Breast cancer and family systems therapy theory presentation

Breast Cancer: A Family Systems Therapy Theory Perspective

BY ASHKHEN SARGSYAN NURS 480: FAMILY HEALTH CARE NURSING PROFESSOR BENNETT 3/26/17

Breast Cancer Breast cancer is one of the leading killers in the United Sates. This disease involves the uncontrolled and mutation-ridden growth and proliferation of cells in the breast, usually in the duct tissue (Starks et al., 2013). There has been very little improvement in the incidence of breast cancer over the past decade, which has remained at roughly 120 new diagnoses per 100,000 women in the United States (Breast cancer, 2017).

There are around 20 deaths per 100,000 per women, or 40,400 people total. It is the second most prevalent cancer in the nation (Breast cancer, 2017). Also, the incidence of breast cancer differs by race, with white and AfricanAmerican people having higher incidence rates than Asian-Americans or Hispanics (Breast Cancer, 2017).

However, gene mutation rates, mortality rates, and the stage when breast cancer is detected are all higher among low-income Americans and ethnic minority groups (Starks et al., 2013).

Meet the Patient and Family Deanne, age 37, is married to her husband Tyler, age 38. They are both African-American. They have one child, Vanessa, who is 7 years old.

Both Deanne and Tyler work full-time, but still have a relatively low household income, and live in a crowded urban area. Although their family has health insurance, only Vanessa receives yearly checkups to save money. Deanne had noticed an swelling on her right breast and went to the doctor for the first time in five years. The doctor ordered a biopsy and CT scan. She diagnosed Deanne with stage IIIA cancer and ordered surgery and a chemotherapy regimen to remove the tumor and three affected lymph nodes. How will Deanne and her family manage this challenge?

Culture and Breast Cancer Culture has a major impact on breast cancer health outcomes. African-American women are more likely to have higher stagings of breast cancer at the time of diagnosis compared to the general population (Stark et al., 2013). These involve stagings of IIIA or higher, where cancer cells have migrated past the initial tumor, or even metastasized to other parts of the body.

African-American women who live in lowincome areas, like Deanne, are twice as likely to be exposed to pollution from the environment, cigarette smoke, and pesticides, which turn on genes that predispose women to breast cancer (Mason et al., 2015). Women like Deanne who are in 150% of the federal poverty line are more likely to have a larger number of mutations when their cancers are diagnosed, which can raise the risk of metastasis (Starks et al., 2013).

Family Factors and Communication Strengths and Challenges 

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Strengths 

Deanne and Tyler have insurance, even if they do not always use primary care.

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The family has some money saved up for emergencies.

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Deanne and Tyler have large extended families and their church group, who live near them they can rely on for assistance like child care, transportation, and cooking (Thistlewaite, 2013).

Communication Practices 

Verbal 

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Challenges 

The family has limited finances to rely on after their savings, and many other expenses.

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Vanessa will still have to go to school, get help with homework, and eat healthy meals while the family deals with the time and costs of appointments and treatment.

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Deanne is feeling depressed about her diagnosis, while Tyler and Vanessa are highly worried.

Deanne and Tyler are highly verbally communicative of their emotions, concerns, and hopes regarding Deanne’s treatment (Moore-Thomas & Day-Vines, 2010).

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At times, though, this open expression can lead to arguments.

Deanne and Tyler have openly told Vanessa about the situation, but not about the severity and possibility of Deanne’s negative health outcomes.

Nonverbal 

The nonverbal communication of the family is highly expressive (MooreThomas & Day-Vines, 2010). 

This also means Vanessa suspects the situation is worse than her parents are telling her.

Family Systems Therapy Theory 

Family systems therapy theory says that families operate as units

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However, family members like Deanne also have to realize they are individuals, who are different from their family (Boss, 2015).

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Deanne and her family must be aware of their own internal interactions and structure in order to know how they can healthily respond to the challenge of breast cancer (Boss, 2015).

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Only after understanding the family as a unit, and the members as individuals, can Deannes’s family come to an understanding of utilizing their internal and external resources to address problems and the stress that comes with them (Boss, 2015).

Application of Family Theory Evidence-Based Interventions 

Helping the family understand how Deanne’s cancer and chemotherapy side effects (like pain & fatigue) will impact her family role. Developing plans to address these changes (Oktay et al., 2011).

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Examining family assets and how the family may draw on outside assets (extended family, church, social welfare programs) to address deficiencies (Rothwell & Han, 2010).

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Teaching agency to all family members, including Vanessa, to show how they are empowered to make decisions (Boss, 2015).

Possible Outcomes 

The family will be able to adjust their functions and roles to ensure that basic processes, from cooking food to taking Vanessa to school, are accomplished without inhibition from cancer or chemotherapy side effects (Oktay et al., 2011).

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The family will be able to draw on outside resources and use effective social programs as needed, leading to better health and quality of life outcomes (Rothwell & Han, 2010).

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Agency will empower Deanne and Vanessa in particular as agents who make decisions to help themselves and the family, instead of feeling like victims of circumstance (Boss, 2015).

References Boss, P. (2015). On the Usefulness of Theory: Applying Family Therapy and Family Science to the Relational Developmental Systems Metamodel. Journal Of Family Theory & Review, 7(2), 105-108. doi:10.1111/jftr.12068 Breast cancer. (2017). Centers for Disease Control and Prevention. Retrieved from https:// www.cdc.gov/cancer/breast/ Mason, J. K., Klaire, S., Kharotia, S., Wiggins, A. A., & Thompson, L. U. (2015). Îą-linolenic acid and docosahexaenoic acid, alone and combined with trastuzumab, reduce HER2-overexpressing breast cancer cell growth but differentially regulate HER2 signaling pathways. Lipids In Health & Disease, 14(1), 110. doi:10.1186/s12944-015-0090-6 Moore-Thomas, C., & Day-Vines, N. L. (2010). Culturally Competent Collaboration: School Counselor Collaboration with African American Families and Communities. Professional School Counseling, 14(1), 5363.

Oktay, J., Bellin, M., Scarvalone, S., Appling, S., & Helzlsouer, K. (2011). Managing the impact of posttreatment fatigue on the family: Breast cancer survivors share their experiences. Families, Systems & Health: The Journal Of Collaborative Family Healthcare, 29(2), 127-137. doi:10.1037/a0023947 Rothwell, D. W., & Han, C. (2010). Exploring the Relationship Between Assets and Family Stress Among LowIncome Families. Family Relations, 59(4), 396-407. doi:10.1111/j.1741-3729.2010.00611.x Starks, A. M., Martin, D. N., Dorsey, T. H., Boersma, B. J., Wallace, T. A., & Ambs, S. (2013). Household income is associated with the p53 mutation frequency in human breast tumors. Plos ONE, 8(3), 1-7. doi:10.1371/journal.pone.0057361 Thistlethwaite, J. (2013). Communication learning needs of health professionals: Conflict resolution. Clinical Teacher, 10(6), 418-419. doi:10.1111/tct.1215