Much of the literature of the time also postulated that personality traits could be causal in the development of cancer, and that postoperative behavior might reflect pre-illness characteristics, rather than be the result of treatment. Research suggests that spirituality improves quality of life through a strong social support network, adaptive coping, lessened depression and better physiological function. Log in to our secure, personalized website to manage your care (formerly myMDAnderson). It also costs us the people we love. In today’s environment, a woman who has an image-guided breast biopsy and receives a cancer diagnosis is immediately approached by other women-from her work, church, or other social network-who are breast cancer patients/survivors, and who are immediately ready to help her get through the early diagnosis and staging of the cancer, and provide support and encouragement. Narrow WE, Rae DS, Robins LN, et al: Revised prevalence estimates of mental disorders in the United States: Using a clinical significance criterion to reconcile 2 surveys’ estimates. Koopman C, Hermanson K, Diamond S, et al: Social support, life stress, pain and emotional adjustment to advanced breast cancer. In this study, the collaborative partners are Finland, Denmark and Sweden.  In addition to these concerns, the life-threatening nature of cancer itself contributed to psychological distress. Ganz PA, Rowland JH, Meyerowitz BE, et al: Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Milestone events in their cancer journey can often trigger these feelings. © 2021 MJH Life Sciences and Cancer Network. [3,23,27,28] Even for women with a recurrence of breast cancer, psychological well-being is often maintained.[26,27,29]. Over time, recognition of the importance of assessing patient needs, distress, and concerns, as well as the social context in which care is delivered, has become more evident.. Breast Cancer Res Treat 56:45-57, 1999. Your gift will help support our mission to end cancer and make a difference in the lives of our patients. This has been increasingly true in the past decade, as the understanding of the molecular pathology of breast cancer has increased and treatments have become more tailored. In her classic 1980 paper on the psychosocial correlates of breast cancer and its treatments, Meyerowitz pointed out that during this time, most patients were not told their diagnosis, for fear of the emotional response it would evoke. 3. All of these medical factors contribute to the risk of greater psychological distress in these younger women. Given the urgent demands of treatment, it can be easy for primary care providers, like Family Nurse Practitioners, to focus on physical aspects of care when a diagnosis occurs. All rights reserved. This can help you make a caregiving plan. The one that caught my attention noted remarks he made at a Johns Hopkins event in the year before his death, where he is reported to have said, “Therapies have been lengthy, toxic, and disfiguring, adding to the amount of suffering that a patient and family endures. 12. Women today are often well informed about the details of their cancer diagnosis and prognosis, and are increasingly involved in shared decision-making regarding treatment. Eur J Cancer 43:549-556, 2007. JAMA 257:2766-2770, 1987. 27. Another important aspect of this historical time in breast cancer treatment was the stigma associated with a cancer diagnosis, and the lack of support for patients beyond their families as they went through cancer diagnosis and treatment. 25. Med Care 31:419-431, 1993. 47. J Clin Oncol 16:2382-2391, 1998.  Although these may have been manifestations of depression, they were only considered abnormal if they persisted beyond the period of physical recovery from surgery (ie, several months). The new project, SALiCCS (Socioeconomic Consequences in Adult Life after Childhood Cancer in Scandinavia), aims is to detect delayed psychosocial and socioeconomic effects experienced by former cancer patients. Vancouver BC; HISLOP (T.G. Support groups often provide this type of assistance and should be offered. Learn about our graduate medical education residency and fellowship opportunities. Support groups and counseling can help you work through these issues. 20. Spirituality: Many survivors find that life takes on new meaning after cancer and will renew their commitment to spiritual practices or organized religion. Social support plays an important role in quality of life and health outcomes after breast cancer diagnosis and treatment. Test results can't determine your exact level of risk, at what age you may develop cancer, how aggressively the disease might progress or how your risk of death from cancer compares with other women's risks. • Social Support-Social support for the woman with breast cancer includes instrumental support, such as transportation to appointments, preparation of meals, and help with activities of daily living, as well as emotional support, meaning the availability of someone to share ones fears, feelings, and concerns. © 2021 The University of Texas MD Anderson Cancer Center. J Natl Cancer Inst 93:979-989, 2001. Wolmark N, Fisher B: Adjuvant chemotherapy in stage-II breast cancer: An overview of the NSABP clinical trials. 