and when to I disclose my cancer history, or do I disclose it?’.
How to reveal this particularly private part of your life to a potential future partner is a major concern (Ruddy et al 2013). Exactly how much detail women want to provide must be decided as well as how and when this information should be communicated (Klitzman & Sweeney 2011). Mutual disclosure plays a vital role in the development of any new intimate relationship (Sprecher et al 2013), lending to greater closeness.
If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help!Find out more
Kurowecki & Fergus (2014) research revealed that many young women perceive the dating process as a series of tests, whereby they reveal little by little in order to ascertain the potential future partner’s ability to cope with the disclosures. The relationship can continue to physical level should the potential partner ‘pass’. Women are ‘highly attuned to the potential to be hurt’ (Kurowecki & Fergus 2013) and the possibility of being sexually intimate created feeling of anxiety and worry.
Amy: ‘The thought of being intimate with anyone again, scares me to death’.
Physical changes due to treatment can leave many young women feeling deeply unattractive, leading to low sexual self-esteem and undesirable to a potential future partner. It can cause apprehension about entering a physical relationship. Treatment side effects can also challenge women’s psychosocial and psychological well-being, which can have an impact on sexual satisfaction and functioning (Holmberg et al 2001), which include loss of libido, menopausal symptoms and discomfort/pain during intercourse (Kurowecki & Fergus 2013). Many young women will tend to avoid situations that may lead to sex, as they may feel discomfiture at being seen naked.
In a study by Sharratt et al (2018) one participant revealed how her visible changes had the ability to ‘steal the moment’, just by moving her head on the pillow reminded her of the fact that she has no hair.
Issues such as contraception need to be discussed with the patient, reliable and reversible non hormonal methods as well as permanent methods need to be considered (Cardoso et al 2012).
Amy: ‘My late 20’s I feel this is the time of my life I should be out partying and socialising, letting my hair down not watch it falling out’.
Numerous young women with breast cancer, diagnosed in their 20s and 30s feel robbed of time. This is a typical time to be out socialising and potentially meeting a lifelong partner and starting and new family. A breast cancer diagnosis in this chapter of life can delay reaching all these milestones (Corney et al 2014).
Amy: ‘If I did meet the man of my dreams and he wanted children would I be able to give them to him?’.
For young women with BC, future fertility is a major concern. Many premenopausal women can experience temporary or permanent chemotherapy induce amenorrhea (CIA) (Howard-Anderson 2012), which impairs ovarian function which is especially important in those who desire future pregnancy. Up to 70% of women under the age of 40 years can experience CIA (McCray et al 2016)
Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.View our services
For Estrogen Receptor (ER) positive BC, adjuvant hormone therapy is typically recommended for a period of 5-10 years post diagnosis (Davies et al 2013) because of the teratogenic effect of BC treatment, pregnancy is contraindicated, which further delays childbearing plans in women who already have a diminished ovarian reserve (Torino et al 2014).
Young women diagnosed with breast cancer have very specific future concerns, from coping with the physical changes and emotional anxieties to dating and the possibility of having children. Young women who experienced changes in their physical appearance due to breast cancer treatment fear judgement and anticipate rejection. Ben Charif et al (2015) stated that women who were well informed and given the relevant information on the various issues pertaining to them as individuals experienced an enhanced quality of life and minimised the negative impact on intimate relationships. McCray et al (2016) also concluded that improvements in the dissemination of information, to include all available treatment options, will help young BC survivors make decisions for the future.
‘Breast cancer is ‘just something that happened to them…... it doesn’t define them’. (Freidus 2017).
- Ben Charif, A., Bouhnik, A., Rey, D., Provansal, M., Courbiere, B., Spire, B. and Mancini, J. (2015). Satisfaction with fertility- and sexuality-related information in young women with breast cancer—ELIPPSE40 cohort. BMC Cancer, 15(1).
- Brower, V. (2017). Scalp cooling and hair loss during breast cancer chemotherapy. The Lancet Oncology, 18(4), p.e199.
- Cardoso, F., Loibl, S., Pagani, O., Graziottin, A., Panizza, P., Martincich, L., Gentilini, O., Peccatori, F., Fourquet, A., Delaloge, S., Marotti, L., Penault-Llorca, F., Kotti-Kitromilidou, A., Rodger, A. and Harbeck, N. (2012). The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. European Journal of Cancer, 48(18), pp.3355-3377.
- Corney, R., Puthussery, S. and Swinglehurst, J. (2014). The stressors and vulnerabilities of young single childless women with breast cancer: A qualitative study. European Journal of Oncology Nursing, 18(1), pp.17-22.
- Davies, C., Pan, H., Godwin, J., Gray, R., Arriagada, R., Raina, V., Abraham, M., Alencar, V., Badran, A., Bonfill, X., Bradbury, J., Clarke, M., Collins, R., Davis, S., Delmestri, A., Forbes, J., Haddad, P., Hou, M., Inbar, M., Khaled, H., Kielanowska, J., Kwan, W., Mathew, B., Mittra, I., Müller, B., Nicolucci, A., Peralta, O., Pernas, F., Petruzelka, L., Pienkowski, T., Radhika, R., Rajan, B., Rubach, M., Tort, S., Urrútia, G., Valentini, M., Wang, Y. and Peto, R. (2013). Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. The Lancet, 381(9869), pp.805-816.
