Breast Cancer: Health Psychology Plan

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Table of Contents

The Subject
Health Hazards and Risks Faced by the Subject
How the Subject Found out about their Health Issues
Psychological Issues and States of Mind
Health Priorities Needing Intervention
Interventions and Why They Were Chosen
Potential Hazards and Risks of the Planned Interventions
Track Record of the Planned Interventions
What Could be Learned
References

The Subject

The subject is a 55-year-old white female who works as an accountant in a small enterprise. She has a husband, who is five years older, and two children, who are now in their twenties. The subject had her menopause four years ago, which manifested in common symptoms, including the lack of menstruations, reduced libido, vaginal dryness, and night sweats. The subject generally has healthy care-seeking behaviors and visits her primary care physician regularly. She describes herself as a relatively healthy person with a few chronic health problems that impact her life.

The subject has a healthy weight, leads an active lifestyle, and has no complaints regarding her health condition. She admits to smoking one pack of cigarettes daily since the age of 30 but says that her alcohol consumption is moderate and she only drinks red wine one or two times per week. She was diagnosed with hypertension six years ago and uses beta-blockers to manage blood pressure. Another chronic health issue that is evident in the patient is chronic gastritis, which started when she was 40. Although the PCP prescribed medications for gastritis, the subject did not complete the treatment because the treatment disappeared after dietary changes.

Despite having generally good health, the subject was recently diagnosed with stage 1 breast cancer. Breast cancer is the key cause of concern for the subject at the moment because it can have severe consequences if left unaddressed. Therefore, the present health psychology plan will be focused on breath cancer. The goal of the plan is to identify the psychological issues and health priorities of the subject and propose a strategy for addressing them.

Health Hazards and Risks Faced by the Subject

The primary health hazard for the subject is breast cancer since it poses a threat to her future life and health. Breast cancer is a dangerous disease that affects millions of women globally. According to World Cancer Research Fund (WCRF, 2019), there were two million new cases of breast cancer in 2018 globally, and the United States is among the 25 countries with the highest rate of breast cancer. Although the age-standardized rate of breast cancer is 84.9 cases per 100,000, various demographic, genetic, and lifestyle factors impact the development of this condition (WCRF, 2019). For example, the Centers for Disease Control and Prevention (CDC, 2018) states that white women had the highest rate of new cancers diagnosed in 2015. The risk of breast cancer also increases with age, and postmenopausal women have a higher chance of developing it. As shown by CDC, the highest rate of breast cancer is found in women aged 70 to 74, but the rate for women aged 55 to 59 is also significant (CDC, 2018). The age distribution of cancer has been linked to hormonal changes that take place in the body after menopause.

Lifestyle risk factors that contribute to the development of breast cancer are also documented in research. Dieterich, Stubert, Reimer, Erickson, and Berling (2014) confirm that obesity, smoking, physical inactivity, and alcohol consumption are risk factors for several types of cancers, including breast cancer. Since the patient is a smoker and consumes alcohol in moderate amounts regularly, these factors could have affected her diagnosis. Moreover, they can pose a risk of other types of cancer in the future. Breast cancer can also develop due to genetic predisposition caused by the presence of specific genes (Maas et al., 2016). The subject did not obtain the results of testing for these genes, and thus it is impossible to say if this factor played a role.

The five-year survival rate for breast cancer is relatively high. CDC (2018) reports that 68.9 percent of women in the subject’s age group live for 5 or more years after the diagnosis. Additionally, survival rates vary depending on the stage of cancer diagnosed, with early breast cancers having the highest survival rates. As explained by Huzar (2018), the survival rate for stage I breast cancer is almost 100 percent. This information means that the patient’s overall prognosis is good despite this health hazard.

Other conditions reported by the subject can also pose some risks in the long term. Studies show that if left untreated, chronic gastritis could lead to gastric cancer, as well as other less severe complications, including gastric atrophy and ulcers (Yoshida et al., 2014). Similarly, hypertension requires treatment to prevent associated conditions, such as aneurysms, chronic kidney disease, heart failure, and stroke (National Heart, Lung, and Blood Institute, 2018). Based on the analysis of health hazards and risks, it is evident that treatment adherence is crucial for the subject and must be addressed as part of the health psychology plan.