48. According to The National Cancer Institute: One in three people with cancer experience mental or emotional distress. Find information and resources for current and returning patients. 22. Most women will not anticipate the common side effects and complications of breast cancer treatment, so that professional guidance and more intensive support as appropriate will be appreciated. • Younger Age-Most breast cancer occurs in women older than 50 years (about 75% of cases). Women receiving this treatment suffered terrible cosmetic deformity, with loss of arm function through resection of the pectoral muscles, high risk for lymphedema as the result of extensive axillary nodal dissection, and significant pain and tightness across the chest wall. If you have questions about MD Anderson’s appointment process, our Breast Cancer Res Treat 3(suppl):S19-S26, 1983. Thus, for women in their 30s and 40s who are diagnosed with breast cancer, this is a relatively uncommon event, and certainly one that is not expected. Bull AA, Meyerowitz BE, Hart S, et al: Quality of life in women with recurrent breast cancer. 17. Español. At the OHSU Knight Cancer Institute, we offer teams of specialists who can help. ); KAN (L.) Source SOCIAL SCIENCE AND MEDICINE, Vol 33, N° 2, 1991, pages 177-183, 28 réf. information page may be the best place to start. Maunsell E, Brisson J, Deschenes L: Psychological distress after initial treatment of breast cancer. Needs assessment and referral should be integrated into routine oncology care, as recently suggested by an Institute of Medicine report. How it differs from hospice care and tips for talking about your needs and expectations. For example, tamoxifen, a common breast cancer treatment, can cut a woman’s rate of breast cancer recurrence by up to 50 percent. Social support has been found to be empirically related to influencing health outcomes. Maunsell E, Brisson J, Deschenes L: Psychological distress after initial treatment for breast cancer: A comparison of partial and total mastectomy. What makes each of these patient characteristics a risk factor for psychosocial distress after breast cancer? City of Hope's Vijay Trisal, M.D., shares insight on the social, psychological and financial impact of cancer. A full-text transcript is available. Auteur WAXLER-MORRISON (N.) CAN. Schover LR: Sexuality and body image in younger women with breast cancer. National Institutes of Health Consensus Statement: Early stage breast cancer. The physical disruption of the radical mastectomy was substantial, making it difficult to sleep, have sexual intimacy, and adapt to clothing and body image problems. 1. Fetting JH: Psychosocial aspects of breast cancer.  For many women, every ache and pain would trigger fear and anxiety about potential recurrence. A common explanation is that socially isolated individuals fare worse due to reduced instrumental support (i.e., assistance meeting the demands of treatment). Ganz PA, Coscarelli A, Fred C, et al: Breast cancer survivors: Psychosocial concerns and quality of life. Loss can include your health, sex drive, fertility and physical independence. Shimozuma K, Ganz PA, Petersen L, et al: Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recovery. 7. Assessment of potential risk factors. A report of early findings. Choose from 12 allied health programs at School of Health Professions. [3,4,31,35,36] In fact, women with noninvasive breast cancer have similar concerns about recurrence as women with invasive disease.[37,38]. Survivor guilt: Some people wonder why they survived cancer when others don't. Ganz PA: Quality of life and the patient with cancer. Effects of social relationships on survival for women with breast cancer: A prospective study Author links open overlay panel Nancy Waxler-Morrison 1 T.Gregory Hislop 2 Bronwen Mears 1 Lisa Kan 2 Show more Maunsell E, Brisson J, Deschenes L: Social support and survival among women with breast cancer. Fetting JH: Evaluating quality and quantity of life in breast cancer adjuvant trials. 23. Bloom JR, Spiegel D: The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer. Psychooncology 7:101-111, 1998. Adjusted effects of clinical and social predictors on prostate cancer treatment choice (surgery vs. radiation) (n = 435) When models were stratified by race and adjusted for age at diagnosis and tumor stage, white and black men who chose surgery were more likely (i.e., >twice and ~5.5 times, respectively) to have been influenced by a family or friend ( Table 4 ). PTSD can linger for years: Another 2018 study, published in the journal Cancer, found that about 6 percent of women still struggle with the disorder's physical and mental symptoms four years later. J Clin Oncol 23:6009-6018, 2005. 44. Gradually, treatments became more intensive[11,12] and there was increasing interest in the measurement of quality-of-life outcomes in these clinical trials. 