Download BagleyGeorge1988

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
FEMALE BREAST CANCER
TRAINING MATERIALS FOR MEN
A project submitted in partial satisfaction of the
requirements for the degree of Master of
Public Health
by
George William Bagley, Jr.
January 1988 ·
l:oJ4: George
William Bagley, Jr. is approved:
Steve Gabany, Ph.D.
rty, Dr. P.H.
Shelia C. Harbet, 'H.S.D., Chair
California State University, Northridge
ii
ACKNOWLEDGEMENTS
I
want
to
thank
the
members
of
my
committee:
Dr. Shelia Harbet, Dr. Steve Gabany, and Dr. Krishnamurty.
They
have
preparation
given
of
much
this
of
their
project.
time
They
to
also
me
during
gave me
the
their
guidance, knowledge, and encouragement.
These three individuals were chosen because they have
become a part of my life through my college career over the
past several years.
They were
chosen because of their
expertise and willingness to give of their time during the
preparation of this project.
They were also chosen because
I have come to respect them and consider them my friends.
iii
Table of Contents
Page
..... ........
........ ..... .....
Acknowledgments
Abstract
iii
vi
Chapter
1.
................
Statement of the Problem . . . . . . .
Purpose of the Project . . . . . . . .
Limitations of the Project . . . . . . . .
Definition of Terms • • • . . . . . . .
Review of the Literature . . . . . . . .
Introduction
-
2.
1
3
6
8
9
13
The Existence of Training Materials
on the Physical Aspects of Female
....
13
Change Programs • • • • • • • • • • • • •
16
Breast Cancer for Men • • • • • •
The Value of Knowledge in Behavior
3.
Methodology • •
Phase I:
Phase II:
• • • • • •
18
..
18
The Review of the Literature
The Needs Assessment
Instrument
Phase III:
• • • • •
.........
Results and Findings of
...
21
...........
22
the Needs Assessment Questionnaire
Phase IV:
19
The Development of the
Training Materials
iv
Phase V:
Validation of the Training
..........
Materials •
4.
23
The Curriculum Model for Female Breast
Cancer:
Training Materials for Men
Proposed Implementation Scheme
......
27
27
28
Proposed Evaluation Scheme
The Curriculum Model for Female Breast
Cancer:
Training Materials for Men
31
..............
80
A.
Survey Participants • • • • • • • •
86
B.
Table 1.
Bibliography
Appendixes
Frequency Distribution of the
Importance of Inclusion of Subject Area
in the Training Materials
c.
Table 2.
• • • • • •
89
Distribution of Responses by
Reviewers on How Well the Subject
Areas are Covered
D.
The Needs Assessment Questionnaire
v
91
93
ABSTRACT
FEMALE BREAST CANCER
TRAINING MATERIALS FOR MEN
by
George William Bagley, Jr.
Master of Public Health
The
purpose
of
this
project
was
to
develop
an
educational set of training materia'ls to inform men about
the physical aspects of female breast cancer.
A review of
the literature over the past several years revealed that
although there
were many
informative programs
cancer, they were basically aimed at women.
on
breast
None had been
developed that were oriented to male partners of women who
have or have had breast cancer.
Men are thus kept ignorant
of what the treatment of a partner's breast cancer consists
of.
Attendance at a support group of women who had had
breast cancer treatment indicated that male partners who had
some knowledge of what would happen to the women during
treatment
were more
supportive
vi
of
the
women
during
the
treatment
and
treatment.
reported
rehabilitative
These
feeling
women
better
phases
who
had
about
of
more
breast
cancer
partner
themselves
and
support
were
more
likely to follow their physician • s orders both during the
treatment and the rehabilitative phases of treatment.
This
indicated that men who were informed were more likely to be
supportive of their partner and thus take a more active role
in
helping •their
partner maintain her
optimum level
of
wellness.
In an effort to find out what information should be
included
in
assessment
an
educational
instrument
health educators.
was
program
given
to
for
men,
several
a
needs
professional
They indicated that the materials that
were proposed to be used in these training materials would
be very useful to men.
The training materials consist of a curriculum covering
basic cell biology, signs and symptoms of breast cancer, and
the treatments used in treating breast cancer.
given
the
training
materials
would
Participants
also
be
given
instructions on doing breast self-exam on their partner as
well as on themselves.
This project
materials
that
was
are
designed
needed
in
to
identify and
educating
physical aspects of female breast cancer.
vii
men
assemble
about
the
Chapter 1
INTRODUCTION
Breast cancer affects
mo~e
than 90,000 women each year.
It will kill 34,000 of them annually.
This incidence means
that one out of 11 American women will have breast cancer in
their lifetime.
It is the major killer of American women
over age 35 and is the leading cause of all deaths of women
from ages
40-44 years
(University of Southern California
Comprehensive Cancer Center, 1985).
