Being a mother with cancer: achieving a sense of balance in the transition process.

For women with cancer and with children living at home, the demands of being a good mother while undergoing treatments and recovering from illness have been described as a difficult life process. The aim of this study was to further examine the transition process with focus on women's experience of their responsibility toward their children. Interviews from 2 previous studies investigating the transition process of women with cancer were gathered and were subjected to a qualitative secondary analysis, an analytic expansion of the transition process. The 3 phases in the transition process were used in an interpretive description: ending an earlier life situation, in-between, and new beginning. A main theme that integrated these phases was constructed: "the desire to manage ones responsibility as a parent," within the context of mothering. The women expressed moral concern about not being able to function as "good" mothers yet attempted to find a balance between experiences of exhaustion and other experiences that made it difficult to maintain their responsibility as parents. All of the women included in this study expressed the need for professional support to help them endure treatment procedures as well as to sustain their moral responsibility as good mothers.

Body experience and reliance in some women diagnosed with cancer.

Physical disease, like cancer, can be perceived as a psychological crisis. Part of this crisis concerns changes in the body. The aim of this study was to describe the phenomenon "body experience" with special attention to "body reliance" among women with cancer. Participants were 10 women with different cancer diagnoses who had been under oncological medical care or were receiving treatment to palliate cancer symptoms. All were scheduled to begin physiotherapeutic rehabilitation. Semistructured interviews were conducted and analyzed from a phenomenological-hermeneutical point of view. Cancer caused a radical change on many levels. A new sensitivity to bodily signals developed, which could be related to insecurity associated with the disease and the treatment. Many worried greatly about a recurrence. This was related to a questioning of trust in the body and in life. There was an existential dimension in listening to the body's signals: the body was transformed into a messenger in a wide sense. It was meaningful to investigate the cancer experience from a bodily perspective. The results indicate that it can be helpful to communicate with the patient regarding body experience in cancer rehabilitation.

Experience of dealing with moral responsibility as a mother with cancer.

This study explored how women with a diagnosis of cancer (lymphoma) deal with moral concerns related to their responsibility as parents. Ten women with cancer and who had children living at home were interviewed. The interviews were analysed according to the constant comparative method used in grounded theory. In order to provide a focus for the analysis, the ethics of care and the concept of mothering were used as sensitizing concepts. The core concept 'experience of dealing with moral responsibility of being a parent with cancer by redefining oneself as a mother was identified. The processes involved were: interrupted mothering; facing the life-threatening illness and children's reactions; striving to be a good mother; attempting to deal with moral responsibility; and coming to terms with being a mother.

Quality of life in women with breast cancer during the first year after random assignment to adjuvant treatment with marrow-supported high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin or tailored therapy with Fluorouracil, epirubicin, and cyclophosphamide: Scandinavian Breast Group Study 9401.

PURPOSE: To compare, in high-risk breast cancer patients, the effects on health-related quality of life (HRQoL) of two adjuvant treatments. Treatments were compared at eight points during the first year after random assignment to treatment with tailored fluorouracil, epirubicin, and cyclophosphamide (FEC) therapy for nine courses versus induction FEC therapy for three courses followed by high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin (CTCb) supported by peripheral-blood stem cells. PATIENTS AND METHODS: From March 1994 to March 1998, 525 breast cancer patients (estimated relapse risk > 70% within 5 years with standard therapy) were included in the Scandinavian Breast Group 9401 study. HRQoL evaluation, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and EORTC Breast Cancer Module-23, included 408 of 446 eligible patients in Finland, Norway, and Sweden. RESULTS: Eighty-four percent to 95% of the patients completed questionnaires at eight points of assessment. Nostatistically significant overall differences were found between the tailored FEC group and the CTCb group for any of the HRQoL variables. Statistically significant differences over time were found for all HRQoL variables. HRQoL in the CTCb group demonstrated a steeper decrease, but a faster recovery than in the tailored FEC group. Emotional functioning improved with increased time from randomization. Higher levels of problems in body image and arm symptoms were reported in the tailored FEC group compared with the CTCb group. Sexual functioning and satisfaction were impaired during the study period. CONCLUSION: Both treatments had a negative influence on HRQoL during the treatment period. Despite the aggressive therapies, the patient's HRQoL returned to levels found at inclusion on most variables.

Side effects of adjuvant endocrine treatment in premenopausal breast cancer patients: a prospective randomized study.

PURPOSE: To compare the effect of adjuvant endocrine therapies with and without chemotherapy on physical symptoms, anxiety, and depressive symptoms in premenopausal women with breast cancer in a randomized clinical trial (the Zoladex in Premenopausal Patients trial). PATIENTS AND METHODS: The patients were randomly assigned to goserelin, goserelin plus tamoxifen, tamoxifen alone, or no endocrine therapy. The duration of the endocrine treatment was 2 years. The groups were observed for 3 years after primary treatment (ie, during 2 years of active treatment as well as 1 year after cessation of the adjuvant endocrine therapy). All patients with node-positive disease received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF), which was given concurrently with the endocrine treatment. RESULTS: Patients treated with CMF typically reported higher levels of physical symptoms than did patients who did not receive CMF. It was only among patients who did not receive chemotherapy that the endocrine treatment had differential effects. Goserelin was most burdensome and resulted in similar symptom levels as those of CMF, whereas the side effects of tamoxifen alone were milder. After cessation of the endocrine treatment, the side effects diminished in patients who had not received CMF, whereas patients treated with CMF reported ongoing problems at the 3-year follow-up. In contrast, anxiety and depressive symptoms were not significantly affected by endocrine treatment or chemotherapy during the 3 years of assessment. CONCLUSION: Goserelin and tamoxifen resulted in menopausal symptoms, but these symptoms were reversible. However, women treated with CMF experienced physical symptoms throughout the whole study period.

The meaning of breast cancer.

Breast cancer patients' perception of illness could influence preferences in decision-making. According to Lipowsky, the meaning of illness might influence coping abilities and he suggests eight categories of meaning as prevalent in our culture: 'challenge', 'enemy', 'punishment', 'weakness', 'irreparable loss', 'relief', 'strategy' and 'value'. In this study 187 Swedish breast cancer patients chose one of these eight categories as their meaning of breast cancer. 'Challenge' was chosen most often, by 33% of all patients and by 40% of patients in middle life (51-65 years). Older patients (> or = 66 years) chose 'challenge' less frequently (17%) but chose 'relief', 'strategy' or 'value' more often than younger patients. The few patients with metastatic disease chose 'enemy', 'punishment', 'weakness' and 'irreparable loss' more often than patients in the earlier stages of disease. There were differences in perception of illness depending on patients' age and stage of disease but not depending on their preferences in decision-making.

Men with cancer. Changes in attempts to master the self-image as a man and as a parent.

Little is known about men's experience of how cancer affects their role as a father. The aim of this study was to gain an understanding of changes in these men's everyday family lives. The study had an interpretative descriptive design, utilizing the concept of transition as a fore structure. Eight men with different types of blood cancer and with children living at home were recruited for the study. Interviews, guided by the main components of the concept of transition, provided qualitative data for analysis. Through the interpretative process, the central theme--change in self-image as a man and as a parent--was generated. This theme consists of the subthemes gaining control, balancing emotions, subjective well-being, being open or not toward the family, and challenges in family life and to family well-being. The time after diagnosis influenced the process of transition. Self-image changes are more obvious shortly after diagnosis. Further study is needed to identify how nurses and other clinicians can assess the family's needs and support the parental role, especially in consideration of the findings of this study.