M Tish Knobf1. 1. Yale University School of Nursing, USA. tish.knobf@yale.edu
Abstract
BACKGROUND: The survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known. OBJECTIVES: Th e purpose of the study was to develop asubstantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer. METHODS: Qualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women's writings about menopause and midlife women's health were used to increase interpretation of the data. RESULTS: Vulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives. CONCLUSIONS: This study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.
BACKGROUND: The survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known. OBJECTIVES: Th e purpose of the study was to develop asubstantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer. METHODS: Qualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women's writings about menopause and midlife women's health were used to increase interpretation of the data. RESULTS: Vulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives. CONCLUSIONS: This study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.
Authors: Carolyn Y Fang; Carol Cherry; Karthik Devarajan; Tianyu Li; John Malick; Mary B Daly Journal: Gynecol Oncol Date: 2009-01-13 Impact factor: 5.482
Authors: M Tish Knobf; Karl Insogna; Loretta DiPietro; Christopher Fennie; A Siobhan Thompson Journal: Biol Res Nurs Date: 2008-07 Impact factor: 2.522
Authors: Tsogzolmaa Dorjgochoo; Asha Kallianpur; Ying Zheng; Kai Gu; Zhi Chen; Wei Zheng; Wei Lu; Xiao Ou Shu Journal: Breast Cancer Res Treat Date: 2009-06-20 Impact factor: 4.872