Approximately
95
cancers themselves.
can be cured.
age.
of
women
discover
breast
About eight out of ten breast cancers
Thus, risk for breast cancer increases with
App~oximately
the age of 50.
percent
75 percent of breast cancers occur after
A National Cancer Institute survey of a
random group of American adults revealed that 58 percent of
the women and 53 percent of the men indicated that breast
cancer is the most serious health threat to American women
(University
of
Southern
California
Comprehensive
Cancer
Center, 1985).
One reason so many women die from breast cancer is that
their fear of the disease prevents them from seeking medical
care.
In our society a diagnosis is often felt to be a
death sentence.
This fear often prevents many women from
performing Breast Self-Exam [BSE], which would allow them to
1
2
find their tumors at an early stage and would allow time for
life-saving treatment.
Rollins
(1980)
In her book First You Cry, Betty
stated that even educated,
affluent women
often avoid performing BSE because of their fear of finding
breast cancer.
This fear of discovering breast cancer results in only
about 67 percent of all women performing BSE on a monthly
basis.
Only 47 percent of women surveyed in one
cross~
section of American women reported having any knowledge of
breast reconstruction following surgery, and 58 percent of
those
women
indicated
that
knowledge
reconstruction helped reduce their anxiety.
that
of
breast
This indicated
increased knowledge through education helped lessen
their anxiety by increasing their knowledge about breast
cancer treatment (Public Attitudes Toward Cancer and Cancer
Tests, American Cancer Society, 1980).
Lasser (1974), National Consultant and Coordinator of
the
"Reach
to
Recovery
Programn
of
the American Cancer
Society, stated that the breast cancer treatment period was
an intense period of time and was very emotionally trying.
Victims were usually fearful and depressed because they did
not know what to expect during the various treatments used
today in diagnosis and treatment of breast cancer.
Many
women reported that if their partner was also informed about
what to expect during breast cancer treatment the partner
was generally very supportive and that this support helped
3
the women deal with their
treatment with less fear
and
anxiety.
These comments by women indicated that many women being
treated for breast cancer felt less anxious and depressed
about
their
treatment
and
rehabilitation
if
they had a
partner who was also knowledgeable about what occurs during
breast cancer treatment.
These comments also indicate that partners of women
being treated for breast cancer could be of more support by
being informed about the types and physical _effects that
breast cancer treatment can have on a woman.
But are there
established training materials that educate men about the
treatment of breast cancer and, if so, what do they consist
of?
STATEMENT OF THE PROBLEM
Many women do perform Breast Self-Exam
many do not.
care
when
[BSE],
while
This results in many women seeking medical
their
cancer
will
require
extensive
surgery,
radiotherapy and chemotherapy that may not have been needed
if their cancer were diagnosed earlier.
Hochbaum {1970) indicated that fear of cancer was the
main reason people avoided seeking medical help when they
suspected they had signs or symptoms of cancer.
indicated
that
people
threats to their health.
had a
look
at
immediate
versus
He also
future
This means that if an individual
high temperature and difficulty
in breathing they
4
would be more likely to seek medical care quickly because
they felt miserable and could lose time from work or even
die.
BSE may then be viewed as an activity that was future
oriented
because
a
automatically mean
lump
in
the
breast
it was malignant.
was
unlikely
to
Many lumps are the
result of hormonal changes, use of drugs or illness, and are
thus not malignant.
If a woman occasionally performs BSE
she may not be aware of new lumps and would consider them to
be insignificant.
Thus, performance of BSE is a life-saving
procedure that is easily learned.
Hochbaum
behavior
oneself
is
(1970)
motivated
against
individual
also
primarily
threats
perceives
indicated
a
to
by
health
threat
to
that
a
human
desire
and
to
safety.
their
health
likely take action to preserve and maintain it.
health
protect
If
an
they will
Thus, fear
of having breast cancer can lead to inaction by the woman
because of fear of cancer and fear of immediate discomfort
which would result from cancer treatment.
Green
information
information.
(1978)
does
stated
not mean
that
that
merely
people
giving
will
health
utilize
that
Thus, telling a man or woman about BSE and
breast cancer treatment may not be enough to spur them to
utilize that information.
Becker (1977), in the •aealth Belief Model,• concluded
that
one
must
perceive
a
severity
and
personal
susceptibility before a person will take actions designed to
protect one's health.
By acquiring knowledge about personal
5
susceptibility the individual will most likely recognize the
benefits of taking action.
barriers to resistance.
This will aid in overcoming
Action will reduce the individual's
susceptibility to the original threata
health
education
theory,
people
According to current
will
not
change
their
behavior unless they perceive it to be an immediate threat
to their own health.
Women who are aware of the importance of regular BSE
but fail to do it, are often afraid of the unknown.
often fear what they do not understand
People
(Wallston, 1978).
Many nurses are aware of this fear and offer to educate
women about their breast cancer treatments.
