Breast Cancer and Body Image: The Roles of the Male Partner

Abstract

Background: 

Cancer is a group of diseases with different causes, manifestations, treatment, and prognosis, characterized with an uncontrolled growth of abnormal cell. In women; cancer of the breast is the second most common cancer after cervical cancer and the second leading cancer’s death following lung cancer among women in Sub-Saharan Africa. In Nigeria, it has become the most common female malignancy with a prevalence of 12.5%. However, the same treatment that offers better cure rates may also result in a serious decrease in quality of life, psychological problems, as well as provoking changes in their bodies. Societal behavior towards breast cancer patients makes a woman that is newly diagnosed with breast cancer become tearful, ashamed, and discouraged.

Aims: 

To examine breast cancer, body image and the roles of the male partner.

Methods: 

The data for this review paper are from published studies. Electronic databases of Medline, Scopus, PubMed, CINAHL, and Google Scholar were searched using the keywords: breast cancer, body image, roles of the male partner and literature were retrieved and screened for eligibility. The date limit considered in the literature search was from 2016-2021 to capture only the variables identified in this seminar objective. The author defined the topic of interest and the goal was to address the objective of the seminar topic.

Results: 

Four themes (issues) emerged which are: (1) The Model of Whole-Person Caring, (2) Disturbed Body Image, (3) Psycho-Social Impact of Breast Cancer and (4) Roles of the Male Partner.

Conclusion: 

Breast cancer poses a significant financial and psychosocial burden not only on patients, but also on their spouses, families, and broader social network. Breast cancer disease usually changes spousal roles as the women’s husbands take over their responsibilities. The disease influenced both partners and made stress a common factor shared by them. Husband plays a vital role in the lives of breast cancer patients through managing the finance, decision-making, providing emotional support, and remaining involved throughout the disease. Therefore, involving the husband in planned psycho-social interventions produces better results than merely patient-focused strategies. Male partners have a great role to play and should be encouraged and allow partaking in the treatment process of their spouses as this will positively influence their recovery.

INTRODUCTION

Cancer is a group of diseases in which cells begin to grow out of control.^[1] This deadly disease affects both sexes at different parts of the body. In women, cancer of the breast is the second-most common cancer after cervical cancer and the second-leading cancer death following lung cancer in women in Nigeria.^[2] Breast cancer death rates have been steady in women younger than 50 years but have continued to decrease in older women;^[3] this was found to be related to hormonal changes associated with aging. In young women, breast cancer is mostly hormone-receptor-negative, very aggressive, with fewer treatment options, and this is with poorer prognosis when compared with older women’s prognosis of the diseases.^[4] There has been an increase in the incidence of breast cancer globally, including Nigeria and other Africa countries. According to Mensah et al. breast cancer is the most prevalent cancer in Ghana with an alarming occurrence in young women aged 40–49 years and it is one of the most common causes of cancer deaths in women.^[5]

The breasts of women are multifunctional including nourishment of their offspring, sensual organ in a relationship, and a feminine symbol. Irrespective of the age and socio status of any woman, the diagnosis of breast cancer comes as a surprise to her status because women perceive their breasts as something that makes them whole or complete, and therefore feel dejected and hopeless when they lose their breast (s). To worsen the situation, the societal attitude and perception toward breast cancer patients make a woman that is newly diagnosed with breast cancer become tearful, ashamed, and discouraged.^[6,7] This was further explained by other studies, they reported that young women living with breast cancer most time presented with severe depression and other concerns which could be physical, psychological, and social issues that require special care from a multidisciplinary health-care professional and their significant others for effective management.^[8,9]

In general, treatment of breast cancer involves surgery, chemotherapy, and radiotherapy. Surgical interventions are associated with a lot of complications such as deformed breast (s) and scars that women find demeaning, while chemotherapy and radiotherapy cause weight loss, nausea vomiting, myalgia, hair loss, and skin discolorations that disrupt their daily activities. Likewise, hormonal therapy is not an exemption, it also brings about hot flushes, muscle cramps, joint stiffness, joint pains, and loss of libido, which may be a major concern for women, especially the younger ones.^[6] Another study identified decreased libido, fear of sexual intimacy, menstrual irregularities, and destruction of ovaries which usually leads to infertility could be sexual and fertility problems that are related to the physical impact of breast cancer treatment.^[10] Based on these complications, breast cancer cannot be managed effectively using a single method; there is a need for the Whole-Person Caring model [Figure 1].^[11] Therefore, this review’s aim is to examine the impact of breast cancer on the body image of breast cancer patients, and to identify the roles of the male partner in reducing the impact of breast cancer on the patients.