How the Subject Found out about their Health Issues

The subject was diagnosed with stage I breast cancer less than three weeks ago. She reports performing regular breast self-exams for the past few years. During the self-exam she did in March, she discovered a small lump in her left breast. The subject reports that she did not have any other symptoms and decided to wait for a few days to see if the lump would go away by itself. When it did not, she scheduled an appointment with her primary care physician, who referred her for mammography. The imaging showed a small lump of approximately 1.5 centimeters in diameter. After seeing these results, the primary care physician referred the subject to an oncologist. The oncologist collected the subject’s information and ordered a biopsy, which confirmed that the lump was invasive ductal carcinoma (IDC). The doctor offered two treatment options to the subject, which involve either a total mastectomy or lumpectomy followed by radiation treatment. These treatment options are in line with recent clinical guidelines, which posit that both treatments should be effective in the subject’s case (Gradishar et al., 2018).

Other health risks found in the subject were discovered during routine medical exams. The subject reports that she did not experience any symptoms associated with hypertension before the diagnosis. With regards to chronic gastritis, she recalls complaining about stomach pain and heartburn to her PCP a few months after the symptoms first started. An upper endoscopy and blood tests confirmed the presence of inflammation in the subject’s stomach, caused by Helicobacter pylori bacteria. The PCP prescribed medication to treat the condition, but the patient does not remember the name of the drug or how long she used it before the symptoms disappeared.

Psychological Issues and States of Mind

Approaching the subject’s case from a biopsychosocial perspective means that it is critical to take into account physical, psychological, and social factors influencing their health and health behaviors. To understand the subject’s psychological issues and states of mind about health, a cognitive appraisal was performed to identify her response to the situation. During the primary appraisal, the patient identified being diagnosed with breast cancer as a stressful experience. She also recalled that her reaction to the other two diagnoses was neutral, as she saw them as irrelevant to her health in the long term.

During the secondary evaluation, the subject was asked about her coping options and resources. She stated that she hoped to receive the treatment for breast cancer and “forget about it” after she enters a remission stage. The subject also revealed that she did not tell her husband, children, or friends about the diagnosis because she did not want them to worry. This means that the subject uses problem-focused coping, which leaves her emotional state and stress unaddressed until her health condition changes.

Based on the information above, the patient is in a negative state of mind because of the fear and anxiety relating to the diagnosis of breast cancer. This state of mind results in multiple psychological issues which could affect the subject’s psychological well-being before, during, and after treatment. Firstly, the patient experiences the stress associated with the diagnosis. This is a widespread response among cancer patients and occurs irrespective of the prognosis. According to Perez et al. (2014), many breast cancer patients exhibit symptoms of posttraumatic stress and acute stress disorder. Secondly, the patient also shows signs of denial and avoidance related to the diagnosis. This is evidenced by the fact that she did not tell her family and friends about the diagnosis. The study by Ewing et al. (2016) suggests that sharing cancer diagnosis with friends and family is a sign of coping with and accepting the illness. Thus, it appears that the patient has not processed the diagnosis yet. Both of these issues are important because they could affect the subject’s well-being and mental health in the long term.

Health Priorities Needing Intervention

Several health priorities require intervention in the subject’s case. First of all, the patient exhibits signs of stress, denial, and avoidance about her breast cancer diagnosis. Stress and anxiety are known to impact disease progression and may cause complications such as depression, digestive system disorders, sleep disturbance, and other physical and mental health conditions. Denial and avoidance are also dangerous because they prevent the patient from coping with the diagnosis healthily.

Secondly, the patient lacks social support from friends, family, and other persons who play an important role in her life. The lack of social support can contribute to stress, especially if the subject refuses to disclose the information about her diagnosis to her loved ones. According to research, social support promotes a healthier response to traumatic stimuli, such as the diagnosis of cancer, and helps patients to create a more hopeful mindset (Perez et al., 2014). Low support, on the other hand, may result in fatalism and feelings of helplessness, as well as additional mental health consequences (Perez et al., 2014). Therefore, this aspect of the subject’s current situation also needs to be addressed.

Thirdly, the patient has destructive behaviors that need to be addressed because of their potential influence on her health condition. Smoking and alcohol consumption are among the key risk factors for complications that can result from the subject’s chronic diseases, as well as for other illnesses. Fostering a healthier lifestyle would help her to achieve health promotion and prevention goals in the future while also improving the effectiveness of any treatments suggested by care providers.