This tends to
reduce fear and increase compliance in performing BSE and
following the physician's orders
Nurses, ACS, 1975).
report
that
they
(A Cancer Sourcebook for
Many partners of breast cancer victims
would
partner's treatment.
desire
to
do more
during
their
Men are often told very little about
what the treatments consist of, the need to make sure their
partner performs BSE continuously after treatment or their
responsibilities in helping their mate remain healthy.
Dollinger
participate
in
(1976)
the
reported
treatment
that
phases
many
of
males
their
do
not
partner's
breast cancer because they too were fearful of cancer and
were ignorant about breast cancer treatment.
men
should
know
more
about
breast
cancer
He stated that
because
his
experience has shown that men who were informed about what
breast cancer treatment consists of were more supportive of
6
their partner.
If men could be educated about female breast
cancer they might recognize that their professed desire to
help their partner was not matched by their behavior, and
that a change in their behavior was necessary.
Diane Cooper (1982), a former social worker at the Van
Nuys Unit of the American Cancer Society, and Dr. Robert
Hoffman (1982), a psychiatric oncologist, have substantiated
the need for an educational program aimed specifically at
educating men about the physical aspects of female breast
cancer.
Neither of them knew of the existence of training
materials for men on the topic of the physical aspects of
female breast cancer.
A review
program
for
victims
of
of the
men.
literature failed
Additionally,
breast cancer
have
to
locate such a
professionals
reported
that
a
who
treat
course
of
instruction for men on this topic should be prepared because
women undergoing
get.
treatment need all the support they can
Many men report wanting to help their partner, yet
remain
ignorant
about
what
their
partner's
treatment
involves.
PURPOSE OF THE PROJECT
The purpose of this project was
to design a
set of
training materials for men that would explain the physical
aspects
of
breast
rehabilitation.
cancer
These
detection,
materials
would
treatment,
be
utilized
and
to
educate men about breast cancer 1 and by increasing their
7
knowledge
of
breast
cancer,
it
is
anticipated
that
they
would feel less afraid and more helpful and supportive of
their partner.
The
first
education.
increase
step
in
creating
behavior
change
is
Education can exist in several forms and should
the
destructive
recognition
and
that
that
behavior
actual
change
behaviors
will
are
result
in
positive, rewarding results.
Matthews (1975) stated that in order to change behavior
you must have three
(2) motivational;
kinds of structures:
and
(3)
behavior action.
(1)
cognitive;
This supports
Becker's premise that one must have knowledge that a problem
exists and that to take action is more rewarding that not
taking action.
Health
Education
can
be
designed
to
create
a
motivational state where a person recognizes that cognitive
elements,
attitudes
or
opposition to each other.
perceived
behaviors,
are
in
Thus, a person may say they would
like to know more about cancer but then fail to take steps
to
increase their
knowledge of cancer.
Education,
then,
would help the person to realize that their beliefs should
match their actions.
A set of training materials for men would begin with
the cell biology leading to an exploration of breast cancer
treatment
structured
in
so
its
that
entirety.
completion
The
of
materials
one
area
would
be
positively
8
reinforces the learner to continue to the next level of
learning.
Behavioral
scientists
that
believe
positive
reinforcement can help in the development of new behaviors
(Kagan, 1976).
Informing men about how they can help their
partner maintain her highest level of wellness both during
and after treatment in a positive way should be a major
component in these training materials.
The set of training materials should be aimed at men
whose
partners
treatment.
are
having,
or
have
had,
breast. cancer
Additionally, the training materials should be
available to men who do not have a mate or whose mate does
not have breast cancer.
These groups of men would be those
in high school, college, or
unmarried.
Training materials
would be helpful to use with them because it would help
sensitize them about their
role
in helping their
future
partner maintain a high level of wellness.
Another purpose of the project was to survey several
health professionals about the need for
the creation of
training materials for men on the physical aspects of female
breast cancer and how it is diagnosed and treated.
This
survey would identify those areas that would be appropriate
to include in a curriculum dealing with breast cancer.
LIMITATIONS OF THE PROJECT
The needs assessment was given only to health educators
and health professionals, and thus reflects their bias as to
9
the value of these training materials.
This meant that no
input was used from surveying non-health educators,
i.e.
social studies teachers, because the scope of the materials
was narrow and did not deal with any social or emotional
aspects of breast cancer treatment.
This was recognized as
a limitation at the onset of the project.
DEFINITION OF TERMS
A terminology was compiled following a review of the
literature.
Fuller definitions can be found in the Cancer
Word Book published by the American Cancer Society.
Many
libraries have books dealing with cancer, and these can be
found in most college and public libraries.
The following terms are defined as they are used in
this project are:
Acute Disease:
a disease that appears suddenly and
dramatically.
Axilla:
the armpit area where breast cancer
cells
often spread first.
Benign Cells:
cells that may grow abnormally but do
not break off from the original tumor and spread
to other parts of the body, e.g. a lipoma, which
is composed of fat cells.
Biopsy:
a technique where the doctor takes a sample of
tissue suspected to be malignant.
This can be
done by needle aspiration or by taking a piece of
the tumor by excision.