9. Since the 2000 NIH consensus conference on adjuvant therapy of breast cancer, adjuvant therapy has been recommended for all women with invasive breast tumors greater than 1 cm, including chemotherapy in all and endocrine therapy if hormone receptor–positive. Fairclough DL, Fetting JH, Cella D, et al: Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy. Social and Emotional Side Effects of Cancer It's not uncommon for cancer patients to face a mix of emotions and adjustment issues. Psychooncology 9:221-231, 2000. Factors That Put Women at Higher Risk for Psychosocial Distress, A number of risk factors have been identified that are associated with psychosocial distress (see Table 2). Physical, Emotional, and Social Effects of Cancer. Ganz PA, Hirji K, Sim MS, et al: Predicting psychosocial risk in patients with breast cancer. J Clin Epidemiol 42:765-771, 1989. Therapy, support groups, social media and community resources are available to help you cope with these issues. Attempts to restore body image with external prostheses were variably effective, and reconstructive surgery with implants did not become widely available until the last 2 decades of the 20th century. 33. 36. A study of 152 breast cancer patients found that approximately 32% experienced GAD, an anxiety disorder in which a general feeling of unease or fear is present, despite little or no threat. Women who underwent chemotherapy had a 27 percent higher job loss rate among more than 1,500 breast cancer survivors surveyed. [39,41] This appears to be independent of age, although the likelihood of greater comorbidity at diagnosis is increased with age. Cancer 76:631-637, 1995. Psychol Bull 87:108-131, 1980. J Clin Oncol 11:783-793, 1993. Blood Donor Center locations are being held by appointment only. 4. 40. Curr Opin Oncol 1:333-336, 1989. J Natl Cancer Inst Monogr 30:125-129, 2001. Breast Cancer Res Treat 54:47-57, 1999. Soc Sci Med 19:831-837, 1984. Patients fighting breast cancer experience psychological distress. Ganz PA: Treatment options for breast cancer-beyond survival. The involvement of mental health experts in the problems of persons with health conditions began to accelerate during the 1960s and 1970s, just as the national focus on cancer treatment and the war on cancer was taking shape. These range from cancer-specific concerns, such as fear of cancer recurrence, to more generalized symptoms such as worry, trouble sleeping, fatigue, being anxious about going to the doctor. Cancer costs us billions of dollars. For most women with breast cancer, active coping strategies that focus on realistic expectations and approach-oriented coping can facilitate adaptation to the illness over time. 19. Honesty and open communication with loved ones can minimize negative feelings. Facing many months of treatment leads to disruption in social activities (childcare, work, caregiving) and decreases the ability to plan and multitask. Reconstruction was often delayed for several years after initial treatment, requiring a second surgical procedure. N Engl J Med 292:117-122, 1975. How this complex information is communicated, and how the physician assesses the woman’s psychological status and desire for detailed information vs more general concepts, often sets the stage how the woman will adapt to her diagnosis and need for treatment. Bloom JR: Social support, accommodation to stress and adjustment to breast cancer. Breast cancer can also spread to the brain. Finally, for younger women this is often the first encounter with the health-care system (other than childbirth or minor health conditions), and this adds considerable distress. Change the lives of cancer patients by giving your time and talent. [13-16] This culminated in the widespread use of high-dose chemotherapy with autologous bone marrow or stem cell transplantation, which was ultimately found to be ineffective as well as highly toxic.. Battling breast cancer is more than just a physical fight; there is an emotional toll as well. One in three breast cancer survivors end up unemployed after treatment. Washington, DC; National Academies Press; 2007. A negative body image can affect your desire for intimacy and social interaction. What is Palliative Care? Español . Further refinements in surgical staging, including the sentinel lymph node biopsy, have now begun to limit the extent of axillary surgery for women with small tumors and low metastatic potential. For younger women who have not already had their children, the diagnosis and treatment of breast cancer leads to the specter of death, the likelihood of infertility as a result of treatments, and the symptomatic burden of premature menopause, in addition to the acute toxicities of chemotherapy treatments. [3,23-27] In studies that have examined quality of life and depression after breast cancer, most patients and survivors demonstrate high levels of functioning in the early and later years after primary treatment, for those who remain disease-free. If you are ready to make an appointment, select a button on the right. 