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Status & experience of young women affected by breast cancer in Taiwan Dr. Fiona Cheng T-F Shin Kong Wo Ho-Su Memorial Hospital Taipei, Taiwan 鄭翠芬 醫師 新光吳火獅紀念醫院.

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Presentation on theme: "Status & experience of young women affected by breast cancer in Taiwan Dr. Fiona Cheng T-F Shin Kong Wo Ho-Su Memorial Hospital Taipei, Taiwan 鄭翠芬 醫師 新光吳火獅紀念醫院."— Presentation transcript:

1 Status & experience of young women affected by breast cancer in Taiwan Dr. Fiona Cheng T-F Shin Kong Wo Ho-Su Memorial Hospital Taipei, Taiwan 鄭翠芬 醫師 新光吳火獅紀念醫院

2 Why Concern about Psychology impact on Breast Cancer 為何要重視乳癌對心理 衝擊 Reason for psychology impact smooch on breast cancer survivors : the organ that diseased are associated with 乳房是代表 Attractiveness 吸引力 Ferminity 女性象徵 Sexuality 性代表 Motherhood 母性 Body image 體態 Self esteem 自尊

3 Three areas of psychology influence in cancer patients Psychological discomfort 心理上的不舒適 Change in Life Pattern 生活上的變化 Fear & Concern 恐懼

4 Psychological discomfort 心理上的不舒適 Presented in : Anxiety 焦慮 Depression 低潮 Anger 忿怒不平

5 Change in Life Pattern 生活上的改變 Marital disruption 婚姻的危機 Disfigurement 容貌的改變 Altered activity level 活動力受 引 影響

6 Fear & Concern 恐懼 擔憂 Body mutilation 身體傷口 Disease recurrence 復發 Uncertainty of future 對將來不確定性 Death existential issue 死亡威脅

7 Reproductive and Late Health Effects of Treatment social and emotional functioning, and vitality were lowest in the youngest women 社會功能 情緒 是年輕乳癌較受影 響 More depression symptoms, more negative affect in youngest women 年輕乳癌較會有負面思考 憂鬱 (Ganz et al., JCO, 2003)

8 Web-Based Survey of Fertility Issues in Young Women with Breast Cancer 657 women median age 33 at diagnosis of breast cancer 年齡小於 33 歲 57% substantial concern at diagnosis about fertility after treatment 生育能力是選擇治療的考量 29% reported that fertility concerns influenced treatment decisions (Partridge et al., J Clin Oncol, 2004)

9 How Breast ca survivors react ? 病友如何應對 ?

10 Three Frequent Coping Strategies Seeking Social support 尋求支持 Positive focus 正面思考 Distancing 假裝忽略

11 Taiwan Young Breast cancer 2008 data from Department of Health Female cancer( all type) in Taiwan 34,647 所有女性癌症人數 Median age 59 yr 年齡中位數 Male : Female 1.3 : 1 男比女

12 Male 男 Female 女 Total Incidence No of patients 45,17134,64779,818 Median Age 65 59 63 Incidence / 100,000 每 10 萬人 388.5 303.6 346.5 Age Stratify incidence/ 100,000 317.3 237.8 276.5 M/F 1.3 1 2008 Taiwan cancer incidence 台灣各癌症發生率 2008 年

13 Occur order Death in order Site Numbe r Incidence/ 100,000 Medium age 1st 4thBreast8,137 56.1 51 2nd 3rdColon11,004 37.6 68 3rd 1stLiver & Biliary 10,565 36.8 65 4th 2nd lung9,516 32.2 70 5th 7thProstate3,603 24.6 75 The Top 5 Cancer in Taiwan 2008 Data adapted from Taiwan NIH 2011 Apr


15 Breast CA Colon Incidence of all type of cancer in Taiwan 1979~~2007 Skin cancer

16 Taiwan Breast Cancer Alliance

17 2010 conducted Questionnaire for Age < 40 breast cancer survivors 2010 Aug ~2010 Sep 430 questionnaire 130 response 102 valid response rate 23.7 %

18 Age distribution Age < 30 yr 31~40 yr No.

19 Type of Cancer No. % Invasive 侵襲性 58 56.9 Noninvasive 非侵襲性 17 16.7

20 Patient’s Demography Stage of disease Stage 0 Stage I Stage II Stage III Stage IV No %

21 How women discover Breast cancer Self Exam By spouse by Health check by massager Incidental Indicating self examination is important

22 Type of treatment Surgery Chemotherapy Radiation Hormone Target

23 Marital status for age < 40 Single Married Devoice NO % Marital status Total 102

24 Sexual partner No % Yes with partner No partner

25 Does Breast cancer affect women in career ? Employment Before & After Diagnosis of B CA Before CA After CA With Job No Job Employment status affected follow by diagnosed with Bca

26 Menstruation Present of Menstruation Amenorrhea

27 Cause of Amenorrhea Temporary Permanent Other reason

28 Joining Supportive Group No % Not joining Never Now Joining

29 Cancer Impact on Sexual Any diagnosis of cancer, but particularly those primarily affecting areas related to sexual function, can lead to sexual impairment 任何癌症 皆會 影響性功能 特別是與性相關的部位及器官 both biological and psychosocial mechanisms are involved in sexual difficulties after cancer. 性功能障礙有生理 與心理因素

