Although not included in our review, most studies of cancer survivorship and QOL focus on the immediate post-diagnostic and posttreatment periods. Some of the earliest systematic work on breast cancer was conducted by Morris and her colleagues26 and by Maguire and his colleagues,27 on Hodgkin's disease by Fobair et al.,28 and on prostate cancer by Litwin et al.29 Early work on emotions is exemplified by the Psychological Aspects of Breast Cancer Study (PABC).19 Almost three decades ago, longitudinal data collected at 3 month intervals indicate that, over time, the dysphoria associated with diagnosis of early breast cancer (Stage I and Stage II) lessens and that emotions stabilize. By the end of 1 year, the psychological profile of women with breast cancer was found to not be significantly different from that of women who did not have cancer.19 A more recent study reaffirms these early findings and did not find further improvements when the cohort was compared at either 2 or 3 years later.30 The study by Morris and colleagues,28 indicated that emotional problems prior to the breast cancer diagnosis were exacerbated following diagnosis and treatment. To separate the effects of preexisting emotional difficulties from those related to the diagnosis and treatment of breast cancer, both the PABC and the Ganz studies excluded women who had such problems.19,30
Also with regard to breast cancer, most studies indicate that the major difference between breast sparing surgery and a mastectomy are found in body image with poorer body image being associated with mastectomy.31 In our study of breast cancer survivors we also found that among those who had a mastectomy, women who chose reconstruction compared to those who hadn't yet decided had the poorest body
There is also consensus regarding a third set of findings from this literature on early effects of diagnosis and treatment with regard to the physical realm. These include menstrual changes and menopause, infertility, sleep problems, lymphedema, pain, problems with physical and recreational activities, and weight gain and reduced energy.15,18,30,32-40 Ganz found nearly identical rates of arm problems 2 and 3 years posttreatment related to the initial surgical procedure (numbness, tightness and pulling in the arm, and intermittent mild pain).30 Other early effects are energy reduction, decreases in physical functioning, and symptom distress as found in our early study of Hodgkin's disease.28 Sexual, urinary, and bowel function changes are specific to prostate cancer.29
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