Медицинский совет (Dec 2019)
Sensitivity of patients to the disease depending on the degree of its awareness in breast cancer
Abstract
The relevance of the study is conditioned by the growth of breast cancer (BC) incidence in the population and the need to identify psychosocial factors that cause inappropriate behavior of patients. The authors try to understand the reasons for this behavior (late access to medical care, patients’ lack of recognition of signs of relapse). The aim of the study is to find out how the level of awareness of breast cancer patients of the disease mediates their sensual perception of the disease, their understanding of symptoms, and their behavior. Materials and methods: 38 women with breast cancer of stage I–III of the Department of Thoracic Surgery and Chemotherapy of M.F. Vladimirsky Moscow Regional Research and Clinical Institute participated in the study. Semistructured clinical interviews were conducted to identify patient perceptions of the disease, treatment, and behavioral strategies. Sensory perception of the disease, understanding and categorization of its manifestations were studied with the help of the modified test «Choice of descriptors of intraceptual sensations» developed by Tkhostov and Elshanskiy in 2003. As a result of the interview the patients were divided into 3 subgroups: with full awareness of the fact of the disease, partial and its absence. Patients with full awareness are characterized by the presence of clearly localized bodily sensations and diffuse, generalized markers of general painful condition (described by means of feelings). Patients consider anxiety and depression to be symptoms of cancer, and therefore probably expect to get rid of them as a result of basic therapy (which is impossible). Patients with partial awareness of the disease mix the physical symptoms of the cancer with those of the comorbid disease (which are considered to be the main one), do not recognize the dangerous sensations, underestimate their significance and, consequently, may miss the onset of a relapse. Patients with a lack of awareness of the disease do not know what to navigate by, underestimate dangerous sensations (e.g. pain), overestimate the importance of the sensations associated with the operation (e.g. numbness), but their physical experience of the disease is similar to that of patients with full awareness, and the declared anozognosis is psychologically protective. Patients need explanatory work on differentiation of physical experience of the disease, determination of marker sensations requiring medical assistance and formation of motivation for further (postoperative) therapy.
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