Figure 1: Model of whole-person cancer care^{[ 11 ]}

WHOLE-PERSON CARING MODEL FOR BREAST CANCER PATIENT

when a breast cancer patient goes to the hospital for treatment, they bring with them a complex and interconnected set of circumstances that contribute to the development and exacerbation of their conditions. While it is very common for doctors and nurses to see the person sitting before them as a composite of symptoms, and a problem to be solved, there is usually much more at play that needs to be addressed during the care process.^[12] Even though a person might present with cancer disease, there is a host of co-occurring factors that can complicate the condition, or reduce the success rate of cancer treatment regimen. Although their living situation, emotional status, and love from husband and other family members may seemingly unconnected with cancer treatment, this can play a serious part in the patients’ overall health and their quality of life. The term wholistic treatment is used to describe treatment of the totality of the condition and has become one of the major effective methods of cancer management.^[13]

Therefore, nurses working in oncology units are expected to offer care for the entire course of the patient with cancer, including the processes of diagnosis, treatment, possible recurrence, survival period, palliative care, and assisting in a peaceful death.^[14,15] The contribution of nurses is crucial in the management of breast cancer but also needs a close collaboration with patient relatives and other health team members. The needs of patients with cancer are complex, which include different aspects of life such as psychological, physical, financial, social spiritual or religious issues, family relationships, emotional concerns, practical issues, information needs, self-esteem, body image issues, and other daily demands.^[16,17] In order to support breast cancer patients, nurses will have to identify their needs using a holistic approach. The philosophy of nursing is the adoption of a nursing care which integrates all dimensions of life.^[18] Caring for breast cancer patients is a dynamic process to address their needs, with adaptation each time to the demands generated by the disease and its treatment. An oncology nurse will need to personalize and design their nursing care to meet social, spiritual, physical, and psychological needs such as the issue of body image perception. The breast is the epitome of femininity and anything that affects it leads women to question their attractive roles, feminine individuals, and breastfeeding mothers. Body image affects one’s self-esteem and sexuality, thus understanding these issues is a way of understanding the female universe,^[19] and this comprises self-esteem and attitudes related to the body that involves thoughts, beliefs, feelings, and behaviors associated with the changes that may occur.^[20] Self-esteem could be described as a set of impressions that is either positive or negative about oneself after self-assessment. Consequently, individuals with low self-esteem have difficulties employing suitable social strategies, they recurrently face the conflict to take the challenge to succeed, and most time earn the approval of others that life is worthless. Based on this fact, cancer patients run the risk of depression and suicide.^[21,22] It is of utmost importance to assess the outcome of breast cancer treatment on body image and self-esteem since women with breast cancer partake in the decision-making process concerning their treatment.^[23] Self-esteem is lower in women that had a mastectomy done compared to average women with their breast intact. Therefore, the loss of a sensual organ that is capable of stimulating sexual desire may damage a woman’s physical structure, leading her to feel that she has lost her femininity and physical attractiveness, and may lead to diminished self-esteem. Mastectomy involves the loss of the former figure and harms the image the woman makes of her body, it is considered an attack on body image, which makes the patient feels she is not beautiful.^[19] Therefore, nurses and other health-care practitioner’s must pay keen attention to the proper management of self-esteem associated with changes of body image among patients with breast cancer, after Mastectomy; this study found that this is capable of increasing the current success rate in breast cancer management.

BODY IMAGE OF PATIENTS WITH BREAST CANCER

These are psychosocioeconomic factors associated with cancer; the treatment process, changes in patient’s physical appearance, and sexual function influence the body image of women with breast cancer. Body image is defined as internal cognitions, feelings, evaluations, and behaviors of individuals toward their appearance.^[24] A study by Broder in 2017 opined that the body image of women with breast cancer is influenced by the treatment process, psychosocioeconomic factors, changes in patient’s physical appearance, and sexual function.^[25] In addition, this study also discovered that society regards the breast as the symbol of femininity, attraction, and sexuality, so any damage to the breast can lead to worries and distress and harm women’s whole life. Moreover, the presence of the disease, treatments, and adjuvant therapies, such as radiation therapy, worsen body image, create psychological problems, and reduce women’s acceptance of their changed body image after treatment.^[26]

The provision of appropriate interventions to cope with the disease can reduce the impact of disease-related problems on women’s body image. For instance, cognitive coping strategies, social support, and adaptation are the most effective interventions. Also, strategies, such as educational interventions, pamphlets, online educational support, cognitive coping, social support, and self-efficacy, will help improve the psychosocial impact of a patient with breast cancer diagnosis and management.