30 Change of Sexuality after treatment Same as before Less Interest No Interest Alter In Sexual Interest

31 Reason for Sexual dysfunction Treatment with adjuvant chemotherapy accounts for much of the sexual morbidity of breast cancer Reason: chemotherapeutic agents affect mucous membranes of the body, and can therefore cause vaginal mycositis 化療的因素 致黏膜組織遭受影響 包括 陰道黏膜 進而影響性生活

32 Fear and concern Always fear of recurrence Agree Disagree

33 Mood Alter after B CA Frequent Low mood Agree Disagree

34 Change of Life pattern Agree Disagree Breast cancer cause Change of future life More than half of women show future life been affected with the disease

35 Self appearance Satisfactory of self appearance before / after B ca SatisfyNot Satisfy Before CA After CA About 35 % of young women unsatisfied the overall appearance after treatment of B ca

36 Impact from type of Surgery excision of the total mammary gland is associated with frequent changes in mood and with a negative sense and image of the body 乳房全切除 對於年輕病友 較會造成情緒 低落並對外表不滿意

37 Type of Surgery MRM BCS Without Reconstruction With reconstruction No Op

38 Potential Long-Term and Late Effects of Breast Cancer Treatments---Surgical Numbness 麻痺 Weakness of affected side 手術側變無力 Pain 疼痛 Lymph edema 手臂淋巴腫

39 To lower the impact of Surgery 減少手術對乳癌的衝擊 When patients are thoroughly informed about the oncological necessity, and their personal considerations are taken into account, the type of primary surgery does not significantly impact on their sense of well-being 妥善的術前溝通 量身訂作的考量 可 減少手 術對乳癌的衝擊

40 Reconstruction 乳房重建 proportion of women who choose this type of surgery is low and depends on the patients' cultural, psycho-social, and economical environment 年輕乳癌病人對於重建應有更大需求

41 Reconstruction Without reconstruction Prostheses AUTOLOGUS RECONSTRUCTION Still high proportion of young women does not have courage to receive reconstruction

42 Support source Spouse Mother Sibling Friend Mother sibling spouse Friend expectation Support from family / friend Most patients gain support from mother instead of spouse

43 Expectation of Group support Medical conf Life pattern conf Sharing Psychology Supp B ca prevention 60 % of B ca Survivors concern on getting new medical knowledge and future lifestyle / nutrition and hope for sharing with other women

44 Smile……

45 Report from Single Medical Center (SKH) Taiwan QOL of Bca < 35 yr 1993~~~2010 Total 219 patients diagnosed Breast cancer at age ≤ 35 yr EORTC QLQ-BR23 Questionnaire total responders 112 patients

46 Age distribution Total Number of P’t < 35 yr 219 1993~2010 in SKH 新光醫院 診斷時年齡小於等於 35 歲

47 Table 1 Background for Bca age ≤ 35 yr Stage StageN = 219% IIIa3114 % IIb8941 % IIa7132 % Ia2813 % 86 % Chemotherapy 52 % Hormonal therapy 30 % Radiation therapy

48 怪罪自己 與人疏離 Most frequent used strategies of breast cancer compare to benign disease self-blame less often ; distancing more frequent

49 Yangmingshan 101 Tower

50 PTSD post trauma stress syndrome Four main type of PTSD in Breast cancer survivors 乳癌病友最常見壓力徵候 1. Afraid of disease recurrence 擔心乳癌再次復發 2. Unhappiness recall of treatment distress 再次想起接受乳癌檢查及治療時不愉快的感受或畫面 3. Distancing 刻意避免想到和乳癌或健康有關的事情 4. Nervousness of any change 容易受到驚嚇

51 psychological resilience 心理復原力 The sprout forming and progressing of the psychological resilience were mainly influenced by participants’ personality, characteristics,self belief, emotional status,religion and social support 心理復原力與個人性格 自信 宗教信仰及外 部支持有關 心理復原力 與

52 創傷後成長﹝ PTG ﹞ Post traumatic Growing A person that after experience trauma, regain new personal relationship from spouse, family,friends and also obtain psychology adaptation, change of life pattern, ( including regular exercise, adequate nutritional concepts) 一個人經歷創傷後,重新獲得人際關係﹝包含夫妻、 親子及朋友關係﹞、心理調適以及生活改變﹝飲食習慣 改變、規律運動習慣、生活作息正常﹞上的機會。

53 information seeking behavior 資訊尋求行為 資訊尋求行為會受到教育程度和目前癌症狀況影響,病患 之情緒和其資訊尋求行為高度個體化;結果顯示,病友及 病友團體的協助對乳癌病患之正面影響,包括穩定病患情 緒,滿足病患資訊需求,更進一步影響病患就醫治療等相 關決策,提升病患對疾病之了解與照護信心 The motivation for information seeking behaviors highly influenced by education and current cancer situation, highly individualized

54 How Can Doctor Help ?

55 Fig Hypothetical example of how many breast cancer survivors an average oncologist will have in follow-up after 10 years with 100 new patients per year. The total number is 890. Patricia A. Ganze JCO 2008

56 Most Dr are Working too hard……


58 Help from Support Groups 支持團體的角色 support groups will positively influence breast cancer patients including: 1). stabilizing patients’ emotion 情緒安定 2). satisfying patients’ needs for information 滿足病友對醫療資訊的需求 3). arising patients’ confidence in self-care about their disease. 提高病友的自信去對抗癌症

59 Thank you for attention

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