Authors

1. Campbell-Enns, Heather
2. Woodgate, Roberta RN, PhD

Abstract

Review question/objective: What are the psychosocial experiences of women with breast cancer across the lifespan, including similarities and differences in the psychosocial experiences of younger, middle-aged and older women with breast cancer?

Background: The experience of a life threatening illness, such as cancer, requires a person to consider an array of emotional, medical, social and existential demands.1 Specific to breast cancer, research shows that the experience of diagnosis and treatment of breast cancer may result in considerable distress.2It is also known that a diagnosis of invasive breast cancer propels women into a time of uncertainty3,4, that brings fear5,6 and emotional work.7 This disease oftentimes challenges a woman's identity8, self-esteem9,10, body image2,11 and relationships.1,12 However, even with these commonly felt distresses, most women adjust well to a breast cancer diagnosis and the treatments experienced, particularly if they do not experience a recurrence of cancer.13 Protective factors for distress include supportive care networks, such as family and support groups and professional resources provided by clinical staff, such as timely referrals to specialized services.14Although most women adjust well to breast cancer, understanding distressing experiences among this population is crucial because, when experienced, the negative psychosocial impacts can be significant.15 Women who do experience distress due to breast cancer are at a risk of distress accompanying them through the breast cancer journey and impacting their long-term quality of life.14,16,17

Although literature suggests that the psychosocial experience of a breast cancer diagnosis may be different across the lifespan4, less is known about the similarities and differences in the psychosocial experience between younger and older women with breast cancer. However, this study4examines the experience of one age group and no comparisons between different age groups in this or other studies have been found at this time. Among what is known, younger women with breast cancer are at a heightened risk of anxiety and depression in comparison to older women and younger women experience more worries about their careers and finances than older women.14,15,17,18 There is also evidence that young women perceive their quality of life to be lower than older women as a result of breast cancer.17 This may be attributed to poorer emotional wellbeing, specific cancer-related concerns, depression and intrusive thoughts for this younger group.19 On the other hand, older women with breast cancer experience more health problems than younger women in survivorship, independent of receiving chemotherapy.17,20 In general, older breast cancer survivors experience overall better quality of life and mental health than their younger counterparts, but they tend to have poorer physical health and health-related quality of life due to comorbid conditions.17,21 Another risk factor for psychosocial distress is low income, which may be particularly salient for older women who are more likely to be on a fixed income than their younger counterparts.17 However, literature suggests that a higher degree of psychosocial adaptation can be found among older women with breast cancer because these women have had more life experience, including prior experiences with the health care system14, witnessing the diagnosis of others with cancer14, and having few competing demands.22 It is thought that these factors contributed to coping and successful adaption to the disease among older women.14

When studying how women acclimatize to breast cancer in the early stages of the cancer journey, it has been found that the main concerns for these women were concepts connected to identity.23 Breast cancer threatens women's self-integrity and the restructuring of life after a cancer diagnosis calls for the new experiences and feelings to be integrated into a revised self-narrative, sometimes referred to as 'meaning-making'.24 Little is understood about the differences between younger and older women in their construction of identity or how they make meaning in the context of breast cancer. What is known is that, for younger women, the diagnosis of cancer is shocking7, and is an opportunity to contemplate mortality.25 Older women are more likely to approach their diagnoses in a matter-of-fact manner associated with the expected process of aging.26

The concept of body image can be found as a focus of breast cancer literature which describes the level of investment women put into their body in order to help them determine their wellbeing.27 The disruption of body image in breast cancer is attributed to hair loss, as well as changes in the breast and weight.2 Studies show younger women do seek normality in their breasts following mastectomy28, and seek breast reconstruction more often than older women.29 Regarding older women with breast cancer, little is known about the experience of specific body image concerns, such as short- or long-term changes in the body due to treatment. It is known that older women with cancer experience body dissatisfaction and may even experience higher levels of dissatisfaction than younger women, possibly due to more persistent problems with the physical functioning of their body.30

It is also known that the diagnosis and treatment of breast cancer affect relationships including spousal relationships31, and relationships with children32,33 and older parents.34 As a woman with breast cancer experiences vulnerabilities, so too does her family.35 Spouses and partners of women with breast cancer work to adjust roles and to balance added household responsibilities, particularly during times of treatment.36 Children of women with breast cancer are impacted by the level of interaction with their mothers, with increased positive mother-child interactions associated with the increased wellbeing of family members.37 On the other hand, children are impacted negatively by a negative change in the mother's mood or marital tension.37 Lastly, parents of women with breast cancer are also affected since, they too, need to come to terms with the early timing of their daughters' diagnoses.34

Family relationships are vital for women with cancer because these relationships provide a high degree of social support, including emotional, tangible, informational and experiential support.38 Literature shows family relationships are improved for both younger and older breast cancer survivors.20 However, the intimate relationships of younger women are more likely to be strained in comparison to the intimate relationships of older women in the context of breast cancer survivorship.20 Also, younger adults with cancer experience increased loneliness39, and a greater sense of isolation from peer and support networks than older adults perhaps because they perceive themselves to be different from their peers as a result of cancer.4,40

This incomplete understanding of the psychosocial experience of women with breast cancer across the lifespan requires an urgent need for research to facilitate a greater understanding of the psychosocial needs of these women. To allow for the effective delivery of appropriate cancer care support to these populations, a greater understanding of the unmet needs of these women must occur, including an understanding of the similarities and differences of younger and older women with this disease. A synthesis of literature from multiple contexts of the psychosocial experiences of younger and older women with breast cancer will add to the understanding of the experiences of these women. No systematic review on this topic was found when searching Cochrane Database of Systematic Reviews, PROSPERO and the JBI Database of Systematic Reviews and Implementation Reports.