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new voices
their needs effectively? Do they themselves understand these needs and how they might change over time? Are feelings of vulnerability or a lack of selfconfidence barriers to asking for support in an effective way? The overwhelming side-effect described by participants was fatigue, whether as a result of surgery, chemotherapy or hormone treatment, which supports previous findings (e.g. Hansen et al., 2008; Kim et al., 2008). Fatigue can severely impact work performance, and may continue for years following treatment (Kennedy et al., 2007). Workers often require more flexibility in the nature of their tasks in order to cope. For example, a deputy headteacher reduced her hours, took regular breaks and worked more efficiently in order to manage her feelings of fatigue. Those I spoke to did not confirm previous findings that younger breast cancer survivors suffer more intensely than older candidates (Kim et al., 2008), or that the aggressiveness of treatment is a predictive factor (Bower et al., 2006). Clear differences were observed in coping ability between survivors who undertook multiple roles, and those who had adult children and reduced responsibilities. A lengthy absence and therefore the ability to fully recover, along with the ability to work part-time or phase their return, was associated with a marked reduction in these symptoms. My interviewees talked of experiencing a range of anxiety-provoking thoughts concerning their well-being. There is, however, no indication that the participants in this study who reduced their working hours, or changed their employment situation, did so because of depressive or anxious symptoms. The overwhelming issue regarding appearance
relationships among self-efficacy, psychological adjustment, and physical condition in Japanese advanced cancer patients. PsychoOncology, 11, 221–229. IPOS 10th World Congress of PsychoOncology Abstracts. (2008). Oral presentations Psycho-Oncology, 17, S1–S179. Kennedy, F., Haslam, C., Munir, F. & Pryce, J. (2007). Returning to work
was hair loss. Two participants communicated this as the most distressing experience in relation to having breast cancer, which adds credit to previous evidence (Kennedy et al., 2007; Munstedt et al., 1997). Financial pressures are common amongst cancer sufferers, with many patients reporting having to return to work despite being physically or emotionally inadequate (Amir et al., 2008; Breast Cancer Care, 2008; Kennedy et al., 2007). Most of the men and women I spoke to harboured worries over the possibility that their cancer would recur in the future, often linked to symptoms of minor illness (supporting Brain et al., 2006; Lethborg et al., 2000). Concerns seemed to abate gradually over time. Work may assist in making cancer feel like a more distant experience. This may be true following any traumatic event, however the reality that cancer may again rear its head is always lurking somewhere in the shadows, no matter how distant the initial diagnosis or how successful the treatment. All of the participants I spoke to indicated having a greater sense of mortality, and that their priorities had altered as a result. Overall, findings demonstrate that the ability to manage one’s difficulties is to some extent determined by a survivor’s perception of control over their situation (Bárez et al., 2008; Hirai et al., 2002). A ‘one size fits all’ approach may prove ineffective, due to the uniqueness of the breast cancer experience. Interventions may instead concentrate upon promoting high-quality communication between cancer patients, medical professionals and employers and ensuring that survivors can exercise appropriately guided choice and control over their treatment and working lives. Survivors themselves may need to be encouraged to voice their
following cancer. European Journal of Cancer Care, 16, 17–25. Kim, S.H., Son, B.H., Hwang, S.Y. et al. (2008). Fatigue and depression in disease-free breast cancer survivors. Journal of Pain and Symptom Management, 35(6), 644–655. Lethborg, C.E., Kissane, D., Burns, I. & Snyder, R. (2000). ‘Cast adrift’. The experience of completing treatment among women with early stage
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concerns and needs against a backdrop that is open and accepting. They may need permission to take backward steps as well as forward ones, due to the emotional and physical unpredictability of the cancer journey. Research should continue to emphasise the need for individuals to bridge the ‘intention–behaviour gap’ in relation to behaviours such as selfexamination, mammography uptake and seeking health advice (Danish et al., 2008; Harmon et al., 2005); especially amongst ethnic minority and disadvantaged communities. Increasing knowledge (and therefore self-esteem) may enable men and women to become more confident in observing and reporting changes within their own bodies; but will this translate into being confident to voice their own support and medical needs should cancer be found? Harmon et al. (2005) found that teaching students about their genealogical history, and therefore their susceptibility to disease, significantly increased their intention to perform self-examination. It would be interesting to determine the attitudes of those who discover they are at a ‘low’ risk, as one in every eight women in the UK general population will receive a diagnosis of breast cancer sometime in their lives. As for me, I was amazed to discover that our family history is not driven by a breast cancer gene; although my ‘familial’ make-up does not rule out the possibility that I am at a higher risk than average. At least I feel prepared to cope more adequately should I encounter such a diagnosis. Our inheritance often takes us on a voyage of discovery, and I have found facing up to the ‘monster’ enlightening and rewarding.
breast cancer. Journal of Psychosocial Oncology, 18(4), 73–90. Main, D., Nowels, C., Cavender, T., et al. (2005). A qualitative study of work and work return in cancer survivors. Psycho-Oncology, 14, 992–1004. Munstedt, K., Manthey, N., Sachsse, S. & Vahrson, H. (1997). Changes in selfconcept and body image during alopecia induced cancer chemotherapy. Support Care Cancer,
Caroline Muttitt is a psychological research master’s student at Sheffield Hallam University. cmuttitt@blueyonder.co.uk
5(2), 139–143. Peteet, J.R. (2000). Cancer and the meaning of work. General Hospital Psychiatry, 22, 200–205. Rasmussen, D.M. & Elverdam, B. (2008). The meaning of work and working life after cancer: An interview study. Psycho-Oncology, 17, 1232–1238.
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