Breast Cancer's Impact on Adolescent Daughters: A Literature Review

Introduction

Cancer is a serious health issue that threatens millions of Americans. Women in particular are heavily affected by breast cancer, which crosses racial and age borders (American Cancer Society, 2006). Millions of women become victims of breast cancer annually. Such a traumatic experience as cancer can affect not only the patient, but also her family (Romer et al., 2002). These effects have been shown to hit daughters of breast cancer patients the hardest. Thus, the purpose of this study is the further exploration of the effects breast cancer has on patients' adolescent daughters. It aims to do so using qualitative measures that allow the everyday experiences of such adolescents to reveal the depth of cancer's impact on them. This information will then provide further insight into the nature of psychological distress and anxiety experienced by some adolescent daughters of breast cancer patients, which can help shape current programs and counseling methods into more effective care, for both the breast cancer patient herself and her entire family.

This literature review first explores the theoretical orientation for the study before examining previous research. Moustakas's (1994) transcendental phenomenological model will be used within a qualitative design. This will aim to bridge the gap of knowledge within much current research. The effect of breast cancer on the family, and especially the adolescent daughter, is examined alongside the importance of her role in supporting and caring for both the family as a whole and her mother who is afflicted with breast cancer. The literature discussed was surveyed using search terms such as "adolescent daughter" and "breast cancer," and searches were conducted through publications such as Sagebrush along with local library resources.

Theoretical Framework: Transcendental Phenomenological Model

The phenomenological approach allows for analysis of lived experience. Moustakas's (1994) transcendental phenomenological model will be implemented in order to better understand the experience of the daughter throughout her mother's battle with breast cancer. It relies on the theories initially posited by Edmund Husserl, who in the early twentieth century began his theoretical investigations into the meaning of day-to-day experiences (Moustakas, 1994). This model relies on an understanding of experience — the everyday — as relating "to knowledge as it appears to consciousness, the science of describing what one perceives, senses, and knows in one's immediate awareness and experience," and is heavily influenced by the field of philosophy (Moustakas, 1994, p. 26). In fact, phenomenology was first used as early as 1765 within the philosophical writings of Kant, and Husserl was also heavily influenced by the theories of the early philosophical genius René Descartes (Moustakas, 1994). The method relies on the idea that phenomenon — initially meaning "to show itself, to appear" in Greek — actually creates the environment seen inside individual consciousness (Moustakas, 1994, p. 26). It is this phenomenon that presents a clear and usable starting point for the investigation of scientific study, seen in this research as the onset of breast cancer in the adolescent daughter's mother.

The transcendental phenomenological model also requires an understanding of intentionality — the idea that we as humans know ourselves in relation to external factors, and that the human mind can carry meaning in comparison to other individuals and external events (Moustakas, 1994). It can be effective when studying the experiences of adolescent daughters in relation to later psychological stress and caregiving. This model requires the researcher to remain completely unbiased while dealing with very personal information: "to be completely open, receptive, and naive in listening to and hearing research participants describe their experience of the phenomenon being investigated" (Moustakas, 1994, p. 22). The investigator is therefore responsible for providing clear insights for future research while avoiding personal judgments or biases throughout. Accordingly, recorded interviews must be examined objectively when assessing the initial data findings of this research.

The nature of the interview itself is well suited to the transcendental phenomenological model. All participant interviews will be open-ended, beginning with the prompt: "Tell me about the time when you first learned that your mother had breast cancer." The interview will then draw out the recollected experience of the adolescent female who has been forced to cope with her mother having breast cancer. All participants will also be allowed to direct commentary and ask questions of the researchers during the process, in order to ensure the utmost comfort while discussing such an intimate topic. Studies have proposed that when dealing with such intimate topics, the relationship between the interviewer and the interviewee becomes important to the validity of the data (Bryman, 1988). The better the relationship between the two, the more accurate the participant's answers are likely to be. Open-ended and conversational interviews therefore create a relaxed atmosphere that fosters friendly relations between the researcher and the participant, encouraging deeper disclosure of the participant's unique experiences with a dangerous condition and all the grief and anxiety that comes with it.

All elements of the study design are consistent with the theoretical framework presented within the transcendental phenomenological model as discussed by Moustakas (1994). Such methods compile the lived experiences of the adolescent daughter through both interviews and conversations. The approach also concentrates on the lived experience as a whole, rather than in parts, as other methodologies suggest. It focuses on relating lived experiences to actual units of meaning, which are the essence of the daughter's everyday experiences with a mother suffering from breast cancer. These units of analysis can then provide flexible and in-depth data that is not possible with more quantitative designs. To better understand the importance of the daily experience of the adolescent daughter and thereby improve care of breast cancer patients, the transcendental phenomenological model proves a beneficial approach (Moustakas, 1994). Phenomenology can give a clearer picture of how everyday experiences shape meaning (Van Manen, 1998). The model also provides systematic steps for analyzing personal data and guidelines for understanding and assessing the everyday experiences of participants (Percy & Kostere, 2006). Several other qualitative studies have used the approach designed by Moustakas (1994) as the theoretical foundation for their phenomenological studies (Bondas & Erikson, 2001; Kluge, 2002; Padilla, 2003; Moerer-Urdahl & Creswell, 2004).

This framework uses individual lived experiences to represent data. This study therefore employs a qualitative theoretical approach to further understanding of the research question.

Psychological Effects of Breast Cancer on Adolescent Daughters

All family members are affected by the onset of cancer. Family members of cancer patients may in some cases develop a tendency toward chronic illness (Romer et al., 2002). Studies have also posited that children are especially affected (Armistead, Klein, & Forehand, 1995). Among the various groups of children affected, adolescent girls appear to be the most vulnerable (Romer et al., 2002).

Psychological stress can develop in adolescent females as a result of their experience with breast cancer through their mother (Wellisch et al., 1991; Wellisch et al., 1992; Wellisch & Lindberg, 2001). These experiences can manifest as symptoms such as anxiety and depression, correlated with their mother's diagnosis of breast cancer (Compas et al., 1994). Compas et al. (1994) and Wellisch et al. (1991) have posited that adolescent daughters are in many cases very close to their mothers. This closeness fosters an environment in which the mother shares intimate details regarding both the psychological and physiological effects of cancer. In many cases, adolescent daughters transform this information into fear, creating an anxious environment (Spira & Kenemore, 2004). Anxieties regarding the fear of recurrence and their own potential battle with cancer manifest as a tendency toward anxiety. Studies have demonstrated that adolescent daughters are indeed at risk for later contracting breast cancer through heredity (Cappelli et al., 2005). In many cases, this anxiety creates a belief that the adolescent faces an overestimated risk of contracting cancer (Esplen et al., 2000). Other research has identified a tendency for adolescent daughters to experience guilt, fear of abandonment, obsession over appearance, and fear of the future (Haber et al., 1995). These symptoms are also coupled with expressions of anger when financial support is limited, along with a gradual decline in social activity (Haber et al., 1995).