Breast Cancer has become an important public health concern worldwide.

The most prevalent female malignancy across all age groups, seems to be breast carcinoma, which accounts for 30% of all new cancers in Canada.

Within the Canadian population, 22 300 new cases of breast cancer is diagnosed annually, of which 5 300 lives are claimed (Canadian Cancer statistics, 2007).

Early breast cancer affects one in every nine women along with their families (Sandra Naaman et al.,2009).

Advances in screening and biomedical interventions have changed the face of breast cancer from a terminal condition to a chronic disease with bio psychosocial features.

Since patients are now living longer, they are faced with multiple challenges beyond the acute phase of medical treatment.

These include dealing with having been diagnosed with a potentially lifethreatening illness, long term effects of toxic treatments, the possibility of recurrence, career interruptions and financial strain.

Cancer is also a "family affair" and a "family problem" that affects spouses and children.

Research from the USA estimates between 35% and 50% of cancer patients are affected by psychological problems (Spiegel, 1996 and Zobora et al., 2001), with adjustment disorders and depressed mood being the most common clinical diagnoses. 42% of early stage breast cancer patients experience anxiety, depression and adjustment disorders (Kissane, et al.,1998)

Adjustment and psychosocial adaptation to cancer has been defined as an ongoing process in which the individual attempts to manage emotional distress, solve specific cancer-related problems, and gain mastery and control over cancer-related life events.

Initial reactions can be intense and typically involve feelings of shock, disbelief and often denial of medical findings.

Once the new "reality" is acknowledge, feelings of depression, anxiety, insomnia (sleeplessness), anorexia and poor concentration typically soar (Epping-Jordan et al., 1999).

With more information regarding treatment options, adequate social support at work and at home, and initiation of medical therapy, intrusive thoughts about the illness and the possibility of death may subside.

During the post-treatment phase, adjustment typically involves utilization of a variety of coping strategies, the most useful of which has been shown to be emotionally expressing coping (Stanton et al., 2000).

Emotionally expressive coping is defined as strategies involving active processing and expression of negative emotional reactions to stressors.

Psychological morbidity associated with breast cancer

Research generally converges on the finding that a cancer diagnoses generates greater distress levels compared to any other disease.

With assistance, most women or men will manage to survive the threat of diagnosis and the invasive treatment associated with breast carcinoma.

The most potent concern for patients with early stage 1 & 2 breast cancer is fear of recurrence and uncertainty regarding the future.

Specifically, in a study of 92 women diagnosed with stage 1 & 2 breast carcinoma, those found to cope using emotional expression around their diagnosis had fewer cancer-related morbidities, decreased distress, and enhanced health (Stanton et al., 2000).

The ability of patients to openly engaged in communication of their feelings about the illness has been linked to positive adjustment, enhance cohesiveness, and decreased destructive conflict.

Similarly, breast cancer survivors who confined in their partners during times of crises enjoyed better prognoses, as measured by survival (Weighs, Enright & Simmens, 2002).

Close relational bonding has a protective impact on emotional and physical health, including restoration of immune competence, as well as mediating optimal coping with adversity, including chronic illness (Kiecolt-Glasser et al., 1993).

A large body of research concurs that secure attachment or connectedness, which has been linked to an "inner resource", effectively enables the individual to cope more adaptively in the face of stress

Interpersonally, individuals with secure attachment styles are able to seek and utilize support provided by significant others who through past experience have demonstrated their accessibility and responsiveness, particularly in times of distress.

How can Managers and/or Supervisors assist employees with breast cancer?

The following methods may be used:

2. Allow the employee to speak their concerns without interrupting.

3. Be open to the idea that the employee may express psychological distress.

4. Acknowledge the employee's concerns for taking leave for chemotherapy or radiation therapy.

5. Use questions appropriately which may lead to further disclosure.

6. Use words with emotional content that demonstrates empathy.

7. Recognize and acknowledge distress and summarize the employee's needs.

8. Give advice in terms of outside resources which the employee may utilize, such as a support group at CANSA or visiting a Psychologist or Social Worker for trauma counselling.

9. Utilize the Employee Assistance Programme in your own Company, where applicable. References

1. Sandra Naaman, Karam Radwan and Susan Johnson, Coping with Early Breast Cancer:

Couple Adjustment Processes and Couple-Based Intervention, Psychiatry 72(4), Winter 2009.

2. H.Ryan, P.Buttow and P. Schofield, How to recognize and manage psychological distress in cancer patients, Blackwell Publishing Ltd., 2005

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