Behavioural, cognitive and emotional responses are the common side effects of breast cancer diagnosis on the patient. These changes occurring within the patient leads to serious disruption in the quality of life of the patient. The case management depends largely on the responses that the patient experiences and the way in which the patient perceives her illness (Boyle et al., 2017). The present paper discusses the emotional, cognitive and behavioural responses that the patient Mary is likely to experience with regards to her diagnosis.
Feelings of anxiety, fear and depression are the common responses to the life changing experience of being diagnosed with breast cancer in women. Depression is the most prevalent side effect arising due to cancer diagnosis. Major depressive disorder is a clinical syndrome occurring in most women diagnosed with cancer. Psychological stress and depressive symptoms are the highest in the initial six months after a patient is diagnosed with breast cancer. The severity of distress is then found to decline over time with the patient adjusting to initial shock of diagnosis and its acute impacts. As expected, depression has the possibility of creating a detrimental effect on all the possible aspects of quality of life. In addition, the patient might be having poor medical adherence and increased challenges to care for cancer, encompassing lack of proper understanding of the recommended treatments and the associated anxiety. Research also indicates that morbidity is also high in case of cancer patients. As a matter of fact, depression is a representation of an imperative target for identification and treatment (Hill et al., 2011).
In the present case, Mary is likely to suffer from depression due to her early stage cancer diagnosis. Multi-dimensional factors play a role in the development of depression in the patient given the social context she lives in. Mary is socially isolated as she lives alone with her twin sons. Her partner is away since the birth of her children and is not in daily contact with him. In addition, she does not get support and help from her family as they live in a different place and have not met with Mary since her children were born. Mary does not have social support and required to undertake proper treatment and adhere to management regimen for her breast cancer. This possibly would be the reason Mary would suffer from depression. As Mary does not have the physical presence of her husband and her family, it is likely that the depressive symptoms would be more for her in compared to patients who receive the support and help of the family members. As opined by Maass et al., (2015) patient diagnosed with breast cancer require social support that make them less anxious and less depressed. Mary would suffer from depression and anxiety from the thought of undergoing changes in her body that often affects one’s confidence level and self-esteem. Work roles and family might be altered to a considerable extent. Mary is likely to feel grief at these possible changes and loses. Physical symptoms like extreme tiredness, nausea and pain also contribute to emotional distress that the patient is likely to suffer. Mary might also fear pain, suffering and death and the aspects unknown to her in future that would lead to severe depression. She is likey to suffer from despair and hopelessness. The psychological challenges and emotional reactions would determine the effectiveness of treatment provided to her (Ancoli-Israel et al., 2014).
According to Bower (2008) psychosocial issues like stress, worry and anxiety are factors that determine the cognitive functioning of the patient. Such factors would lead to cognitive decline in Mary, with possible impacts on the quality fo life. Physical issues such as fatigue and sleep disturbance, along with psychosocial conditions like stress and anxiety would influence Mary’s cognitive functioning. Research indicates that all patient diagnosed with cancer have issues with short-term memory, though tests find that the memory is in normal stage. It is the ability to have focused attention and the speed of processing information that gradually declines after diagnosis of cancer. The issues can be related to memory problems since the brain is not able to process the information in a suitable manner. The concept of cognitive reserve comes into the limelight in this regard, which connects the level of knowledge of a patient with her perceptions about cancer. It is likely that Mary would be facing difficulties in carrying out executive functions in her daily life. As she has to manage her household single-handedly without any help from family and partner the daily activities of living are likely to suffer.
Increased chances of developing insomnia and fatigue are to be mentioned in the context of the present case study analysis as the course of these responses have been well characterised in comparison to other behavioural side effects. Psychosocial factors along with medical conditions are likely to change to course of behaviour presented by the patient. Mary has increased chances of experiencing fatigue as she is required to carry out all responsibilities of her house and manage her two children who are young in age (Bower et al., 2011). Facing a life threatening disease like cancer would shift the focus and perspective of Mary, having a direct impact on her behaviour. She is presented with chances of developing risky behaviours like drinking and smoking in order to cope with the stress amongst other medical treatments. It is often devastating to cope with breast cancer and patients have the tendency to become restless and agitated at the slightest pretext. Behaviour changes encompass irritability, loss of interest to socialise and take part in activities, changes in appetite and loss of motivation and energy. Feelings of worthlessness and hopelessness make a person have reduced self-esteem. Mary might also suffer from severe panic attacks. Though the behavioural changes might vary depending on the support Mary receives and might be difficult to identify at times, these changes in behaviour have the ability to make a long-term impact on the treatment and management of the illness. The physically and emotionally draining illness is to reduce the quality of life of Mary as she is to receive adequate emotional and social support to fight breast cancer.
From the above analysis, we find that Mary is faced with multifaceted challenges as she is diagnosed with breast cancer at an early age. Given the social context she is living in, chances are high that she would suffer the adverse emotional, cognitive and behaviour changes a patient diagnosed with breast cancer suffers. This implies that suitable nursing and psychological interventions are required for addressing the needs of Mary and enhancing her quality of life.
Ancoli-Israel, S., Liu, L., Rissling, M., Natarajan, L., Neikrug, A. B., Palmer, B. W., ... & Maglione, J. (2014). Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Supportive Care in Cancer, 22(9), 2535-2545.
Bower, J. E. (2008). Behavioral symptoms in breast cancer patients and survivors: Fatigue, insomnia, depression, and cognitive disturbance. Journal of Clinical Oncology?: Official Journal of the American Society of Clinical Oncology, 26(5), 768–777. https://doi.org/10.1200/JCO.2007.14.3248
Bower, J. E., Ganz, P. A., Irwin, M. R., Kwan, L., Breen, E. C., & Cole, S. W. (2011). Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism?. Journal of clinical oncology, 29(26), 3517-3522.v
Boyle, C. C., Stanton, A. L., Ganz, P. A., Crespi, C. M., & Bower, J. E. (2017). Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of consulting and clinical psychology, 85(4), 397.
Hill, J., Holcombe, C., Clark, L., Boothby, M. R. K., Hincks, A., Fisher, J., ... & Salmon, P. (2011). Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychological medicine, 41(07), 1429-1436.
Maass, S. W., Roorda, C., Berendsen, A. J., Verhaak, P. F., & de Bock, G. H. (2015). The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review. Maturitas, 82(1), 100-108.
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