10
Bone Scan:
a medical procedure in which x-rays are
taken of the skeleton to see
cells are growing on them.
if breast cancer
Breast cancer cells
often attach themselves to bones.
Breast Self-Exam
[BSE]:
a manual set of techniques
used to examine the breast for lumps and tumors.
Carcinogens:
any environmental factor that is believed
to play a role in the formation of cancer cells.
Chemotherapy:
the
the use of chemicals or biochemicals in
treatment
of
cancer
and
cancer-related
abnormalities.
Chronic
Disease:
a
disease
that
often
appears
gradually over time and may or may not be fatal.
Many cancers are considered to be chronic in that
tumors often grow slowly.
Following diagnosis of
cancer the patient can live for months or years.
Estrogen:
a hormone that triggers the growth of sexual
characteristics
in women.
Some breast cancers
grow rapidly in the presence of estrogen and are
thus labelled
Lymph
Nodes:
•estrogen dependent.•
clusters
of
tissues
that
serve
as
drainage centers where bacteria and tumor cells
are collected.
Breast cancer often first spreads
to the lymph nodes in the axilla.
Malignant Cells:
cells that grow abnormally and may
form tumors that may fatally interfere with normal
body functioning.
Malignant cells easily break
11
off from the original tumor and spread to other
parts
of the
body to begin the growth of new
tumors.
Mammography:
a medical
x-ray that
is used in the
diagnosis of breast cancer.
Mastectomy:
a
surgical
procedure where
the
breast
tumor and surrounding tissues are removed.
This
often means that all or part of the breast(s} is
removed.
National
Cancer
Institute:
major
a
research
organization that investigates new treatments for
many kinds of cancers.
Oncogenes:
genes that occur in the human cell nucleus
that may, under certain circumstances, alter the
functioning of the cell, turning it malignant.
Oncology:
the branch of medical science that studies
the diagnosis and treatment of cancer.
who
specialize
in
their
field
Physicians
are
called
oncologists.
Radiotherapy:
a medical procedure that uses various
types of radiation in the treatment of cancer.
Survival Time:
the time a person can be expected to
survive their
cancers.
Cancers
that have
a
50
percent survival rate means that 50 percent of the
people treated for that type of cancer can be
expected to live for at least five years.
12
Testosterone:
the male sex hormone that is used in the
treatment of some cancers to slow the growth of
cancer cells.
Immunotherapy:
a technique used by physicians in which
they use various chemical and biochemical agents
to stimulate the body's defense system.
Virology:
the science that investigates the roles that
viruses play in the formation of human disease.
Some viruses are known to be able to turn normal
cells
into
malignant
cells
by
altering
their
quality of
life
genetic make-up.
Wellness:
a
term
that
denotes
resulting
from
optimum
good
a
health.
Wellness
includes those activities that an individual can
make to better insure that one's body functions at
its best.
The next chapter will review the literature concerning
the existence of training materials on female breast cancer
and
the
programs.
value
of
knowledge
in
other
behavior
change
Chapter 2
REVIEW OF THE LITERATURE
The review of the literature involved two areas:
the
existence of any training materials dealing only with the
physical aspects of female breast· cancer, and the value of
knowledge in other behavior change programs.
THE EXISTENCE OF TRAINING MATERIALS ON THE
PHYSICAL ASPECTS OF FEMALE BREAST CANCER FOR MEN
A review of the various medical journals over the past
three years did not reveal the existence of any training
materials on the physical aspects of female breast cancer
for men •. Several Med-Lines run at the library of California
State University,
Northridge, and independent research at
the American Cancer Society in Van Nuys, California, local
area
hospitals,
and
the
UCLA-USC
Cancer
Center
in
Los
Angeles, California failed to locate the existence of any
such materials.
There was a vast amount of information on cancer, per
se,
so a focus
was made as to what materials to bring
together for this project.
foundation
as
to
what
One major idea that laid the
should
be
responsibility one has to his partner.
13
included
was
the
Another main idea
14
was
the notion of wellness
and the maintenance of good
health.
Any definition of good health or wellness includes the
implication
recipient
that
of
a
person
cures
and
must
be
more
treatments.
than a
People
passive
must
feel
obligated to take an active role in the maintenance of their
well-being.
about
each
Thus,
both partners should become concerned
other's
level
of
wellness
and
optimum
good
health.
To assist in identifying topics to be covered in the
creation of a set of training materials a survey in the form
of a questionnaire was utilized.
The literature indicated
that questionnaires were often used to assess health needs.
Since
there
were
no
materials
on
this
topic
found,
a
questionnaire would identify those areas that needed to be
covered.
Instruments have long been used to measure interest in
a topic.
Goodrow (1977) performed a study at the University
of Western Kentucky to determine an interest profile for
beginning health classes.
Among the 786 students surveyed,
disease prevention and wellness issues ranked the highest.
The creation of an assessment instrument on the need of
training materials for men seemed the best way to find out
if such a program was needed.
