A breast cancer diagnosis can be overwhelming – an emotional rollercoaster ride that includes anger, depression and powerlessness. So many decisions need to be made regarding treatment options. But those emotions, particularly the powerlessness, can be heightened by the dynamic of intimate partner violence, and the result can have a profound effect on treatment outcomes and cancer survivorship.
Now, a study completed at the UCLA School of Nursing by PhD candidate Wendy Johnson and published May 19 in the online issue of Cancer Nursing, is taking a look at treatment decision making among women diagnosed with breast cancer and who live with intimate partner violence. Johnson completed a literature review to assess the presence of intimate partner violence among female cancer survivors. What she found was that research exploring the relationship between cancer survivors and domestic violence is limited and relatively new.
Johnson, who is an oncology nurse, said the idea for the study came out of a conversation she had with a colleague who told her that she believed one of her patients was a victim of IPV, but wasn't sure what to do with the information or how it was impacting the woman's treatment.
"When a woman decides not to get treatment, we have to look at other factors, not just presume that the patient is not interested."
It is already known that women who live with domestic abuse present with acute injuries, non-acute symptoms and chronic health problems. In the oncology setting, the results of abuse can make symptoms difficult to diagnose or treat.
The impact of the cancer diagnosis on IPV is complex and anecdotal horror stories abound, Johnson related in her study. For some women, the abuse escalates after the cancer diagnosis. For others, emotional abuse turns violent. In many cases, women describe how their abusive partners displayed control over the money, insurance and treatment. Women in rural areas found themselves driving to appointments when they had the lack of ability to do so. Women who suffered physical abuse told stories of levels of abuse resulting in broken bones, bruises and scratches and being "bumped" in their surgical sites. Delay in treatment can lead to cancer advancing.
The abuse can also extend to the healthcare providers, jeopardizing the overall safety of everyone.
According to the study, nurses can play a vital role in assisting patients with their emotional, psychosocial, and physical needs when dealing with cancer. Oncology nurses often have a special bond with their patients that allows them to support the patients and promote safety and health.
"At a time when these women need support the most, their cancer treatment has to take a back seat to the abuse that is going on in their lives," said Johnson. "Oncology nurses can help create a clinical environment in which patients feel safe and supported."
Johnson's study includes clinical guidelines that nurses and other healthcare providers can use to address suspected abuse. If abuse is identified, clinicians can address issues of safety and resources for intervention. Proper documentation is also critical for treatment regimens and potentially legal evidence. While oncology nurses play a critical role working with patients, success requires a multidisciplinary approach and collaborate team work.
Johnson is now talking to women who did not feel supported when they had to make decisions about their breast cancer treatment. Future studies may include men and homosexual relationships as well as looking at specific cultures.