Breast Cancer And Stress Pdf
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Stress is an inevitable part of life. Recent studies have shown that chronic stress can induce tumorigenesis and promote cancer development. This review describes the latest progress of research on the molecular mechanisms by which chronic stress promotes cancer development.
- Chronic Stress Promotes Cancer Development
- Oxidative stress in breast cancer
- Challenges, Coping Strategies, and Social Support among Breast Cancer Patients in Ghana
Chronic Stress Promotes Cancer Development
Despite the high incidence and mortality rate of breast cancer BC in Ghana, little attention has been given to the issue of how adult women cope with having BC. The aim of this study was to explore the challenges, coping strategies, and support systems among women diagnosed with BC in Ghana. A systematic random sampling technique was used to select women with a confirmed diagnosis of BC.
The most and least adopted active coping strategies were religious coping and humors, respectively. Self-distraction and substance use were the most and least adopted avoidant coping strategies, respectively.
This study demonstrates that women diagnosed with BC in Ghana adopt varied coping strategies to deal with these challenges. The forms of coping strategies adopted by women diagnosed with BC are influenced by the extent of social support received.
Psychosocial counseling and support should be an integral part of BC management. Exploring and including social networks could play an important role in the management of BC in Ghana. Globally, breast cancer BC remains the second leading cause of mortality among women, with increasing rates particularly in developing countries where the majority of cases are diagnosed in late stages [ 1 ].
In Africa, it is the most commonly diagnosed cancer annually, with an estimated incidence of , cases and 74, related deaths in [ 2 , 3 ]. In Western Africa, although precise estimates are lacking as a result of absence of a cancer registry in most countries, recent GLOBOCAN data estimate age-standardized incidence and mortality rates of Survival from BC is known to be markedly lower in Africa compared with other regions in the world [ 5 ].
This is not different in Ghana where BC has become the leading cause of mortality among women and it is also the common cause of hospital admissions among Ghanaian women [ 3 , 6 ]. Breast cancer diagnosis along with its treatment can contribute to physical, social, and psychological turmoil.
These challenges extend to the periods of posttreatment and recovery. Additional concerns include physical appearance and disfigurement after treatment, uncertainty regarding recurrence in the future, periods of anxiety and depression, difficulty maintaining hope, fear of death, as well as loss of self-esteem [ 8 ] for the patients and their loved ones, particularly life partners [ 9 , 10 ].
Challenges also include the shock of a cancer diagnosis and fears about the future or the side effects of treatment, such as nausea and fatigue [ 11 ]. Practical aspects of treatment such as the cost and travel also pose challenges [ 11 ]. Although relatively rare, BC presents with even more challenges in younger women, who tend to have a more aggressive biology and an associated poorer diagnosis [ 12 ].
A study conducted among BC patients in Ghana reported a high prevalence of depression Experiences of emotional reactions such as sadness, fear, severe pain leading to suicidal ideations, and loss of hope have also been reported among Ghanaian women diagnosed with BC [ 14 ].
Women diagnosed with BC develop coping strategies to deal with the multifactorial unpleasant experience of a psychological, social, and spiritual nature of their new life situation [ 15 ].
Effective coping strategies are indispensable for adaptation and adjustment to BC and improvement in survival [ 17 , 18 ]. In Ghana, accepting the disease and surrendering to God has been reported as a coping strategy among women living with advanced BC [ 14 ].
The effectiveness of the coping strategy, however, depends on the degree of distress, variations in individual coping, the level of social support available and, to a large extent, the consultation skills and support of health professionals [ 21 ]. A link between social support and coping skills has been previously reported [ 22 ]. Early identification of coping strategies adopted by women with BC as well as patients who are coping poorly is important for treatment compliance, control of distress, and patient care in general.
Effective social support for BC patients could help reduce the negative impact of diagnosis and treatment and promote their psychological well-being [ 23 , 24 ]. The social networks include friends, family members, healthcare professionals, and neighbors, and forms of support are mainly instrumental, structural and functional, emotional, and informational [ 11 ].
Health workers play an important role in orienting patients prior to treatment to help them choose the most suitable methods, thereby minimizing the level of stress and uncertainty [ 25 ]. In a study among young women diagnosed with BC, an increase in social support measured by amount of social contacts was associated with increased likelihood of survival [ 22 ].
Women living with BC in Ghana are known to receive some form of support from their families, spouses, friends, health professionals, and spiritual leaders [ 14 ]. Despite the high incidence-mortality rate of BC in Ghana, and the related psychosocial challenges, less attention has been given to the issue of how patients cope with their condition. Lazarus [ 26 ] identified two major types of coping strategies. Problem-focused coping includes obtaining relevant information about what to do, whereas emotion-focused includes avoiding to think about the threat or reappraising it without changing the realities of stressful situations.
The two coping strategies can both facilitate and impede each other throughout a stressful situation. The concept of social support has been defined and operationalized in different ways and is identified as important in adjusting to breast cancer [ 29 ]. It is a multidimensional concept that is generally theorized from a quantitative-structural perspective of social networks, such as numbers of persons and formal relationships with them, or from a qualitative-functional perspective of social support, such as the perceived content and availability of relationships with significant others [ 30 ].
The qualitative-functional support relates to the quality or function served by the structural support components and is mainly divided into the provision of instrumental, emotional, and informational support [ 31 ].
This study dwells on the buffer theory, which reflects the belief that support buffers against the adverse effects of stressors under conditions of high stress.
These studies generally conclude that social support from family and friends is associated with a better adjustment to BC. The aim of this study was to explore the challenges, coping strategies, and support systems reported by women diagnosed with BC in the Kumasi metropolis, Ghana, and to assess the associations among sociodemographic characteristics, social support, and coping strategies.
The oncology unit, which is part of the clinical directorate of the hospital, was opened in The study population included women with a confirmed diagnosis of BC at the oncology unit of Komfo Anokye Teaching Hospital and was willing to participate in the study. The researchers were trained to ensure consistency in the administration of the questionnaire including the translation of the questions to the local language for participants.
The questionnaire was administered by the researchers to all those selected for the study. The study participants were recruited using a systematic random sampling technique. On each day, during the visit hours, a first participant was identified and interviewed as the starting point, followed by the K th respondent. This was repeated until the required sample size for each day was attained.
We included women, 18 years and above, who had confirmed BC diagnosis at KATH and consented to participate in the study.
This instrument has been used to assess both habitual and dispositional coping how people react in general , and more specific coping how people react in relation to a specified stressful encounter. The Brief-COPE is a well validated scale that has been used extensively to assess coping strategies for many conditions including cancer [ 35 ] and depression [ 36 ]. The 14 items of the Brief-Cope measure self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame.
The responses were on a Likert scale of four 4 , directed at teasing out the frequency with which the women engaged in each strategy: 1 I have not been doing this at all , 2 I have been doing this a little bit , 3 I have been doing this a medium amount , and 4 I have been doing that a lot.
Challenges experienced were assessed on a Likert scale of five responses: 1 never , 2 rarely , 3 sometimes , 4 often , and 5 always. There was a total of 10 items to measure possible challenges faced by women, including physical symptoms such as fatigue, fear of recurrence, body image disruption, sexual dysfunction, depression, and anxiety.
The reliability statistics were mean Sociodemographic characteristics and social support were assessed using a structured questionnaire. The sources of social support assessed were spouses, children, parents, religious bodies, friends, physician or caregivers, and support groups. This was developed with recourse to other studies [ 38 ].
Using a Likert scale of five 5 —1 strongly disagree , 2 disagree , 3 neutral , 4 agree , and 5 strongly agree —responses indicated the level of agreement to whether support is received from any of these sources. The reliability statistics for this scale were mean The forms of support assessed were financial, escort, emotional, and psychological counseling. Psychological support in this study meant psychological counseling to help the women deal with emotional and mental issues, whereas emotional support has to do with the receiving genuine concern and empathy from another person.
The sources of social support were used as a proxy for the social network. This ranged from 1 to 8, based on the 8 sources of social support described above. All statistical analyses were carried out using SPSS, version 22 [ 39 ].
General characteristics are summarized as proportions and mean SD or median 25th and 75th percentiles based on the distribution of the variables. Two models were fitted; model 1 to control for the sociodemographic characteristics, while model 2 adjusted for both the sociodemographic characteristics and social networks.
Two-tailed significance tests were used throughout, and was considered statistically significant. An ethical approval and registration certificate was obtained from KATH to carry out the study. Research procedures were explained, and informed consent was received from all participants. The mean age SD of the women was 55 years Majority of the women were married, of which The majority The median 25th, 75th percentile number of children was 3 2, 5 , and The mean responses indicate that most of the women sometimes experienced physical symptoms such as fatigue, trouble with sleeping, pain, and burnout, mean, sexual dysfunction, threat to their safety, and felt vulnerable.
Most of the women often had intrusive thoughts about their illness and hence were depressed and anxious. Some women also had communication issues with their partners and body image disruptions Table 2. We further aggregated the sources of social support and used as a proxy for the social network. The forms of support received by the women were financial, escort, emotional, and psychological or counseling Figure 2. The most form of support offered by spouses or children was financial The most form of support offered by religious groups was emotional support Psychological support or counseling was also provided mostly by physicians and care providers Majority of women frequently engaged in active coping strategies.
The most adopted active coping strategy was religious coping, while the least adopted was humor. Self-distraction and substance use were the most and least adopted avoidant coping strategies, respectively Table 3. Age, marital status, and employment status were associated with coping strategies adopted by women with BC. Higher age has no influence on active coping but might be associated with less avoidant coping only shown in model 1.
Being married was also associated with higher active coping in model 1 but not with avoidant coping. Being employed had a positive association with both active and avoidant coping strategies, although effect on avoidant coping was only observed in model 1. In the adjusted model, being employed was associated with 0. Support by more than 2 persons increases both active and avoidant coping. Women who had more than 5 sources of support had 1.
The women often had unpleasant thoughts about their illness, including fear of recurrence of the disease and were anxious and depressed. Sometimes, the women felt vulnerable and had sexual dysfunction, physical symptoms such as fatigue, burnout, and trouble with sleeping, and partner communication issues.
We also found that coping strategies were associated with the extent of social network or support as well as the employment status of women diagnosed with BC. Our findings corroborates those in Ghana that found a high prevalence of depression and anxiety [ 13 ] and experiences of sadness, fear, and severe pain leading to suicidal ideas among women living with BC [ 14 ].
Oxidative stress in breast cancer
Metrics details. Women diagnosed with breast cancer frequently attribute their cancer to psychological stress, but scientific evidence is inconclusive. We investigated whether experienced frequency of stress and adverse life events affect subsequent breast cancer risk. Breast cancer incidence was analysed with respect to stress variables collected at enrolment in a prospective cohort study of , women in the United Kingdom, with incident breast cancer cases. Relative risks RR were obtained as hazard ratios using Cox proportional hazards models.
PDF | Background: Stress is a reaction to physical, psychological and emotional events. Respective to other chronic diseases, breast cancer.
Challenges, Coping Strategies, and Social Support among Breast Cancer Patients in Ghana
Despite the high incidence and mortality rate of breast cancer BC in Ghana, little attention has been given to the issue of how adult women cope with having BC. The aim of this study was to explore the challenges, coping strategies, and support systems among women diagnosed with BC in Ghana. A systematic random sampling technique was used to select women with a confirmed diagnosis of BC. The most and least adopted active coping strategies were religious coping and humors, respectively.
Accumulating evidence suggests that exposures to elevated levels of either endogenous estrogen or environmental estrogenic chemicals are associated with breast cancer development and progression. These natural or synthetic estrogens are known to produce reactive oxygen species ROS and increased ROS has been implicated in both cellular apoptosis and carcinogenesis. Though there are several studies on direct involvement of ROS in cellular apoptosis using short-term exposure model, there is no experimental evidence to directly implicate chronic exposure to ROS in increased growth and tumorigenicity of breast cancer cells. Therefore, the objective of this study was to evaluate the effects of chronic oxidative stress on growth, survival and tumorigenic potential of MCF-7 breast cancer cells.
Correspondence Address: Dr. E-mail: cdemonacos manchester. Demonacos joined the University of Manchester, Manchester Pharmacy School in where he is involved in the investigation of the role of ROS in cellular energy metabolism and breast carcinogenesis. In addition, Dr.