Editing Patient Pathways: Breast Cancer (section)

= Challenges breast cancer patients face during their treatment journey =

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== Challenges during diagnostic evaluation ==

A breast cancer diagnosis can be a stressful and challenging time for patients. Support during this phase can significantly improve the patient’s emotional and physical well-being.

Breast cancer patients face various difficulties during diagnosis, such as physical, psychological, financial and professional difficulties, and lack of information.

'''Physical Challenges'''

'''ymptoms of the disease:''' Lump in the breast, change in the size or shape of the breast, nipple discharge, pain and discomfort during biopsy.

'''Psychological Challenges'''

Fear of a cancer diagnosis, uncertainty about treatment: fear of possible complications and side effects of treatment. The process of emotionally accepting a cancer diagnosis can be very stressful and challenging. The patient needs emotional support, which puts pressure on family and friends to provide support.

'''Social isolation:''' feeling isolated because of the illness and need for privacy.

'''Financial and Professional Challenges'''

Absence from work: frequent medical checkups and treatments can cause absence from work, which can affect careers and financial stability. Costs of diagnosis and treatment, insufficient health insurance.

'''Lack of Information'''

Patients often have difficulty finding reliable and understandable information about their illness, diagnostic procedures, treatment options, and their rights.

'''Insufficiently clear communication with doctors:''' the complexity of medical terminology and lack of time during consultations can make it difficult to fully understand the diagnosis and treatment options.

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== Challenges during treatment ==

'''Physical Challenges'''

Arthralgia, myalgia, Bone loss, heart dysfunction, chronic hair loss and thinning, dry mucous membranes (oral, genital, conjunctival), nutritional problems (eg, weight gain), secondary hematological malignancies (or other secondary cancers).

'''Nutritional problems:''' Difficulty eating due to nausea, loss of appetite or difficulty swallowing.

'''Weight changes:''' weight gain or loss due to hormonal changes.

Scars from surgical procedures can affect appearance and self-confidence.

'''Cardiovascular problems:''' hormonal imbalances can affect the heart.

'''Hair loss:''' may occur due to radiotherapy or chemotherapy.

'''Skin problems:''' dry skin, itching or rash due to therapy.

'''Eye problems:''' Dry eyes or irritation due to radiation therapy.

'''Metabolic problems:''' changes in metabolism due to hormone therapy.

'''Psychological Challenges'''

'''Fear and anxiety:''' fear of the disease, treatment, side effects, and uncertainty of outcome, anxiety related to regular check-ups and fear of recurrence.

'''Depression:''' feelings of hopelessness, loss of interest in everyday activities, isolation.

'''Changes in body image:''' discomfort due to physical changes, such as scars or weight changes.

'''Treatment-related stress:''' Psychological stress due to intensive treatments and their impact on everyday life.

'''Relationship with partner:''' sexual problems, decreased libido, and emotional distance due to illness.

'''Family relationships:''' tensions within the family due to stress, changes in roles and responsibilities.

'''Social Isolation:''' withdrawal from social activities due to fatigue, discomfort, or fear of exposure to infections during therapy.

'''Financial and Professional Challenges'''

Reduced ability to work due to fatigue, side effects of treatment, and emotional problems.

'''Absences from work:''' frequent medical visits and treatments that require absences from work, which can affect career and financial stability.

High costs of medicines, surgeries, therapies and other medical services, travel and accommodation costs for patients who have to travel to health centers.

Reduced income due to reduced work capacity or job loss.

Ongoing costs associated with long-term follow-up and maintaining health.

'''Lack of information'''

Need to understand complex medical information and make informed decisions.

Difficulties in making treatment decisions due to lack of reliable and understandable information or conflicting advice.

Unawareness of patient rights.

Lack of information about healthcare providers during treatment.

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== Challenges during rehabilitation and disease monitoring ==

'''Physical Challenges'''

Postoperative pain and cosmetic problems due to scars. Arthralgia, myalgia.

'''Psychological Challenges'''

'''Fear of recurrence:''' persistent fear of the cancer coming back.

'''Anxiety and depression:''' psychological stress and emotional problems related to the experience of cancer.

'''Social isolation:''' reduced social interaction due to fatigue, anxiety or other symptoms.

'''Financial and professional challenges'''

'''Returning to work:''' difficulties returning to work due to physical and emotional limitations.

Long-term financial burden associated with ongoing medical expenses.

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== Challenges during palliative care ==

Difficulties faced by breast cancer patients in Croatia and their families during palliative care are numerous and include several key aspects:

Limited access to palliative care: there is a significant gap between the need for palliative care and available resources. Insufficient capacities of specialized palliative care providers.

'''Psychological Challenges'''

The psychosocial and emotional burden on patients and their families is often great. Family caregivers often face high levels of stress and emotional burden.

'''Cultural and ethical issues:''' reluctance to discuss end-of-life issues can hinder the provision of effective palliative care. Ethical challenges in decision-making and care provision can also create additional stress for families and healthcare professionals.

'''Financial Challenges'''

Costs of care can be a significant burden for families, especially given the long-term nature of palliative care. The economic pressure can further exacerbate the stress experienced by patients and their families, affecting their overall well-being and quality of life.

Challenges in care coordination: effective palliative care requires coordination among different healthcare providers. In Croatia, there are challenges related to care coordination between hospitals, palliative care units, and home care services. Addressing these challenges requires a comprehensive approach that includes improving access to palliative care, providing emotional and psychological support to families, addressing financial burdens, and ensuring effective care coordination. In addition, public education and awareness raising about the benefits of palliative care can help reduce cultural and ethical barriers.

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== Challenges patients face after completing breast cancer treatment ==

'''Physical challenges'''

Loss of bone density, heart dysfunction, chronic hair loss and thinning, dry mucous membranes (oral, genital, conjunctiva), nutritional problems (e.g., weight gain), secondary hematological malignancies (or other secondary cancers). Problems with the musculoskeletal and connective tissue system.

'''Psychological Challenges'''

Cancer survivors often experience anxiety and fear of the cancer returning, which can affect their emotional well-being. They may also face difficulties adjusting after treatment, including changes in daily routines and life plans. The role of family members as caregivers often changes after treatment is complete. Their support remains crucial, but may need to be adapted to the new circumstances and the reduced intensity of care.

'''Lifestyle and prevention:''' patients are encouraged to adopt healthy lifestyle habits such as regular exercise, a healthy diet, not smoking and stress management in order to improve their quality of life and reduce the risk of cancer recurrence.

'''Financial and Professional Challenges'''

'''Return to work:''' many survivors face challenges returning to work, including fatigue, decreased energy, and physical limitations after treatment. They need support in adapting to the work environment and managing employer expectations. Employers are often unaware of how to support cancer survivors upon returning to work.

'''Healthcare Coordination'''

'''Regular check-ups:''' It is important to continue with regular check-ups to monitor for cancer recurrence or side effects of treatment. This includes blood tests and scans, such as ultrasounds, depending on the risk of the cancer recurring.

Breast cancer patients face various challenges during their diagnostic, therapeutic, and rehabilitation journey, including physical, psychological, financial, and professional difficulties, lack of information, and coordinating healthcare.

Providing comprehensive support that includes medical care, psychological support, education and social services can significantly improve the quality of life and treatment outcomes for these patients.

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