Invited Speakers’ Abstracts / The Breast 21S1 (2012) S1–S9
Results: After breast cancer, the couple relationship is affected most by body image concerns, sexual symptoms and infertility related issues. 23 to 25% of women with breast cancer have to face a separation/divorce after the diagnosis, the younger presenting the higher vulnerability, versus 7% of relationships breakdown when men are affected by cancer. On “her” side, body image concerns may affect self-esteem, willingness to play a seductive role, feeling erotically assertive and confident, with changes in quality of foreplay, acceptance of nakedness and confidence in exposing the breast. Loss of sexual desire, arousal disorders with vaginal dryness, dyspareunia, coital anorgasmia and loss of sexual satisfaction are progressively complained of, as sexual function tend to go worse over time. Age (the younger the woman the more serious the impact), lymphedema, side-effects of surgery, radio/chemotherapy, hormonotherapy, and the cosmetic outcome may modulate the impact of breast cancer on the individual woman and couple. The highest vulnerability is reported in women affected by iatrogenic premature menopause with its cohort of symptoms, secondary to the chronic loss of estrogens, on the brain (depression, anxiety, irritability, memory concerns), on the pathophysiology of sexual response and on the function of the pelvic floor. Women on tamoxifen or aromatase inhibitors may complain of more severe menopausal and sexual symptoms. On “his” side, key issues include sexual dysfunction and dissatisfaction, infertility and the “burden” of looking after a family with children. Loss of estrogen may reduce the “scent of woman” and pheromones, which trigger the biological side of sex drive, and make penetration difficult because of vaginal dryness. Partners may complain of situational loss of desire, and/or of erectile deficit, when dryness itself challenges the quality of the erection or when he perceives vaginal dryness as a sign of refusal. Conclusion: The young couple is more vulnerable to the sexual consequences of breast cancer in comparison to older ones. A multidisciplinary and pragmatic approach to sexual complaints of breast cancer survivors should be offered to women and couples who desire to prevent the sexual consequences of the disease and/or get back to a better sexual intimacy. The presentation will review the (scarce) evidence, report women’s and couple wording and offer concrete suggestions to address the most frequently reported sexual issues and complaints. IN21 “Mommy has breast cancer”: how do children cope? – Protecting: a grounded theory study of school-age children’s experiences in the context of maternal breast cancer E. Furlong *. University College Dublin, School of Nursing, Midwifery and Health Systems, Dublin, Ireland The purpose of this study was to describe and develop a theory of children’s day-to-day experiences as they live with their mother who has been recently diagnosed with, and is receiving treatment for, early-stage breast cancer. Using classic grounded theory methodology, data were collected through 28 interviews with 7–11 year-old children whose mothers had been diagnosed with early-stage breast cancer during the previous four months. Findings revealed that the children employ a strategy called protecting where they mediate three cyclical and iterative processes of shifting normality, shielding and transitioning. Shifting normality described the processes of how the participants contrasted the certainty and control of their lives before their mothers’ diagnosis with their ‘post-diagnosis’ lives. Shielding described how the children tried to maintain normalcy in their lives with the need to curtail their activities in the context of maternal cancer. Transitioning described the process by which the children reconciled their experiences to a ‘new normality’. The central argument in this thesis is that the children were trying to protect their own lives as well as the lives of their mothers. The
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findings provide a mechanism for understanding how the perceived loss of the ‘well’ mother raised concerns for the children and resulted in adaptations of roles and responsibilities. The theory of protecting gives children’s voices an articulated form and creates a basis for a wider discourse on their needs at times of parental illness and their ability to participate in and contribute to relevant research on their experiences. In addition, this theory of protecting informs nursing education, practice and research and policymakers related to school-age children’s experiences in the context of maternal breast cancer.
Session IX. Breast cancer and pregnancy IN22 Breast cancer during pregnancy – the oncologist’s point of view S. Loibl *. German Breast Group, Neu-Isenburg, Germany Breast cancer during pregnancy accounts for approximately 2% of primary breast cancer patients. The median age of these women is below 35 years and the biology of breast cancer in very young women has a more aggressive phenotype [1]. Having said that, breast cancer in the very young women is mostly treated with cytoxic agents as part of the systemic therapy. The type of adjuvant or neoadjuvant chemotherapy however, does not differ by age. It seems that young women benefit from neoadjuvant therapy also in terms of improved disease free and overall survival. Standard (neo)adjuvant chemotherapy regimen today comprise an anthracycline-taxane based therapy, either as combination or as sequential therapy. Dosedense therapy seems to be superior, especially in hormone-receptor negative disease. Today’s credo is to treat pregnant women with breast cancer as closely as possible to standards for young, non-pregnant women with breast cancer. Data are increasing to support this statement. Early preterm deliveries with a high risk of fetal morbidity and mortality are in general not indicated and the general recommendation is to treat the woman during pregnancy and deliver as closely as possible at term. Chemotherapy should be stopped around the 35th week to allow for a 2–3 weeks chemofree interval prior to delivery [2]. As anthracyclines are accepted as chemotherapy for young women during pregnancy, taxanes are not and are in addition often not even recommended during pregnancy. However, the data for the taxanes are increasing and the smaller cohorts treated by taxanes during pregnancy do not indicate a worse outcome for the children exposed to a taxane in utero than for anthracyclines. Standard regimen to be used in pregnancy are e.g. FECx6; FEC-Doc; E(A)C-Doc; E(A)CPaclitaxel weekly. “Chemo-light” with reduced cycles and agents e.g. epirubicin mono, or 4x TC if not completed after delivery is not indicated. No experimental regimen and agents should be used, e.g. nab-Paclitaxel because it is also not indicated for non-pregnant primary breast cancer patients. The percentage of breast cancer patients with a HER2-positive tumour is higher in young women. Our data have shown that around 1/3 of the patients with breast cancer during pregnancy had a HER2-positive disease. The use of trastuzumab during pregnancy is not indicated as the majority of cases treated accidentally with trastuzumab during pregnancy showed an oligo-anhydramnios. Recent data from the HERA study showed that in the 16 pregnancies that occurred while treated with trastuzumab or up to three months after end of trastuzumab treatment no oligohydramnios in the 5 women who continued pregnancy. But the spontaneous abortion rate was high with 25%. None of these patients was exposed longer than 2 months and all during the first trimenon. It seems comparing these data with the data from the case reports that the duration