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The Influence of Endocrine Effects of Adjuvant Therapy on Quality of Life Outcomes in Younger Breast Cancer Survivors(四)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34
ombined with ovarian suppression in premenopausal women [31]. Symptoms associated with aromatase inhibitors include hot flashes, vaginal dryness, bleeding and discharge, sleeping difficulties, fatigue, musculoskeletal complaints, headache, decreased libido, and breast tenderness [37, 38], all of which may negatively impact a woman’s quality of life [37, 39].

  QUALITY OF LIFE IN YOUNG MIDLIFE BREAST CANCER SURVIVORS

  

  Young and young midlife women with breast cancer are more vulnerable to psychosocial distress because of their developmental stage in life [5, 40, 41]. They may be single, married without children, parenting young to adolescent children, and establishing careers. The multiple demands of the cancer illness are layered on top of the multiple demands of a young woman’s life cycle, and women become more vulnerable to psychological morbidity as they attempt to manage multiple stressors [5, 42, 43]. Younger spouses experience emotional distress, have difficulty communicating about the illness and providing psychological support and often have difficulty carrying out household and childcare responsibilities [5]. Families with school-aged children who have a mother diagnosed with breast cancer are particularly vulnerable to poorer psychological outcomes [44, 45]. Experiencing premature menopause can further increase a young woman’s vulnerability, resulting in a greater risk for emotional distress and a poorer quality of life [6, 7]. Vulnerability was identified as the basic problem for young women diagnosed and treated for breast cancer who experienced premature drug-induced menopause [46]. This vulnerability was found to be related to physical and psychosocial distress associated with diagnosis and treatment, existential concerns, lack of adequate preparation for the menopausal experience, uncertainty, severity of menopausal symptoms, and changes in self concept. "Becoming menopausal" was a realization by women that menopause was more than the cessation of monthly menses. Women reported distress at the age inappropriateness of the abrupt menopause, uncertainty related to menopausal symptoms, uncertainty related to the temporary or permanent nature of amenorrhea, feeling older, having no peers to talk with about the experience, and loss of fertility. Young women report feeling different than other women their age, have concerns about early menopause, and describe multiple losses, including loss of menstruation and loss of fertility [46, 47].

  There is an integral relationship among quality of life, chemotherapy-induced menopause, the menopausal symptom experience (from induced menopause and/or endocrine therapy), and sexuality for breast cancer survivors [6, 46, 4851]. Young women report worse emotional well-being, more psychological distress, higher anxiety, more unmet needs, and greater concerns about finances, work, and self-image than older women (Table 2) [7, 4042, 49, 5259]. Chemotherapy is associated wit

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