Fellowship for Celestine Gochett: Breast Cancer Survivorship: Factors Related to Psychological Well-Being

`The concept of cancer survivorship is relatively new and refleots a change from viewing cancer patients as victims of an acute illness, to seeing them as individuals with a potentially life-threatening chronic condition, that may or may not return. In recent years, health care providers (HCPs) have recognized the need to better understand the challenges faced by survivors in order to help them lead the best lives possible. The term "survivor" reflects the fact that women with breast cancer are living longer than ever before. Increases in the number of women who are screened for breast cancer, improvements in the technology used to screen for the disease, and more effective treatments are responsible for prolonging women's lives. For example, thirty three years ago, approximately seven out of ten women diagnosed with breast cancer survived five years. Today, it is expected that nine out of ten women will be alive five years post diagnosis. More importantly in terms of survivorship, eighty percent of women are living ten years following diagnosis and fifty five percent are living twenty years. At the same time that women are living longer, there is a recognition that long term side-effects of the treatment and the disease are causing serious problems. For example, women can experience swelling in their arms years after treatment is completed. Body image concerns can grow and unpleasant side-effects of surgery may worsen. In addition, those psychological states such as helplessness, depression, and anxiety may remain for many years, interfering with a women's attempt to lead a normal life. Continued fear of recurrence can be a burden for women dedicated to childrearing or a career. A clear understanding of the problems faced by survivors is necessary in order to develop effective, supportive interventions. Because positive psychological well-being is a foundation for optimal quality of life, it is important to examine those factors during the survivorship period that influence psychological well-being. This dissertation will examine six variables identified in the literature as important to cancer patients. These variables are: response to symptoms, perceived health status, information needs, depression, anxiety and fear of recurrence. Data will be collected at two psychologically difflcultpoints in time: six months post-treatment and one year post-treatment. Patients often experience feelings of isolation between the end of treatment and their six month follow-up visit because they lose the continuous support of the health care system during that period. At one year post-diagnosis women are beginning to face their lives as increasingly normal and hopefully without the possiblity of cancer. Data collected will provide a foundation for a program of research that will benefit cancer survivors relative to their ongoing quality of life.