revealing needs for supportive care, both during treatment
and afterward. For example, Ganz and colleagues exam-
ined the quality of life in 558 patients with breast cancer
during the period of time immediately after the completion
of treatment, when women need to move beyond cancer
to reestablish their normal life patterns. They found that
women experienced breast sensitivity, muscle stiffness, aches
and pains, difficulty concentrating, and decreased energy,
regardless of the type of treatment (mastectomy, lumpec-
tomy, chemotherapy). These problems were all associated
with poor physical functioning and emotional well-being.
In addition, sexual functioning was worse for women who
received chemotherapy, regardless of whether they under-
went a lumpectomy or mastectomy. After chemotherapy,
women experienced difficulties with sexual interest, lubrica-
tion, and pain with intercourse. These results are important
because they target areas for intervention to help women
make a smoother transition to normal life.
Quality of life issues also have been identified for long-
term survivors who remain free of disease. For example,
some breast cancer survivors—particularly those with
mastectomies or lymphedema—continue to experience
significant problems with body image, sex life, depression,
and symptoms of posttraumatic stress disorder years after
treatment.
In addition, long-term survivors of various
cancers have been found to experience many of the same
problems—namely, chronic fatigue, fear of recurrence
and death, infertility, issues of control and independence,
altered meaning of health, and uncertainty about the
future.
Nurse-delivered interventions have been instituted to
address some of these quality of life issues. For example,
cancer outpatients diagnosed with major depressive dis-
order received a multicomponent intervention delivered
by nurses.
The intervention was effective, in that 38.5%
fewer patients in the treatment group were still depressed
at the final 6-month outcome, as compared with patients
who received the usual care. In another study, breast cancer
patients, who were 3 to 4 months postdiagnosis, received
10 sessions of cognitive-behavioral therapy by telephone.
The women who received the therapy had less anxiety and
confusion at the final 10-month outcome, as compared to
the control group.