Lastly, the subject has a risk of treatment nonadherence because she did not follow her treatment plan for gastritis in the past. In the current situation, nonadherence to treatment can decrease her chances of entering a remission soon. Moreover, the fact that the patient did not complete her prescribed gastritis treatment increases the risk of complications, including gastric cancer. Promoting adherence to medication and health promotion plans would ensure that the subject’s health will improve and she will have fewer possible complications in the future.

Interventions and Why They Were Chosen

Based on the analysis above, three goals could be achieved through health psychology interventions: improving treatment adherence, fostering healthy coping mechanisms, improving the support system, and reducing stress and destructive behaviors. To reach all of these goals, it would be best to use a comprehensive plan consisting of patient education, supportive-expressive group therapy, and mindfulness-based cancer recovery therapy. Each of these interventions will help to attain a different positive outcome.

Patient education involves a care provider discussing various health-related topics with a patient. In the present case, patient education should seek to explain each of the subject’s diagnoses to her, as well as stress the importance of medication adherence. It would be beneficial for the care provider to explain the causes, mechanisms of development, and consequences of each of the subject’s health risks. Then, the care provider should outline the advantages of the treatment proposed by the PCP and other specialists and the risks of not adhering to it. Additionally, education on the effect of smoking and alcohol consumption on the subject’s health condition is required. It is expected that this intervention will improve the subject’s health literacy, leading to better adherence to treatment and health promotion plans.

Supportive-expressive group therapy is often used for patients with various types of cancer to increase their support network and facilitate coping. Patients are usually assigned to a group that meets at regular intervals and includes people with similar diagnoses. During sessions, patients are encouraged to express their emotions, support one another, and discuss stressful events (Carlson et al., 2016). As a result, the intervention seeks to promote healthy coping mechanisms and extend the current support network of each participant.

Mindfulness-based cancer recovery is based on the idea of appreciating the present moment and involves meditations and yoga practices designed specifically for cancer patients (Carlson et al., 2016). Sessions can be carried out both in groups and individually and can be tailored to the needs of specific patients. Based on the information available about this intervention, it is likely to help the subject in managing stress and accepting her diagnosis, thus creating a more positive state of mind.

Potential Hazards and Risks of the Planned Interventions

The planned interventions do not include any medications that are based solely on improving the patient’s mental state and psychological responses to the situation. As a result, there are no health risks, such as side effects or drug interactions, associated with these interventions. There is, however, a potential threat that the interventions will not help the patient to address the priority areas outlined in the previous sections. In this case, the patient might be at risk for the consequences of increased stress, lack of support, destructive behaviors, and negative coping mechanisms. These consequences include adverse outcomes in physical and mental health, such as depression, insomnia, posttraumatic stress disorder, poor cancer prognosis, and exacerbations of chronic diseases (Maas et al., 2016; Perez et al., 2014). Given the subject’s psychological issues, it should be noted that the patient could try to avoid therapy by not showing up because it could be difficult for her to accept help. To address this risk, it would be useful to ask her to note her experiences for the follow-up visit, as well as to refer her to therapy groups directly.

Track Record of the Planned Interventions

The planned interventions were chosen based on research evidence showing their effectiveness in improving patients’ mental state and health behaviors in the target domains. For example, two separate reviews indicate that patient education has a positive influence on medication adherence (Costa et al., 2015; Matthes & Albus, 2014). The authors note that the positive effect is primarily due to the increased health literacy in patients who received education from their care providers (Costa et al., 2015). Patient populations included in studies that were considered in both reviews were mixed, which shows that education will have a positive impact on the subject’s adherence to treatment for all of her conditions.

The effectiveness of supportive-expressive discussion group therapy is also evident from research. In particular, the randomized controlled trial by Tabrizi, Radfar, and Taei (2016) studied the influence of this intervention on the psychological outcomes of breast cancer patients. The authors confirmed that supportive-expressive therapy had a statistically significant positive impact on the participants’ quality of life, hope, emotional functioning, and social functioning (Tabrizi et al., 2016). This shows that the intervention will be helpful in the subject’s case.

