Psychologic adaptation to breast cancer.

Adaptation to breast cancer depends on two parameters: one derived from the patient and one from the disease. The first comprises the psychological and social factors that are determined by the patient and her surroundings: the psychologic adjustment the patient had before illness, her social supports, especially her spouse, and her social context which will contribute to her need to hide her illness or encourage her sharing the loss with others, especially those who have had a similar experience. The other factor determining psychologic adjustment is contributed by the disease itself: the extent of spread, surgical operability, need for adjuvant therapy, the full application of rehabilitative measures, including plastic reconstruction when appropriate, and the psychologic management by the surgeon in the doctor-patient relationship. Each of these variables contributes to the emotional resources available to the woman and to the stresses that must be surmounted in adaptation to breast cancer; each can serve as a positive force or a negative one. At times, one strongly positive factor, such as family support, can counter several exceptionally negative aspects and result in a positive adjustment despite severe illness. Each variable will be discussed in relation to its contribution to an "adaptive readaptation" and optimal psychologic well-being despite illness, versus those factors that create a "maladaptive readaptation" with less than optimal psychologic well being.