PSYCHOSOCIAL IMPACT OF BREAST CANCER

Patients with breast cancer need a comprehensive and holistic approach to care that goes beyond physical treatment and includes support and intervention related to psychological needs.^[27] A woman is expected to play different roles as daughter, wife, mother, or mother-in-law based on the context. During the time of treatment (surgery, chemotherapy, and radiation therapy), her ability to fulfill these roles and responsibilities is severely impacted. Due to the treatment and its side effect, the patient has to deal with multiple issues such as disfigurement of her body, sexual intimacy with the husband, and the ability to care for her children. This leads to psychological disturbance, 38% of the cancer patients are identified with anxiety and depression, distress, adjustment disorders, delirium, and posttraumatic stress disorder,^[28] In order to reduce or eliminate the complications associated with breast cancer, the husband of the patient have a vital role to play by providing emotional support and management of other logistics involve in the treatment.

ROLES OF THE MALE PARTNER CONCERNING BODY IMAGE OF A SPOUSE WITH BREAST CANCER

Diagnosis of breast cancer poses a significant financial and psychosocial burden not only on patients but also on their husband, children, and extended family. According to Alexander et al. in 2019, family plays a vital role in the lives of breast cancer patients through managing their finance, decision-making, providing emotional support, and remaining involved throughout the disease.^[29] Involving the husband in planned psychosocial interventions will produce better results than merely patient-focused strategies. The diagnosis of cancer has a significant impact not only on the patient but also on their spouse/partner, family, and broader social network.^[30] Breast cancer disease usually changes spousal roles as the women and their husbands need to take over the responsibilities; failure on the part of the husband will reduce the success rate of treatment. Therefore, the disease influenced both partners and makes stress a common factor to be shared between the woman and the husband. This change in role and stress toleration negatively influenced the spousal conjugal relationship.^[25] Considering the physical, psychosocial, and economic stress a woman with breast cancer go through, the male partner can assist her to cope with this stress in the following ways: the male partner should endeavor to create time to follow her to every clinic to assist her to take note of important information/instruction given to her because many patients suffer from “chemo-brain” (forgetful feeling). Women receiving breast cancer treatment often feel exhausted and fatigued and experience joint pains and hot flushes following treatments for breast cancer,^[31] therefore, the male partner should try to recognize that this is not ordinary tiredness hence needs to be understood and helped. In addition, cancer women normal experience cancer pain^[32] and they need soothing words; even nonverbal communication from their husband can be comforting enough to reduce the pain then. Furthermore, women receiving breast cancer treatments often experience painful intercourse and decreased libido;^[33,34] hence, the male partner should endeavor to find other creative ways of achieving intimacy. Husbands need to be with their wives in this condition and be open to different ways of expressing physical love. They can listen to music together and play together. The husband should endeavor to accept changes in gender roles such as caring for the kids and doing house chores because women with breast cancer will not be physically strong to cope with their roles. Therefore, as the incidence of breast cancer continues to grow, Whole-Person Caring is needed to ensure that women with breast cancer are not only surviving but also live a quality life, and this could only be achieved if their husband or male partner is ready to play their parts in the management strategies.

CONCLUSION

Diagnosis and treatment of breast cancer result in physical, psychological, and social problems that interfere with the body image and quality of life of patients. Women who are diagnosed with breast cancer require holistic care from health-care professionals and most importantly male partners. It is, therefore, necessary to educate women with breast cancer and their partners on the expectations of the various treatment modalities and how to cope with such to reduce the impacts of breast cancer on the sufferers.

Recommendations and implications for nursing and/or health policy

The husbands of women with breast cancer need more education on breast cancer disease, treatment modalities, and its effects on the patient’s body image. Therefore, nurses should be educated on psychological impact associated with breast cancer and the role of the husband to enhance the success rate of cancer treatment. Male partners’ involvement in the care of patients with breast cancer will greatly reduce the impact of the disease and treatment process by improving their body image and well-being that is capable of reducing the cost of management and hospital stay. Seminars and workshops should be organized by hospital managers for nurses and male partners of patients suffering from breast cancer. This will increase their knowledge level and will be able to provide adequate care for the patients, and finally, husbands should be encouraged and allowed to partake in the treatment process of their female partners suffering from breast cancer. Women will beat breast cancer disease by how she lives, why she lives, and in the manner in which she lives through the support of her husband.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.