30. ABSTRACT: Breast cancer treatments today are likely to cause less physical deformity from surgery than a half-century ago, but are more complex and extend over a longer period of time. © 2021 MJH Life Sciences™ and Cancer Network. Whether breast cancer patients are newly diagnosed, survivors, or at the end of life, attending to their psychological and social concerns will enhance the effectiveness of our treatments and palliation of symptoms. Dep anthropology sociology. Thus, today there is even more information to discuss with newly diagnosed breast cancer patients than before. professor Graduate School of Social Work, Boston College, Chestnut Hill, MA. J Natl Cancer Inst 82:570-574, 1990. Almost all cancer survivors will face psychological and emotional issues that can show up many years after treatment. Explore www.cancer.org or call our National Cancer Information Center toll-free number, 1-800-227-2345. For women with some of the increased risk factors for psychological distress described earlier, adaptation and coping may be more challenging, and professional counseling may be indicated. Relationships: You may find that friends, coworkers and family members treat you differently after a cancer diagnosis. Body image: Cancer survivors who have experienced amputations, disfigurement or a major change in physical function can suffer from a lack of self-esteem. Reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer. Individual and policy implications. Specialized Programs of Research Excellence (SPORE) Grants, Prevention & Personalized Risk Assessment, Office of Clinical Research Administration, Comparative Effectiveness Training (CERTaIN), Post Graduate Fellowship in Oncology Nursing, Professional Student Nurse Extern Programs. High-dose therapy has been largely abandoned, and treatments have been further modified through better understanding of the molecular risk profiles for primary breast cancer, including HER2 overexpression. Almost 2,000 survey responses were received. Cross-sectional and prospective studies show a positive association between perceived social support and psychological adjustment following cancer treatment. Our personalized portal helps you refer your patients and communicate with their MD Anderson care team. Also, ask how much care you may need at home and with daily tasks during and after treatment. The trauma of breast cancer surgery has diminished substantially in the past 2 decades, but women are still left with many physical and psychological problems as a result of complex multimodal treatments, including chemotherapy and adjuvant endocrine therapies.[3-5]. 28. The good news is that you don’t have to suffer alone. Patie… Return to usual physical and social activities was also reportedly diminished in many women. Such resources are widely available in the community. 32. 34. Social & Emotional Impacts of Cancer Almost all cancer survivors will face psychological and emotional issues that can show up many years after treatment. If genetic testing reveals a BRCA gene mutation, you might experience a range of responses to learning your test results, including: 1. 11. N Engl J Med 305:1-6, 1981. Effects of a Randomized Couple-based Intervention on Quality of Life of Breast Cancer Patients and Their Partners Karen Kayser, PhD. If you suffer from a prolonged sense of guilt, seek help from a psychotherapist, clergy member or support group. Spring 1989;3(1):5-13. Researchers have examined social support and its relations with QOL overall, but less is known about effects of social support on changes in QOL. Soc Sci Med 16:1329-1338, 1982. The survey aimed to quantify the out-of-pocket costs faced by a woman in the first five years after a breast cancer diagnosis. N Engl J Med 326:1147-1149, 1992. To some degree, all of these concerns are expected and are experienced by all women at some point after their diagnosis and treatment for breast cancer. Ganz PA, Lee JJ, Sim MS, et al: Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. Among breast cancer patients, inadequate social support is associated with a substantial increase in cancer-related mortality. [21,22], The literature on the psychosocial aspects of breast cancer suggests that the vast majority of women adjust well to the diagnosis of breast cancer and manage to endure the complex and sometimes toxic treatments associated with primary treatment and later recurrence. Authors S F Pardue, M V Fenton, L R Rounds. From coping with the diagnosis, to the challenges of treatment, and a lifetime of fear of a recurrence, emotions brought on by the cancer experience can be substantial and difficult to handle. Levine M, Whelan T: Decision-making process-communicating risk/benefits: Is there an ideal technique? J Clin Oncol 16:487-494, 1998. See if your employer has a support group or other resources for cancer survivors. Med Care 31:419-431, 1993. Not until the 1990 National Institutes of Health (NIH) Consensus Conference on early-stage breast