Other health researchers have
used survey instruments in their search for what to include
in a study, and to find out if the study was needed at all.
One
such
instrument was
developed
by the
University of
15
Wisconsin-Stevens Point {1980).
seek
to
find
some
While their instrument did
collateral
health
history,
the
instrument's principal focus was on current health practices
and
behaviors.
Sections
of
their
needs
assessment
instrument included wellness, personal growth, risk of death
and
an
alert
section.
The
results
indicated
that
the
students surveyed did need further health .education in the
curriculum.
The
need
for
deciding
if
a
health
education
intervention is required is often the result· of using a
needs
assessment
instrument.
The
results
of
those
assessments were a foundation on which materials were often
chosen in order to meet those needs.
That men do need to
know about breast cancer in both men and women was stated by
Roses {1985).
Roses mentioned that knowing and performing
breast palpitation on both men and women was one major way
to detect breast cancer at an early stage of growth.
Thus,
breast self-exam would seem to be a clearly needed skill
that men should be familiar with, both for themselves and
for their partner.
Since there has not been any prior published materials
on
this
topic,
this
writer
surveyed professional
health
educators as to if such materials were needed and, if so,
what topics to include in such a program.
Since this would
be a new avenue of cancer education it was not possible to
ask the lay public about what a program like this would or
should include.
Therefore, it was decided that it was most
16
appropriate to survey professional health educators as to
the
necessity
on
the
creation
of
these
new
educational
materials.
THE VALUE OF KNOWLEDGE IN BEHAVIOR CHANGE PROGRAMS
Roberts (1973) reported that a study at Portland State
College
involved
instructions
the
for
difference
preventing
between oral
sore
throats.
and written
The
greatest
amount of change was the result of both written and oral
instructions.
Oral instruction alone brought about a second
greatest change followed by written instruction alone.
Health
education
generally
revolves
around
interaction between the teacher and the student.
the
The role
of this interaction between the teacher and the student is
necessary
change.
written
for
achieving
Rotter
and
{1977)
verbal
compliance
health
behavior
developed an intervention based on
information
patients at a clinic.
in
that
was
given
to
194
The results were that those receiving
the intervention asked more direct questions than did the
control
group.
Association
successful
In
(1977)
and
fact,
the
American
endorsed written
useful
way
to
College
material
augment
a
as
Health
being
community
a
health
program.
These programs describe behavior change as the result
of increased knowledge.
The questionnaire and the resulting
training
this
materials
in
project
were
only
aimed
at
increasing the student's knowledge about the topic of female
17
breast cancer.
These materials are written,
visual,
and
verbal, and will included the student taking an active part
in the learning experience.
Brunner
and
Suddarth
{1984),
discussing
preventive
health care in the elderly, stated that preventive health
care
in
the aged meant maintaining
detecting
disease
deterioration
of
at
an
an
early
existing
health and
age
function,
and
preventing
the
condition.
Brunner
and
Suddharth thus implied that preventive health care in any
form was
oneself
the
or
result
one's
of
increased
partner
and
how
knowledge either
one
felt
about
about
taking
responsibility to maintain his own and his partner's level
of optimum wellness.
The literature showed that education based on a variety
of
techniques
obtaining
(verbal
behavior
and
changes.
written)
The
was
next
successful
step was
to
in
look
closer at what specific areas would be covered in these
training materials
and how those areas
being a necessary part of these materials.
were selected
as
Chapter 3
METHODOLOGY
This chapter will describe the methods and procedures
that were used in the design of these training materials.
These methods were divided into three phases:
(1) a review
of the current literature that pertained specifically to
breast
cancer1
(2)
the
construction,
administration
and
analysis of a needs assessment questionnaire that was given
to
professional
health
educators
only1
and
(3)
the
development of training materials.
PHASE I
THE REVIEW OF THE LITERATURE
Much ·has been written on the specific topic of human
female breast cancer, but it has been aimed at women and not
to their male partners.
on
this
topic
counselling
are
The programs that do exist for men
those
services.
of
They
psychological
exclude
physical aspects of breast cancer.
information
chapter,
marital
on
the
Any information men get
on this subject is coincidental and limited.
indicated in the previous
and
Nowhere, as
in the literature on
breast cancer does there exist a program to inform men about
breast cancer treatments.
18
19
A broad overview of cancer was undertaken and then the
focus
was
on
those
materials
that
would
be
importance for men to know about breast cancer.
of
most
Thus, five
topics that seemed to be the most needed in the creation of
any set of training materials were:
(1) normal and abnormal
cell
and
growth;
(2)
signs,
symptoms,
causes
of
breast
cancer; (3) oncology; (4) breast self-exam; and (5) personal
responsibilities for males to their partners.
PHASE II
THE NEEDS ASSESSMENT INSTRUMENT
The purpose of the needs assessment instrument was to
determine
these
if
the five
training
areas selected for
materials
would
be
useful
inclusion ·into
and
adequate.
