Breast cancer: communication with a breast cancer patient and a relative.

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Abstract

relatives are predominantly spouses, followed indeterminately by children, parents or siblings [12, 15, 16]. Results of previous studies indicate that relatives are often present in ‘difficult’ situations or when patients are ‘vulnerable’ [12, 15, 16]. Relatives are more likely to be present when the patient is older and has a poorer performance status. Relatives are also more likely to be present at specific time points in the course of the disease: for initial visits, immediately after cancer recurrence and in the terminal phase of the disease rather than in a routine follow-up visit. They mainly accompany the patient to provide support or to serve as the patient’s advocate. Accompanying relatives moreover are also frequently patients’ primary caregivers. As patients’ caregivers, relatives could be reliable witnesses of patients’ difficulties in coping with cancer [17–20]. Therefore, asking them to express their perception of patients’ physical symptoms, distress and concerns could help physicians to inform and support their patients more appropriately. Moreover, the increase in outpatient care and the shortening of hospital stay associated with the increase in cancer patients’ life expectancy have led many relatives of cancer patients to face an increasing amount of emotional as well as practical tasks [21]. Those tasks are often complex and highly burdensome, and can result in heightened distress levels among relatives. Research results indeed suggest that family members of cancer patients show signs of depression and anxiety, and experience restriction of roles and of activities, strain in marital relationships and diminished physical health [22]. Between 10% and 30% of relatives probably suffer from psychiatric morbidity, a level that is likely to increase as the illness advances and treatment becomes palliative [21]. Finally, it is important to note that caregivers’ bad adjustment has been associated with patients’ poor social rehabilitation [23], poor treatment adherence [24] and increased emotional distress [25, 26]. Physicians’ communication skills in addressing relatives could thus improve patients’ support and quality of life, as they could improve this adjustment.