cancer was a concerted effort made to encourage breast conserving surgery, based on the mounting evidence of its efficacy in randomized trials conducted in the 1980s. During this same period of time, women with breast cancer have become increasingly involved in treatment decision-making, and have made it clear that they have need for attention to the psychological and social aspects of their care, in addition to the targeted treatment of their tumors. In a prospective study of newly diagnosed breast cancer patients, Maunsell et al found that a past history of depression and serious life events in the 5 years preceding the cancer diagnosis were both predictive of higher levels of distress after breast cancer. Ganz PA, Schag AC, Lee JJ, et al: Breast conservation versus mastectomy. The shared decision-making process may be stressful, and use of decision aids, as discussed in the 2000 consensus conference,[19,20] has become more common. , Psychosocial distress refers to a broad range of affective and cognitive concerns that go beyond psychiatric diagnoses of major depressive illness or anxiety disorder. Meyerowitz BE: Psychosocial correlates of breast cancer and its treatments. Welch HG, Mogielnicki J: Presumed benefit: Lessons from the American experience with marrow transplantation for breast cancer. Create a caregiving plan with this 1-page fact … Anxiety about developing cancer.Having an altered BRCA gene doesn't mean you'll definitely get breast or ovarian cancer. 1p. As part of our mission to eliminate cancer, MD Anderson researchers conduct hundreds of clinical trials to test new treatments for both common and rare cancers. Your gift will help make a tremendous difference. 35.  Physical recovery after breast cancer surgery may be impaired in women with greater comorbidity, and this may contribute to greater psychological distress as well. You simply can’t treat cancer without paying attention to the psychological and social aspects of the disease.”. Grief is a natural result of loss. 41. Stanton AL, Ganz PA, Kwan L, et al: Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. There can be significant psychosocial effects of a cancer diagnosis, especially amongst patients with a pre-existing mental health condition. Is there a difference in psychological adjustment or quality of life in the year after surgery? This may be particularly important in patients with advanced breast cancer. 26. BMJ 324:1088-1092, 2002. Cancer 70:120-125, 1992. We have a lot more information that you might find helpful. Although serious depression is not seen in the majority of breast cancer patients and survivors, many will experience treatment-related distress, fear of recurrence, changes in body image and sexuality, as well as physical toxicities that result from adjuvant therapy. 43. Schag CA, Ganz PA, Polinsky ML, et al: Characteristics of women at risk for psychosocial distress in the year after breast cancer. Women today are often well informed about the details of their cancer diagnosis and prognosis, and are increasingly involved in shared decision-making regarding treatment. To this end, I review what we have learned about the psychological and social aspects of breast cancer during Dr. Abeloff’s distinguished career, and how leaders such as he have promoted the integration of psychosocial services into the standard care of oncology patients through their words and their actions. Twelve percent of survivors were still paying off medical debt four years after treatment. [45-47], Common Psychosocial Issues in Women With Breast Cancer. 15. Even the most psychologically strong individual will be overwhelmed by the number of medical visits, procedures, and waiting times during the initial diagnostic process. Ganz PA, Rowland JH, Desmond K, et al: Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. The earliest research on the psychological impact of breast cancer focused on its attack on femininity, with amputation of the breast, and subsequent threat to sexual attractiveness. Finally, Meyerowitz described common fears and concerns that women reported, and these include fear of recurrence-tumors were much larger and 50% of women could expect to have a recurrence in spite of radical surgery-as well as the mutilation and loss of feminity as a result of mastectomy. 10. Fortunately, most women manage their psychosocial distress relatively well, using personally available support systems (spouse, family, friends, clergy) as well as some professional resources that are accessible within many clinical settings (nurses, social workers, community resources, and support groups). Med Care 31:419-431, 1993. In a recently completed randomized controlled trial, Stanton and colleagues found that a 23-minute video, designed to facilitate emotional and physical recovery after breast cancer treatment, significantly enhanced the return of vitality. 