Respondents were asked to rate each topic whether it was
important or not important.
whether
the
proposed
They were also asked to judge
materials
would
contribute
to
the
overall goals of the program.
The two questions about the inclusion of the topics of
breast self-exam and the responsibilities a male has to his
partner were items that were suggested as being vital by
women who have had breast cancer.
Those women stated that
when
information
their
partners
were
given
about
what
happens during breast cancer treatment their partners became
more
supportive
rehabilitation.
while
their
to
the
women
They felt
partner
was
during
that men
going
her
treatments
should realize
through
breast
and
that
cancer
20
treatment
she
needed
her
partner's
support
because
treatments can involve long periods of time.
expressed
the
belief
that
men
should
the
They also
that
know
these
extended periods of treatment can alter the woman's ability
to function at home as well as at her work.
The survey instrument was given to 15 health educators
who work at a university, hospital, or in the public school
system in the Los Angeles metropolitan area.
Thirteen of
the respondents were women, all of whom had at least a B.A.
degree in health or nursing with several having graduate
degrees in those fields.
Several of the respondents had had
breast cancer treatment.
Several women respondents were
instructors in health education at a university in the San
Fernando
Valley.
Both
male
respondents
were
health
educators in the public school system with one having a
graduate degree in health education.
The average length of
teaching experience for the group was ten years.
The survey
required
instrument consisted
approximately
five
of three pages
minutes
to
and
complete.
Participation was voluntary and a brief oral explanation was
made to assure the respondents of anonymity.
Following the
briefing they filled out the instrument.
Analysis
consisted
of tallying
the areas
that
were
marked as being important or not important and ranking them
based on totals
on all
the completed instruments.
The
results concluded that there is a need for a program of this
21
type
and
that
the
five
topic
areas
were
relevant
and
necessary.
PHASE III
RESULTS AND FINDINGS OF THE NEEDS ASSESSMENT QUESTIONNAIRE
Over two-thirds of the respondents thought overall that
each of the five content areas were very important.
the
categories
of
Important" were
percent.
"Fairly
added,
Important"
the overall
and
importance
When
"Somewhat
reached 9 0
This would indicate that the topic of informing
men about the physical aspects of female breast cancer was
rated by
the professional
health educators.
Appendix B
shows the distribution of responses of the reviewers on the
importance of the subject areas covered by these materials.
What
areas
to
include
into
the
curriculum
were
justified by professional health educators who agreed that
these five areas were valid in the creation of the training
materials.
Appendix
B
contains
the
scores
of
the
that
the
professional health educators.
Over
half
of
curriculum topics,
In addition,
that
fairly
the
respondents
reported
combined, cover the material very well.
over 85 percent of
topics,
well.
the
combined,
Appendix
C
the respondents
cover
the
shows
the
material
responses
reported
at
of
least
the
reviewers on how well the subject areas are treated by the
materials in this project.
22
One problem in writing the curriculum was deciding what
information to use.
It was felt that the material should
not be difficult for the instructor to present rior for the
student to understand.
Terminology, concepts, objectives,
and learning opportunities were formed so as to let the
materials flow smoothly along, allowing the learner time to
absorb the information being presented and being allowed
time
to
take
the
pre-test
and
other
activities without
feeling overwhelmed.
It was
felt that subject areas were adequately covered
for the purpose of the program,
and the results indicate
that the reviewers also felt that the choice of how to cover
the subject areas was very good.
PHASE IV
THE DEVELOPMENT OF THE TRAINING MATERIALS
The review of the literature and findings of the needs
assessment questionnaire provided the foundation for
training
materials.
This
rested
on
the
premise
the
that
students taking this course would need to have had some
biology background during their youth.
A health educator in
the public school system felt that completion of the ninth
grade would have provided sufficient information to prepare
males for this course.
The following section topics were then developed for
the training materials:
23
1.
Cancer:
From Cell to Tumor
2.
Signs, Symptoms and Causes
3.
Oncology
4.
Breast Self-Examination
5.
Responsibility to One's Partner
The
theories
of
health
instruction
as
presented
by
Fodor and Dalis (1981) were used throughout the creation of
the materials:
content
health generalizations, learning objectives,
outlines,
and
resources
were
developed
for
each
instrument
the
unit.
PHASE V
VALIDATION OF THE TRAINING MATERIALS
Prior
to
completing
the
survey
respondents previewed the actual curriculum contained in the
training materials and were asked their opinions about it.
They were asked to reply as to whether the materials were
relevant
and
presented
in
an
organized
way.
They
all
responded that the materials did satisfy the goals of the
program, and some made additional comments and suggestions.
The
evaluations
and
comments
of
the
respondents
were
utilized to refine the curriculum and other items used in
the creation of the training materials.
Once
all
the
questionnaires were
literature
review
results
of
the
needs
assessment
reviewed and the information from the
was
compiled,
the
decision
as
to what
would be included in each of the five topic areas was made.
24
Of special importance were the results of the questionnaire
because
they
indicated
what
health
professionals
in
education felt were needed to be covered in the curriculum.