- Freidus, R. (2017). Experiences of men who commit to romantic relationships with younger breast cancer survivors: A qualitative study. Journal of Psychosocial Oncology, 35(4), pp.494-512.
- Holmberg, S., Scott, L., Alexy, W. and Fife, B. (2001). Relationship Issues of Women With Breast Cancer. Cancer Nursing, 24(1), pp.53-60.
- Hoskins, L., Roy, K., Peters, J., Loud, J. and Greene, M. (2008). Disclosure of positive BRCA1/2-mutation status in young couples: The journey from uncertainty to bonding through partner support. Families, Systems, & Health, 26(3), pp.296-316.
- Howard-Anderson, J., Ganz, P., Bower, J. and Stanton, A. (2012). Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review. JNCI Journal of the National Cancer Institute, 104(5), pp.386-405.
- Klitzman, R. and Sweeney, M. (2010). “In Sickness and in Health”? Disclosures of Genetic Risks in Dating. Journal of Genetic Counseling, 20(1), pp.98-112.
- Kurowecki, D. and Fergus, K. (2013). Wearing my heart on my chest: dating, new relationships, and the reconfiguration of self-esteem after breast cancer. Psycho-Oncology, 23(1), pp.52-64.
- McCray, D., Simpson, A., Flyckt, R., Liu, Y., O’Rourke, C., Crowe, J., Grobmyer, S., Moore, H. and Valente, S. (2016). Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes. Annals of Surgical Oncology, 23(10), pp.3175-3181.
- Ruddy, K., Greaney, M., Sprunck-Harrild, K., Meyer, M., Emmons, K. and Partridge, A. (2013). Young Women with Breast Cancer: A Focus Group Study of Unmet Needs. Journal of Adolescent and Young Adult Oncology, 2(4), pp.153-160.
- Sharratt, N., Jenkinson, E., Moss, T., Clarke, A. and Rumsey, N. (2018). Understandings and experiences of visible difference and romantic relationships: A qualitative exploration. Body Image, 27, pp.32-42.
- Shaw, L., Sherman, K. and Fitness, J. (2015). Dating concerns among women with breast cancer or with genetic breast cancer susceptibility: a review and meta-synthesis. Health Psychology Review, 9(4), pp.491-505.
- Shaw, L., Sherman, K., Fitness, J. and Elder, E. (2018). Factors associated with romantic relationship formation difficulties in women with breast cancer. Psycho-Oncology, 27(4), pp.1270-1276.
- Sprecher, S., Treger, S. and Wondra, J. (2012). Effects of self-disclosure role on liking, closeness, and other impressions in get-acquainted interactions. Journal of Social and Personal Relationships, 30(4), pp.497-514.
- Torino, F., Barnabei, A., De Vecchis, L., Sini, V., Schittulli, F., Marchetti, P. and Corsello, S. (2014). Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer. Critical Reviews in Oncology/Hematology, 89(1), pp.27-42.
- Ussher, J., Perz, J. and Gilbert, E. (2014). Women's Sexuality after Cancer: A Qualitative Analysis of Sexual Changes and Renegotiation. Women & Therapy, 37(3-4), pp.205-221.
- Cairo Notari, S., Notari, L., Favez, N., Delaloye, J. and Ghisletta, P. (2016). The protective effect of a satisfying romantic relationship on women's body image after breast cancer: a longitudinal study. Psycho-Oncology, 26(6), pp.836-842.
- Loaring, J., Larkin, M., Shaw, R. and Flowers, P. (2015). Renegotiating sexual intimacy in the context of altered embodiment: The experiences of women with breast cancer and their male partners following mastectomy and reconstruction. Health Psychology, 34(4), pp.426-436.
- Minton, S. and Munster, P. (2002). Chemotherapy-Induced Amenorrhea and Fertility in Women Undergoing Adjuvant Treatment for Breast Cancer. Cancer Control, 9(6), pp.466-472.
Cite This Work
To export a reference to this article please select a referencing stye below:
Related ServicesView all
Related ContentAll Tags
Content relating to: "breast cancer"
Breast cancer is when abnormal cells in the breast begin to grow and divide in an uncontrolled way and eventually form a growth (tumour). Breast cancer starts in the breast tissue, most commonly in the cells that line the milk ducts of the breast.
Role Of Nurse In Breast Cancer Health Promotion Nursing Essay
Health promotion has been defined as” the process of enabling people to increase control over their health and its detriments and thereby improve their health” (WHO 2005). Breast Health Pr...
Effect of Paclitaxel for Breast Cancer Treatment
Effect of paclitaxel along with withnia sominiferia on lactate dehydrogenase enzyme activity changes in 7,12 di methyl benz(a) anthracene induced breast cancer wistar rats Dr.N.Muninathan1*, Dr.P. Mo...
DMCA / Removal Request
If you are the original writer of this essay and no longer wish to have your work published on the NursingAnswers.net website then please: