Barriers to clinical trials. Part II: Knowledge and attitudes of potential participants.

The reasons why less than 3% of cancer patients receive treatment in a clinical trial are complex and multiply determined. Because an individual cannot sign herself into a research study, an understanding of the doctor-patient interaction must be considered in addition to individual patient dynamics. Patients may be concerned that a physician's primary allegiance is to the requirements of the trial, not the specific health needs of the individual.

Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences.

Background: Clinical trials comparing mastectomy to conservative surgery plus radiation therapy in the treatment of breast cancer have provided an opportunity to increase understanding of the biology of this disease and the psychological adaptation of the breast cancer patient. Because these local treatments appear to be equal in terms of survival, the question remains as to whether conservative surgery plus radiation therapy confers a measure of psychological comfort superior to that of mastectomy for women diagnosed with early-stage breast cancer.

Methods: One hundred forty-two women participating in a clinical trial randomizing patients to mastectomy or lumpectomy and radiation therapy were prospectively evaluated for psychological response to their respective local therapy.

Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation.

Recent data suggest that prognosis is similar for women with primary breast cancer whether they receive modified radical mastectomy (MRM) or local excision and axillary dissection with radiation (XRT). The effects of either of these treatments on arm mobility, pain, or edema have not been compared. To assess the impact of MRM or XRT on mobility, pain, or edema, we evaluated patients treated in a prospective randomized trial designed to assess prognosis following MRM or XRT.

Psychological functioning of daughters of breast cancer patients. Part II: Characterizing the distressed daughter of the breast cancer patient.

Sixty daughters whose mothers had breast cancer were cross-sectionally studied. Daughters age 11-20 reported feeling significantly more uncomfortable about involvement in their mothers' illness than daughters age 20+. Daughters whose mothers died were more likely to report long-term life plan changes and role changes with their mothers during the mothers' illness.

Psychological functioning of daughters of breast cancer patients. Part I: Daughters and comparison subjects.

Sixty daughters of mothers with breast cancer were matched for age, educational level, and race with 60 comparison subjects without a maternal history of breast cancer to assess the impact on psychological adjustment, coping, body image, sexual functioning, and health knowledge and practices of having had a mother with breast cancer. Daughters of breast cancer patients showed significantly less frequent sexual intercourse, lower sexual satisfaction, and greater feelings of vulnerability to breast cancer, and they could identify a greater number of symptoms of breast cancer. No differences between groups were found in psychological symptoms, coping styles, breast self-examination practices, mammography practices, health knowledge, or body-image ratings.

Physician-patient communication about breast cancer. A challenge for the 1990s.

Rose Kushner, a well-known breast cancer patient advocate and medical journalist who contributed immeasurably to the changes that have taken place in breast cancer management today, summed up the communication dilemma succinctly. She stressed the importance of communication from physician to patient and from patient to physician. "In order for it to work [well]," she said, "it has to go both ways.

Psychosocial outcomes of breast cancer therapies: lumpectomy versus mastectomy.

The psychological status of 50 patients who had been treated for breast cancer was assessed an average of 21 months after treatment. The patients were grouped according to major treatment modalities: mastectomy with breast reconstruction, mastectomy without breast reconstruction, or lumpectomy. Lumpectomy patients had a significantly more intact body image (p less than .

Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer.

A study of the differences in the psychosocial effects of mastectomy versus segmentectomy was done on a group of women who were in a prospective randomized protocol for treatment of primary breast cancer. Through questionnaires designed for this study and standardized psychologic tests, women with segmentectomies responded as significantly less anxious, less sad, and more in control of their life events than women with mastectomies. The women with segmentectomies had a statistically more positive sexual and body image than those with mastectomies.

The sexual and intimate consequences of breast cancer treatment.

Confronting the loss of sexual desire, feelings of sexual attractiveness, range of sexual activities, and ability to reproduce is often a seriously neglected area in oncology and a great source of distress for the breast cancer patient. Addressing the problem early in the doctor-patient relationship and simply giving the woman permission to discuss these critical concerns with the person managing her care will do much to reduce some of the anguish that accompanies breast cancer and its treatments.

The psychological contribution of nipple addition in breast reconstruction.

Two groups of consecutive patients from two different plastic surgical practice populations were evaluated to determine psychosocial differences between those who underwent nipple-areola reconstruction in addition to breast reconstruction (N = 33) versus those who did not undergo nipple-areola reconstruction in addition to breast reconstruction (N = 26). Psychological assessment consisted of a standardized symptom inventory (Brief Symptom Inventory) and a specially designed self-report questionnaire investigating reactions unique to surgeries for breast cancer and breast reconstruction. Both groups were equivalent sociodemographically, with the exception of age, where the nipple-added group was significantly younger (P = 0.

Becoming an informed health care consumer.

Important psychological issues are involved in various cancer therapies. The patient has the ability to impact her own therapy by choosing a physician through personal interview and thus considering the physical and psychological support offered. Individuals who have cancer may have further impact by agreeing to participate in controlled clinical trials to help protect future generations, although patients are often deterred by conjecture that the best care will not be available under trial conditions.

Psychosocial correlates of immediate versus delayed reconstruction of the breast.

Two groups of consecutive patients from two different plastic surgical practice populations were evaluated to determine psychosocial differences between those who underwent immediate (n = 25) versus delayed (n = 38) breast reconstruction. Psychological assessment consisted of a standardized symptom inventory (BSI) and a specially designed self-report questionnaire investigating reactions unique to mastectomy and reconstruction. Both groups were extremely equivalent with regard to sociodemographic data, with the typical subject being a well-educated and employed Caucasian wife.

The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction.

Patients who had reconstructive breast surgery at the time of mastectomy (immediate) or within 1 year (early) had significantly less recalled distress about their mastectomy than those who had it more than 1 year later (delayed). Women who had immediate or delayed reconstructive surgery had similar levels of psychological symptoms, which were slightly lower than those reported by women in the early reconstructive group. The wish to wear a wider range of clothes and the wish to be rid of the external prosthesis were common motivations for reconstructive surgery.

Psychosocial issues in breast reconstruction. Intrapsychic, interpersonal, and practical concerns.

Because the decision to have or not to have breast reconstruction is multiply determined, in-depth inquiry should be made into the patient's intrapsychic (self-directed) motives and interpersonal factors that contribute to her choice. This article discusses five major variables that enter into the final decision. These include knowledge of the procedure, economic resources, medical conditions, psychological dynamics, and reactions of significant others in the patient's life, including spouse, physicians, and mother.

Psychosocial and physical outcomes of primary breast cancer therapy: mastectomy vs excisional biopsy and irradiation.

Thirty-eight patients treated for primary breast cancer as part of a prospective randomized clinical trial were questioned retrospectively as to their psychosocial adaptation to treatment. Twenty patients had received mastectomy and eighteen had received excisional biopsy plus radiation of the intact breast. Aside from body image concerns, there were no marked psychosocial differences detected between these groups.

Patients' rights in decision making: the case for personalism versus paternalism in health care.

The purpose of this presentation is to shine a psychological spotlight on the role of the breast cancer patient in the process of her decision making about her medical care and the specific influence that the nature of the physician-patient interaction has on that behavior. The vision of the parental physician as unilateral authority in decisions about health care is dimming. The picture is being supplanted by a new image that promotes a view of personalism and a concept of "shared responsibility.