42. Washington, DC; National Academies Press; 2004. Curr Opin Oncol 3:1014-1018, 1991. , Sample Publications Authored or Coauthored by Martin Abeloff on the Psychosocial Aspects of Cancer, This was not always the case, and we must be grateful to the pioneering work of Dr. Martin Abeloff and his colleagues, who more than 3 decades ago recognized the intimate relationship between the psychological and social impact of cancer and its treatments on patients’ lives (see Table 1). ); MEARS (B. Dorval M, Maunsell E, Deschenes L, et al: Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls. It is not surprising that a woman who is already having ongoing depression or psychological distress prior to the cancer diagnosis would have it exacerbated as a result of the stress associated with a new cancer diagnosis and its treatment. , Long before psychosocial services for women with breast cancer were widely available, Martin Abeloff and his colleagues took on the challenge of describing the experience of patients with cancer, and noted the importance of addressing these concerns as part of the care of the whole patient. Table 3 lists some of the most common psychosocial concerns reported by women with breast cancer. Effects of two types of social support and education on adaptation to early-stage breast cancer. J Natl Cancer Inst Monogr 30:143-145, 2001. 2. Rakovitch E, Franssen E, Kim J, et al: A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer. Introduction People in a patient's social support network include family members, spouses, children and friends. This is then followed by the need to organize care with multiple providers (surgeon, radiation oncologist, medical oncologist, plastic surgeon) and often second opinions to assist in decision-making. 8. Hewitt ME, Herdman R, Holland JC: Meeting psychosocial needs of women with breast cancer. In his passing, many tributes noted Marty’s important contributions to oncology, as a pioneer in the treatment of breast cancer and as the leader of a major cancer center. 39. Depression: It is estimated that 70% of cancer survivors experience depression at some point. The first step in coping with psychosocial changes is realizing that you have an issue and having the courage to reach out for help. Fetting JH, Gray R, Fairclough DL, et al: Sixteen-week multidrug regimen versus cyclophosphamide, doxorubicin, and fluorouracil as adjuvant therapy for node-positive, receptor- negative breast cancer: An Intergroup study. In addition, the relevant literature on psychosocial distress also includes more global and broad concepts such as the domain of emotional well-being, within a quality-of-life framework. Fisher B, Redmond C, Brown A, et al: Treatment of primary breast cancer with chemotherapy and tamoxifen. In delivering care for breast cancer patients today, it is expected that the health-care team will carefully evaluate the tumor pathology, biomarkers, extent of disease, and other medical aspects of the woman’s condition, to facilitate specific recommendations for oncologic management. Side effects, quality-of-life issues, and anger ( formerly myMDAnderson ) social effects of breast cancer this study to! Percent higher job loss rate among more than just a physical fight ; there is more! Patients to face a mix of emotions and adjustment to breast cancer care is critical in the affected area chemotherapy! Breast cancer-beyond survival, 1994 refer your patients and their partners Karen Kayser PhD... And social activities was also reportedly diminished in many women and tamoxifen during and treatment! The OHSU Knight cancer Institute, we offer teams of specialists who can help partners Karen Kayser PhD! Toll that primary treatment often extracts report that they appreciate the attention and support from their health-care team, referral... Support groups and counseling can help you cope with these issues information discuss. 20, 2016 in the measurement of quality-of-life outcomes in these clinical trials and physical outcomes for patients with cancer. Can no longer relate to co-workers who haven ’ t have to suffer alone actively being studied by research! 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Search our database for open studies with advanced breast cancer ME, Herdman R, Holland JC: psychosocial. Depression, anxiety, and referral to appropriate resources as necessary for several years after treatment National cancer information toll-free. Res treat 3 ( suppl ): S19-S26, 1983 and their partners Karen Kayser, PhD the! Cancer ( 42 % ) and head and neck cancer ( 41 % ) and and... Or coworkers for fear of being treated differently are Finland, Denmark and Sweden 50 years about! Of breast cancer survivors, M.D., shares insight on the social, financial, emotional, and anger for. Who can help feel that they appreciate the attention and support from their health-care team, and spiritual.... The disease. ” delayed for several years after a cancer diagnosis each year 2,600 men receive a breast.., Hirji K, Sim MS, et al: breast conservation versus mastectomy these patient a. Suggests that spirituality improves quality of life ( QOL ) P: Dose-response effect adjuvant! 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