Psicoterapia en cáncer de mama : propuesta y resultados de un programa estructurado
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2013
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12-03-2014
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Abstract
INTRODUCTION AND OBJECTIVES: Breast cancer is a public health problem. Diagnosis causes significant emotional disturbances such as anxiety, depression, and general quality of life altering. 33% of the patients present some of these changes at the time of diagnosis (Burgess et al., 2005). In 2003 published the first recommendations based on evidence directed to the treatment of anxiety and depression in patients of cancer National Breast Cancer Centre and National Cancer Control Initiative. (NBCC & NCCI, 2003;) Turner et al., 2005). In 2004, the Institute of Medicine (IOM) of the National Academy of Sciences, recommended that intervention psychosocial (PI) be incorporated into standard medical care for patients with breast cancer at all stages of treatment (M Hewitt, R Herdman, & Holland, 2004). Therefore the objective of the study is to analyze the effectiveness of an intervention program cognitive-behavioral designed by us according to our clinical experience and the literature revised, by associating components psychoeducational and the visit of former voluntary patients recovered physically and emotionally of their disease cancer.
METHOD: Quasi-experimental study of two groups one experimental and other control. It was applied to the experimental group (G.E) intervention program after the initial evaluation. The Control Group (G.C) did not receive psychological intervention. The inclusion criteria were: own a diagnosis for breast cancer in stage I or II be slopes begin a first line of treatment for his Oncology disease or terminate it during the recruitment period. Patients who underwent radical mastectomy, modified in the surgical act.
These criteria included 84 patients, 47 in the G.E and 37 in the Control Group (G.C). We collected a total of 25 demographic variables, personal, disease, psychological clinics, and over the satisfaction perceived by the patient after the visit of the volunteer. We evaluated the efficacy of the intervention program by means of a semi-structured interview and a satisfaction survey on the visit of the voluntary created ad hoc, scale of anxiety and depression in the Hospital (HADS) (Zigmong and Snaith, 1982), and QL-CA-Afex's quality of life in chronic diseases (A. Font, 1988;) To Font & Bayes, 1993).
The moments of evaluation were in the G.E at the beginning of the treatment of QT by completing the interview the HADs and CA-QL-Afex, and month end chemotherapy treatment complimentando the HADs, QL-CA-Afex and satisfaction questionnaire. The G.C was only evaluated once a month to finalize the treatment of QT, by filling in the Interview (trying to remember how they felt when they were going to start treatment, and HADs and QL-CA-Afex as they felt at the time of completion).The Protocol of intervention that applied to the G.E after the initial evaluation, consisted of 8 sessions with the following content: Information oriented functional arm homolateral, and restoring physical and cosmetic
rehabilitation, management of side effects of medical treatment training in active coping strategies expression of negative emotions expression of fears application of technical cognitive behavioral, emotional cognitive reconstruction patient needs training in relaxation techniques training in techniques of arrest of thinking training in problem-solving techniques
Tras la cirugía radical se producía la visita de la voluntaria ex paciente.
Inferential and correlational statistical analyses were conducted using the statistical package SPSS 11.0 being the confidence interval considered significant P < 0.05
RESULTS: It's two homogeneous groups with a mean age of 48,52 years, 81% of the patients were married, 89% had children, 72% had basic studies and 63 per cent were housewives. As concerns the diagnosis in 39,47% of cases the first concern was afraid to die and 36,84% a possible relapse. Regarding the type of information, in 44% of cases it was complete and real, 36% was incomplete but real and in the remaining 20% was false. 84% considered the information received as satisfactory.
In four variables of the interview we find significant differences: doubts that the patients had about his illness, reason that needed treatment of chemotherapy, reaction of couple and how
they felt emotionally. Regarding the first, the experimental group a number of patients had significantly increased 19% who had doubts against the 2.87% in the GC (Figure 16) (X 2 = 11.484, p = 0.009)(Tabla 7). As regards the need for chemotherapy treatment one greater number of patients in the experimental group 46% thought that treatment that were going to start was to "prevent" that the disease recidivara, compared to 17.6% in the GC., this group was dominant idea that treatment was necessary to "kill" possible cancer cells in your body, 47%. (Figure 17) (X 2 = 11.128, p = 0.025)
In the variable emotional situation, 57% of patients in the experimental group reported feeling emotionally calm compared with 44% of the control group, no patient of the GE reported feeling sad, no interest in anything while the GC 18% reported feeling deprimida(X2=8.188, p=0.042) the same applies to the valuation performed by the patients about the reaction observed in your partnera number significantly more patients in the experimental group felt that her partner had reacted showing a level of involvement and satisfactory support for them 71% compared with 62% of the GC. (X 2 = 12.834, p = 0.025).
Regarding the variables anxiety and depression to compare the results of the GE to the GC to month end medical treatments, found significant differences in both variables in the expected sense [T = - 2.865 (gl = 79), p = 0.005] and [T = - 2.703 (gl = 46.630), p = 0.010] respectively. When the correlational analysis on both variables we can highlight are the patients presenting in the E1 higher scores in the subscale of the H.A.D.S depression, which benefit most when the programme is finished.
In terms of the variable quality of life, intervention program improves significantly, in the expected direction, patients who follow him in the subscales of difficulties in daily habits [T = - 2,543 (gl = 61.168), p = 0.014], family difficulties and social [T = - 3.049 (gl = 54.496), p = 0.004], psychological malaise [T = - 2.334 (gl = 63.744), p = 0.023] and the General assessment factor [T = - 3.014 (gl = 57.904)][, p = 0.004]. Finally with respect to the assessment of the visit of the volunteer, patients felt that it helped them improve their relationships, family and social.
CONCLUSIONS:-the sample is representative of their reference group as the series studied in different studies except in the variable age, it's a sample of other women young 48.5 years, versus the 56 years of other studies (Brana et to the.) 2012) can think that a progressive decline is occurring in the age of diagnosis of breast cancer, as well as the service from which was extracted the sample is reference for this pathology.
- Intervention program reduced the levels of anxiety and depression in patients who followed him, which goes in the direction of other works (Cleeland et al., 2000;) Chang, Hwang, Feuerman, Kasimis, & Thaler, 2000; Fallowfield, Ratcliffe, Jenkins, & Saul, 2001; Pirl, 2004).
-Intervention program is effective for improving the emotional state and the quality of life of diagnosed breast cancer patients. (McDaniel & Rhodes, 1998;) Palsson & Norberg, 1995; Williams & Schreier, 2004; Scheier et al., 2005)
-Intervention program improves particular components of the psychological dimension and the family and social relationships
- Interaction with a positive model of coping mainly improved interpersonal relationships, fears and emotional state.