Lastly, there are many studies focused on mindfulness-based cancer recovery (MBCR), since it is a relatively recent trend in cancer research. A randomized controlled trial by Carlson et al. (2016) showed that MBCR has a positive influence on emotional and functional quality of life in breast cancer survivors comparable to that of supportive-expressive group therapy. However, it also had additional benefits, such as mood disturbance and stress reduction, which is why it was recommended as a complementary intervention (Carlso et al., 2016). A systematic review on MBCR’s effects on women with breast cancer also confirmed its effect on stress, fatigue, quality of life, depression, sleep disorders, and anxiety (Haller et al., 2017).

Therefore, all of the planned interventions have a good track record, meaning that they will be relevant and effective for the subject. Given that the interventions are relatively flexible in terms of schedule and that group therapy is priced moderately, the proposed plan is feasible for the patient. It is anticipated that the benefits of the program will far outweigh the costs because of improved health and well-being, and thus the plan is also cost-effective.

What Could be Learned

The present health psychology plan contains a comprehensive overview of the patient’s current situation, including physical, psychological, and social factors influencing health and health-related behaviors. Because the plan targets a patient with breast cancer, and the proposed interventions fit her health condition, the plan can be used as a framework for health psychology interventions targeting patients with breast cancer. The plan will also be helpful for specialists providing services to patients with serious illnesses that could trigger stress, denial, avoidance, and other behaviors similar to the ones exhibited by the subject. It is expected that the planned interventions will benefit these groups of patients by improving their social support and coping mechanisms and reducing negative behaviors.

References

Carlson, L. E., Tamagawa, R., Stephen, J., Drysdale, E., Zhong, L., & Speca, M. (2016). A randomized-controlled trial of mindfulness‐based cancer recovery versus supportive-expressive group therapy among distressed breast cancer survivors (MINDSET): Long‐term follow‐up results. Psycho‐Oncology, 25(7), 750-759.

Centers for Disease Control and Prevention. (2018). United States cancer statistics: Data visualizations. Web.

Dieterich, M., Stubert, J., Reimer, T., Erickson, N., & Berling, A. (2014). Influence of lifestyle factors on breast cancer risk. Breast Care, 9(6), 407-414.

Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O.,… Marengoni, A. (2015). Interventional tools to improve medication adherence: Review of the literature. Patient Preference and Adherence, 9, 1303-1314.

Ewing, G., Ngwenya, N., Benson, J., Gilligan, D., Bailey, S., Seymour, J., & Farquhar, M. (2016). Sharing news of a lung cancer diagnosis with adult family members and friends: A qualitative study to inform a supportive intervention. Patient Education and Counseling, 99(3), 378-385.

Gradishar, W. J., Anderson, B. O., Balassanian, R., Blair, S. L., Burstein, H. J., Cyr, A.,… Goetz, M. P. (2018). Breast cancer, version 4.2017, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 16(3), 310-320.

Haller, H., Winkler, M. M., Klose, P., Dobos, G., Kuemmel, S., & Cramer, H. (2017). Mindfulness-based interventions for women with breast cancer: An updated systematic review and meta-analysis. Acta Oncologica, 56(12), 1665-1676.

Huzar, T. (2018). Life expectancy for stage 3 cancer.Medical News Today. Web.

Maas, P., Barrdahl, M., Joshi, A. D., Auer, P. L., Gaudet, M. M., Milne, R. L.,… Baglietto, L. (2016). Breast cancer risk from modifiable and nonmodifiable risk factors among white women in the United States. JAMA Oncology, 2(10), 1295-1302.

Matthes, J., & Albus, C. (2014). Improving adherence with medication: A selective literature review based on the example of hypertension treatment. Deutsches Ärzteblatt International, 111(4), 41-47.

National Heart, Lung, and Blood Institute. (2018). High blood pressure. Web.

Perez, S., Galdón, M. J., Andreu, Y., Ibáñez, E., Durá, E., Conchado, A., & Cardeña, E. (2014). Posttraumatic stress symptoms in breast cancer patients: Temporal evolution, predictors, and mediation. Journal of Traumatic Stress, 27(2), 224-231.

Tabrizi, F. M., Radfar, M., & Taei, Z. (2016). Effects of supportive‐expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors: A randomized control trial. Psycho‐Oncology, 25(9), 1057-1063.

Yoshida, T., Kato, J., Inoue, I., Yoshimura, N., Deguchi, H., Mukoubayashi, C.,… Maekita, T. (2014). Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer. International Journal of Cancer, 134(6), 1445-1457.

World Cancer Research Fund. (2019). Breast cancer statistics. Web.

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