Health

Introduction

Breast cancer (BC) is the form of cancer which affects breast tissue, specifically the inner side of milk ducts and lobules which plays the role of supplying milk to the ducts. Cancer state develops in the organism if the cell cycle regulation is not working properly and the amounts of cells produced are uncountable for the immune system to control (Sharma, et al., 2010., Moodi, et al., 2011). Cancer cells are generated due to sudden modification arising due to mutations of the genetic material (DNA and RNA).

Risk factors

The human genes namely BRCA1 and BRCA2 are responsible for producing “tumor suppressor proteins”. When any of the two genes are mutated then the cell is not able to repair the damaged genetic material resulting in a mutation and altered protein gets developed. Therefore when mutated forms of these genes get inherited, it increases the risk of developing the disease throughout lifetime by about 40 to 85%. Women those who are carrying the mutated BRCA1 and BRCA2 gene tend to suffer from BC at a very early age (Weitzel, et al, 2005; Sharma, et al, 2010; Chandira, et al, 2019).

The risk of BC increases with age after 50 years, due to the presence of mutated BRCA1 and BRCA2 genes, early menstruation before age 12 and late menopause after 55 years, having more connective tissue than fatty tissue in breast, family and personal history of breast cancer, had previous exposure to radiation, sedentary lifestyle, being obese especially after menopause, have undergone hormone replacement therapy, alcohol consumption and having first pregnancy after the age of 30 years (Dupont, et al, 1985).

Prevalence and incidence of BC:

A prospective study based on the data obtained from UK Bio-bank consisting of 273,467 females were analyzed for about 9 years and after the follow up it was observed that the total number of cases suffering from BC were 14,231 showing 3,378 (23.7%) incident cases and the incidence rate is 2.09 per 1000 person-years (Al-Ajmi, et al, 2018). BC can be considered to be the most common cancer in the UK affecting women every year with about 55,000 diagnosis in women and 370 men diagnosed leading to huge number of death rates of 11,399 from 2015-17. The survival rates of BC in UK is 87% (Breast Cancer Now, 2019). Higher survival rates is causes to be linked to early detection and diagnosis and medical advancements in the treatment of the disease.

Another similar study based on data available on Geneva cancer registry between 2002 – 2004 reported that the incidence rate of BC among aged between 25 -39 years had increased by 46.7% every year (Bouchardy, et al, 2007). It can be said that the BC rates are rising among women residing in the fast-developing region, the rates are found to be constantly rising throughout every part globally. Unfortunately, the five-year mortality report showing as high as 50% due to diagnosis of the disease at a later stage can be considered as an unacceptable fact (Torre, et al, 2015).

Concept of Family:

The definition of family is changing in increasingly diverse nature and differ depending on the context and theoretical orientation. The family is one of the most important social institutions in a person’s life. According to (Hanson et al., 2005), the family is a social system which is a basic unit of people who depend on one another for physical, financial and emotional support to survive. There is a close association observed between an individual and their family members in terms of social and financial activities (Paltasingh, et al, 2017; Patel, 2005). The family consist of a basic unit according to traditional and legal norms of society which includes both the parents nurturing their children who are united by ties such as blood, marriage and adoption this is what we call a nuclear family (Burgess and Locke, 1953, pp.7-8). Similarly, a set up of family which includes household near relatives such as uncles, aunts, and grandparents in association with core family members is known as extended family.

However, this definition of family excludes many diverse groups such as the gay and lesbian families, single parents with children, grandparents raising their grandchildren who consider themselves as families and perform the same function as a family i.e. bringing up their child, reproductive functions etc. Families vary in structure, function and processes. Nurses caring for patients with BC must consider the whole family rather than just the patient. Nurses determine a patient’s family structure which refers to the ordered set of relationship among family members, the nurse identifies the individuals that make up a person’s family, their relationship to each other and relationship to other family members.

