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The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship

Clayton, Margaret F. PhD, APRN; Dingley, Catherine PhD, RN; Donaldson, Gary PhD

doi: 10.1097/NCC.0000000000000375

Background: Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress.

Objective: The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women’s plans for their visit, negotiation of decision-making roles).

Methods: Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit.

Results: Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers.

Conclusions: Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations.

Implications for Practice: Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based “help lines.”

Author Affiliations: College of Nursing, University of Utah, Salt Lake City (Drs Clayton and Donaldson); and School of Nursing, University of Nevada Las Vegas (Dr Dingley).

This study was funded by the University of Utah Research Foundation Incentive Seed Grant.

The authors have no conflicts of interest to disclose.

Correspondence: Margaret F. Clayton, PhD, APRN, College of Nursing University of Utah, 10 S 2000 E, Salt Lake City, UT 84112 (

Accepted for publication February 12, 2016.

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