Robbie BoonIndiana Wesleyan UniversityPYCF 60GNUR 530 ResearchDr. LeeAnn HawkinsMay 9, 2013

Analysis Two: Assessment of Social Support and Survival in Young Women with Breast Cancer

Social Support and Survival in Young Women with Breast Cancer (2012). Psycho-Oncology Authors- Ann F. Chou, PhD, Mph, University of Oklahoma (U of OK), Department of Health Administration and College of Public Health, Department of Family Medicine Susan L. Stewart, PhD, Department of Medicine, University of California, San Francisco Robert C. Wild, MS, Mph, CPH, Center for Healthy Development, Health and Human Services, Georgia State UniversityJoan R. Bloom, PhD, School of Public Health, University of California, Berkeley

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Title Social support and survival in young women with breast cancerThe title is concise and illustrates the point to the research.The title does illustrate the contentThe title does not indicate the research approach that is used.AbstractIncludes the research problem and states the hypothesis by evaluating the social support of younger breast cancer patients by assessing the effects of the network size changes post diagnosis.The methodology of a population of 584 women followed for 12 years with mean age of diagnosis of 44 years old used Cox regression analysis to estimate survival related to support. The women were 50 years old and younger.The conclusion states the findings of the article.

Introduction and Literature Review

Public health studies revealed social networks to be predictive of mortality.Marriage is found to be beneficial in protecting the survival of breast cancer patients by multiple studies as cited by Chou et al (Goodwin et al., 1987; Le Marchand et al.,1984; Funch & Marshall, 1983).Durheim, E. (1951) considered the importance of family and society as integral in health in his study on the sociology of suicide as noted in Chou et al, 2012.During the 1990s it became noticeable the importance of support on health and survival.

Structural support friends, Functional support family, relatives, co-workers,information, tangible and which form community.Emotional support.Informational support Instrumental support - seeking knowledge relevant transportation, child care, to life experience.and financial assistance.Emotional Support Social support - love, esteem building, andinformation or aid through cared for feelings. Social contact for benefit.(A.F. Chou et al., 2012)Literature Review (continued)The literature review defines the key concepts that have been developed and that need further elaboration. Younger breast cancer patients are in need of more emotional support and social support being involved with their reproductive years and concerns for others.Social support may change for women diagnosed with cancer due to the stigma associated with the cancer as discussed by Holland et al., (2010) and Else-Quest et al., (2009).HypothesisH0 Social support will not affect the survival of young breast cancer patients.HA Social support will improve survival of the young breast cancer patient.

Experimental Design and Methodology in consideration of variablesVariable ABCDSocio -demographicsRaceEducationMarriageWorkTreatment characteristicsLocal diseaseRegional diseaseRemote diseaseEstrogen Receptor statusHealth statusMastectomy/lumpectomyTime from diagnosisTreatment: chemo, radiation, hormone txBaseline general healthSocial supportSees more people than before diagnosisLess support since diagnosisFrequency of contactSample Characteristics of young women with breast cancer (from information of Table 1 in A.F. Chou et al., 2012)8% 2 or less contacts/ month29% 3-5 contacts / month20% 6-9 contacts / month43% 10 or more contacts / month

Hormone Receptor activity and treatment was also figuredSample Selected - Subjects n =584475 or 81% were married109 or 19% were single77% were employed18% had high school education or less82% had a college education or moreMean age was 44 years oldWith Cox proportional hazards regression analysis calculated risks to 95% confidence interval (CI) for social variables and the modifying factors discussed.Data Collection:Further Considerations of Social Support over the two phase project that lasted a median follow up time of 10.3 years. (consisting of phase 1 and 2)Phase 1 consisted of a 10 session psycho-educational support group interventionTopics included:ResourcesEmploymentBody ImageDiet & NutritionSocial functioningFuture planning.

Phase 2 (Randomized Control Group) consisted of 3 Surveys along with the 10 sessions(1) in person / telephone at baseline and3 and 6 month telephone interviews

Phase 2 yielded a lower response rate than Phase 1 and the effects ofthe psycho-educational intervention on survival were not ascertained due to the intervention being only available to phase 2.

Chou et al. (2012)

Ethical ConsiderationsIf patient randomization into the control group did potential harm or increased risk, but that is not the way the study was completed. The study did not follow the psycho-educational group after the courses, therefore the results that discuss the support is based on the interviews with phase 2 and from the Cancer Registry.Consents and providing personal information along with keeping confidentiality are key in any research.Concerns for keeping general and mental health components confidential are important in group settings.

Notice that thewomen that hadmore contactsthanbefore diagnosis were the womenwith greater survivalprobability.

Chart from Chou et al. (2012) page 130. ResultsData AnalysisThe cox regression results demonstrated that one of the indicators of social network contacts was significantly associated with survival for these women younger than 50 years old.The level of emotional support was indicative of improved survival, with a hazard ratio of 0.96 with a 95% CI.Other factors that improved survival by cox regression are health status and treatment in response to disease.Chou et al., 2012

Discussion and ConclusionA social network is important in enhancing self-esteem and helping with coping skills.A social network shows that it benefits in decision-making and increasing supportive relationships for decreasing anxiety, stress, and depression.Depression and anxiety are related to satisfaction of support.S Support received after diagnosis is very important in reducing depression and anxiety over time as noted by Chou et al., 2012.

RecommendationsEvaluation of the effect of the psycho-educational interventions on the survival of the groups that were enrolled in the phase 1 study would provide some more interesting results.Exploration of the types of support and their effect on survival could have been further analyzed. Implications for further study are discussed such as delving deeper into emotional support.Women with child-care issues and women without child-care issues could have made a different structural support group for example. These groups could be subdivided to further study.

Chou, A. F., Stewart, S. L., Wild, R. C., & Bloom, J. R. (2012). Social support and survival in young women with breast carcinoma. Psycho Oncology, 21, 125-133. doi: 10.1002/pon.1863Else Quest, N.M., Lo Conte, N. K., Schiller, J.H., & Hyde, J. S. (2009). Perceived stigma, self blame, and adjustment among lung, breast, and prostate cancer patients. Psychology and Health,24 (8), 949-964. doi: 10.1080/08870440802074664Hamer, S., & Collinson, G. (Eds.). (2005). Achieving evidence-based practice: A handbook for practitioners (2nd ed.). New York, NY: Baillere Tindale. Holland, J. C., Kelly, B.J., & Weinberger, M. I. (2010). Why psychosocial care is difficult to integrate into routine cancer care: Stigma is the elephant in the room. Journal of National Comprehensive Cancer Network 8, 362-366.ReferencesLargoClassical Music ExpertsStudy Smart: 30 Classical Hits To Keep You Focused, track 9/30, disc 1/12012Self-Help166643.55