The
next
training
step
materials
was
and
to
decide
what
how
to
implement
strategies
to
use
presentation by the health educator.
to
be
devised
information
that
from
would
the
allow
instructor
in
the
their
Strategies would have
for
to
a
the
smooth
flow
student
overwhelming the student with complex medical
of
without
jargon, and
yet preserve the physiological concepts and terminology that
must
be
used
materials.
in
the
presentation
of
these
training
The next chapter reflects all of those concerns
in the implementation of the materials.
The instructors should contact health agencies in their
locality
to
see
if
they
setting
can
up
be
and
of
help
presenting
in
provided
the
training
assistance
in
materials.
The American Cancer Society has dozens of local
units that may provide printed matter, movies, slides and a
plastic
model
of
breast.
The
ACS
program,
unit.
allowing
what
a
lump
unit may
feels
also
the meetings
help
like
in
in
the
setting
to take place at
female
up the
the ACS
Many colleges and universities have rooms that they
make available to the public for presentations of this sort.
Medical and nursing colleges are good sources of various
slides and films that could augment the materials presented.
If
none
of
these
sources
are
available
it
should
be
25
remembered that all the materials needed for presentation
are included in this manual.
The
portions
secondary
school
of
materials
these
health
in
educator
those
could
sections
utilize
of
the
curriculum dealing with chronic diseases such as cancer or
arthritis.
The secondary school health educator would be
able to use those parts of the curriculum that would be
appropriate in .a public school setting where the learners
would be younger than 18 and may not be able to be taught
BSE.
The time allotted for presentation of these materials
would be one hour for each of the five sections.
these
sections
should
assuring that all
materials.
be
presented
in
one
Ideally,
night,
thus
those present would be exposed to the
The instructor may decide to allow one-half hour
per secti_on with a 30-minute break, and then form a "round
table" of the learners and briefly review the materials and
provide the instructor with feedback.
The learners could
then be asked to fill out questionnaires evaluating their
experience and offering suggestions as to how to improve
future presentations.
The
instructor
these materials
is
"as is"
allowed
the
option
of
presenting
or tailoring the length of each
section to the situation and atmosphere in which the course
would be taught.
In the school classroom the teacher may
present only parts of one or all of the sections, whereas a
community health educator may have the opportunity of having
26
a facility and students where the course could be presented
over several nights or days.
The room that these materials would be presented in
should be well ventilated, well lit and have adequate chalk
boards,
an
overhead projector
with
a
screen,
pencils for the students, and tables and chairs.
paper
and
Chapter 4
THE CURRICULUM MODEL FOR FEMALE BREAST CANCER
TRAINING MATERIALS FOR MEN
This
chapter
deals
with
the
educational
curriculum
model to be used in this program, as well as a proposed
implementation plan and a proposed evaluation plan.
It will
be noticed that some of the chapter topics of the curriculum
have been altered to better focus the learning on specific
areas.
The five topic areas are entitled:
1.
From Cell to Tumor
2.
Signs, Symptoms and Causes:
What About Lumps and
Bumps?
3.
Oncology:
The Science that Combats Cancer
4.
Breast Self-Exam:
5.
Personal Responsibility to One's Mate
To Save a Life
Each of the above topic areas have their own concepts,
objectives, evaluative criteria, content outlines, learning
opportunities, and resources.
PROPOSED IMPLEMENTATION SCHEME
A health educator who would prepare to present these
materials
curriculum
should
and
become
decide
if
thoroughly
the
familiar
audience
would
with
the
have
the
biological background necessary to easily understand the
27
28
terminology and physiology contained in the material.
The
curriculum model was designed for males who would be at
least 18 years of age and have a partner who has had or will
have
breast
cancer
treatment.
Preferably,
the
material
would be presented by a professional health educator of a
health agency or
as
hospital, hospice,
a
community service
or board of health,
sponsored by a
or in a secondary
school by the health educator.
The content outline and the concepts and objectives
suggest that the learners have had some exposure to biology
during their formal education.
The presenter may also want
to plan to present a pre-test before deciding how to plan to
present the materials.
PROPOSED EVALUATION SCHEME
The
materials
instructor
by
using
may
a
elect
to
evaluate
the
variety
of
means.
As
training
mentioned
previously, the instructor may ask the students to fill out
surveys
that
evaluate
their
experiences
and
the
new
knowledge gained as a result of attending this program.
The
classroom
teacher
test/post-test format.
could
decide
to
use
a
pre-
This would probably be the easiest
and quickest way for a classroom teacher to evaluate the
materials presented to the students.
Outside the classroom the instructor has the option of
using an essay, a pre-test/post-test, or the student selfevaluation form.
All of these allow the instructor to gain
29
valuable information about how the course was presented and
allow the instructor to refine the materials even further.
Fodor and Dalis (1981) stated that evaluation provides
the
·opportunity
instruction
and
to
to
determine
identify
the
areas
effectiveness
of
strengths
of
and
weaknesses.