For the purpose of this literature review, it will be solely focused on the nuclear family and extended family.

The diagnosis of BC in the family poses critical role transitions of individual family members and causes a distinct change in family pattern. It is a well-known fact that families matter a lot in cases when a member of the family suffers from such a deadly disease. The importance of family also lies in the fact that along with the patient, families also directly confronts with the heartbreaking experiences of the illness (Alexander, et al, 2019).During this time they only provide the needed environment of support and care, in which the cancer patient can feel comfortable while going through the painful journey of the disease

The role of a woman is very subjective to the context, i.e., she can be a daughter, a wife, a mother or a mother in law. When she undergoes different phases of the treatment of cancer which includes chemotherapy, radiation therapy and surgery, her capability to fulfil the demands, expectations and responsibility related to each relation gets severely compromised. Previously all mothers used to be the primary person for giving care and support to their family but after diagnosis, the fathers of the family had to take up the role so that the same level of comfort and care can be provided to all the members of the family.

Psychological impact of BC on the family:

“Psychological impact” can be defined as the effect developed due to certain biological and environmental factors on an individual’s thought process and communication affecting their personal and social life (Glanz, et al., 1992). BC shows a profound impact on the social and psychological well-being parameters, not only upon the affected woman but also upon her family members staying close to her. Hence, both the patient and her immediate family members who are closely interlinked experience a huge challenge emotionally as well as financially.

BC in the family impacts negatively on the family causing guilt, anger, resentment and different stages of emotional trauma with the progressing phase of the sickness of the patient (Basra and Finlay, 2007). Families can show anger towards nurses and doctors if they feels the needs of their loved ones are not sufficiently met (Christ, et al., 1983). Family members of the patient may feel guilt for not having regular check-up, lead a healthy lifestyle and listening to the symptoms earlier on. Families may also feel resentment and injustice because they consider the disease to be a punishment from God.

A study conducted by (Manne, et al., 1999) revealed that negative attitude from family members can be linked to increased need of care giving to the patient causing strain and stress in their relationship. Studies shows that 54% of family members reported financial burden and burden of care due to time given to care for their loved ones, transportation costs to appointments and reduction in work hours (Clarke et al., 2010). Financial burden by family members leads to stress, sleep disturbances and worry.

Most of the parents feel that their children are facing the consequences of the diseases due to the physical deformity of their mother during treatment. The children also showed several strategies to cope up with the hard reality of the disease.

Studies show behavioural changes in the family members such as children. Children show poor concentration level due to the non-availability of their closest and primary caregiver (Semple, et al., 2010). Children become young carers and showing enhanced maturity in their behaviour and thought process.

Fathers on the hand expressed mixed feelings, they sometimes want to talk openly about the disease to their children and sometimes they feel immensely worried about the inheritance of the disease to their children. They also show insecurity about how the children will cope up with the truth and therefore they face problem to decide how much to disclose to them. Most of the fathers face difficulty and strained by the demands of becoming an all-rounder for their family and feel the urge to breakdown (Muriel, et al., 2012). Fathers also had to adjust in many conditions to provide comfort to their family people and to be called as a “good father” (Weaver, et al., 2010; Hegel, et al., 2006).

Rationale

Evidence from (Diggins, 2011., Foster et al., 2016) shows the psychological and psychosocial impact of BC on the whole family and nurses must take necessary interventions to reduce the burden on family members using the family-centred care approach. Nurses holistically assess the need for patient and family which includes social, emotional, psychological, psychosocial and spiritual needs. Most studies have looked into the impact of BC on partners and patients children but little studies show how BC affects the family as a whole. Understanding the families perspective will help nurses and other health care professionals to provide adequate care and support needed by families. For this reason, this literature review aims to understand the psychological impact of BC on family members.

Summary

This chapter has looked at BC, its prevalence and incidence, the concept of family, psychological impact of BC on family members. The next chapter will detail the methodology and search strategy used for the literature review.

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