It is a timely communication since cancer treatment in general, and breast cancer treatment in particular, has moved from being delivered mostly in the hospital to the present situation in which treatments are given almost exclusively in the ambulatory care setting. Psychosocial services for women, which in the past, if available, were also largely hospital-based, have not been made available to the same extent in the new outpatient treatment areas. Consequently, a reassessment of the present accessibility, extent, and efficacy of psychosocial services for women with breast cancer is imperative. Breast cancer differs from many other cancers in that it is essentially limited to women, and it also has high incidence, good survival, and well-defined risk factors and screening technologies. Nevertheless, given the crosscutting nature of psychosocial distress in cancer, as defined below, the Board believes that much of the information gleaned from the study of breast cancer patients is also applicable to other cancer patient groups treated now in clinic settings.

This report outlines the status of psychosocial interventions in general and suggests directions for research, delivery, and policy that may be appropriate to other sites of cancer as well as to breast cancer. Specifically, the report means to understand the impact of a diagnosis of breast cancer on a woman, her family and community, the psychosocial needs of such women, and the opportunities to provide support to them along the disease trajectory.

The report addresses 5 questions:

  1. What is psychosocial distress, and how frequently does it occur among women with breast cancer at each stage?

  2. What interventions are available to treat psychosocial distress at all stages of disease, and how effective are they?

  3. What is the status of the delivery of psychosocial interventions and care to women with breast cancer?

  4. What barriers prevent women with breast cancer from getting psychosocial interventions and appropriate psychosocial care?

  5. What can be done to improve psychosocial care for women with breast cancer?

What is psychosocial distress and how frequently does it occur?

Distress in cancer has been defined as an unpleasant emotional experience that may be psychological, social, or spiritual in nature. Distress exists on a continuum beginning with the “normal” and expected feelings of fear, worries, sadness, and vulnerability in coping with cancer and its treatment. However, these normal feelings may extend to become more severe, even



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