Once the instructor has presented these materials it is
hoped that additional new resources would be added to the
manual's appendix, thus keeping the materials up-to-date and
factual.
Some instructors may elect to have their presentation
of the materials evaluated.
They can use the forms for peer
evaluation, teacher self-evaluation, student evaluation of
the instructor, and the theory course evaluation.
An instructor also has the option of having a potential
instructor
attend
the
course
and
then
use
the
peer
evaluation form as a type of preparation tool that both the
present instructor and future instructor could go over to
the benefit of both of them.
These various forms of evaluation can also be used to
prepare a
future
instructor by having them critique the
presentation and then to discuss those evaluations so both
the present and future instructor could benefit and improve
the course.
CURRICULUM
30
TOPIC:
FEMALE BREAST CANCER:
TRAINING MATERIALS FOR MEN
SUB-TOPIC:
From Cell to Tumor
CONCEPT 1:
The human body has processes that may become abnormal.
OBJECTIVE: Following instruction, the student will list several types of abnormal cell
growths (recall).
EVALUATIVE CRITERIA: The student will list two differences between a normal cell and a
cancerous cell in a classroom test involving identification questions.
SUGGESTED CONTENT OUTLINE
I.
Definition of cancer
Introductory Statement
The term cancer refers
to a group of diseases
which develop
abnormally and may
threaten a person's
life.
Generally, cancer cells
change their normal
process of division and
grow and spread to other
parts of the body.
SUGGESTED LEARNING OPPORTUNITIES
Students will be asked
individually to orally define
what they think a definition
of cancer may be.
Students will watch the film
"From One Cell." (30 minutes,
color)
Following the film students
will be asked again to give
a possible definition.
Students will be asked to
describe the difference
between a normal cell and a
malignant cell.
SUGGESTED RESOURCES
"From One Cell," film,
ACS. If this
film is not available
the ACS can recommend
an alternate introductory film on cancer.
Youth Looks at Cancer,
ACS, 1982.
Ackerman, L., Pathology
of Tumors, ACS,
No. 72-25m-3378, 1972.
w
I-'
SUGGESTED COURSE OUTLINE
Normal cells contain a
genetic code contained
in the nucleus of the
cell which is called
its DNA. This DNA
(deoxyribonucleic acid)
determines all growth
by normal division.
SUGGESTED LEARNING OPPORTUNITIES
Students will write what the
function of DNA is in the
human cell.
SUGGESTED RESOURCES
Anderson, w., Synopsis
of Pathology,
c.v. Mosby Co., New
York, 1978, pp. 777794.
These cells and their
division is controlled
and they form and replace
other normal cells in the
body. When they have
achieved their purpose,
they stop.
American Cancer Society
Cancer Facts and
Figures, ACSP, 1983,
pp. 1-4.
Cancer cells lack a
sticky surface that
normal cells have.
Lacking this substance,
they do not stop growing
when they touch each
other.
Cancer cells are so
similar to normal cells
that the body does not
recognize them as
different and does not
fight them.
Students will list three
differences between cancerous
and non-cancerous cells as the
instructor is describing them.
Ackerman, c., The
Pathology of Tumors,
ACS, 1972, pp. 1-55.
w
N
SUGGESTED COURSE OUTLINE
Not all abnormal cell
growths become
cancerous. There
must be two actions:
1. Initiator
2. Promotor/Sustainer
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will copy the words
"initiator" and "promoter."
The instructor can ask students
to describe what they think some
of these are.
!!.Incidence of breast
cancer and mortality.
--110,000 women each
year get breast
cancer and 34,000
die.
III.The following are facts
about cancer:
A. Tumors develop
intensive vascular
systems.
B. Deplete nutrients in
the body.
c. Pre-disposing
factors:
--Irritationchemical radiological viral
infections
--Inadequate diet
Students can be asked how
tumors may affect the weight of
a person who has a large tumor.
Students can be asked to
participate in brainstorming to name any
additional irritants that
they think can pre-dispose
cells to become malignant.
Cancer Word Book, ACS,
1976, pp. 1-15.
A Cancer Source Book
ACS, pp. 1-3.
w
w
SUGGESTED COURSE OUTLINE
--Mechanical
irritation
--Thermal irritation
--weakened immune
system
--Inherited susceptibility (breast
cancer tends to
run in families)
IV.Two types of growths
A. Benign: they have
a membrane covering
and do not spread,
although they may
grow larger.
B. Malignant: these
lack any membrane
covering and usually
metastasize and
interfere with
normal bodily
functioning.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
The instructor will draw on
the blackboard how cancer
cells spread. Students will
be given materials on which
to follow and copy how cancer
cells spread and metastasize.
Brainerd, H., Current
Diagnosis and Treatment
Lange Medical Publications, 1970, pp. 358365.
w
.c::.
SUGGESTED COURSE OUTLINE
v.
Cancer cells are divided
into four types:
A. Carcinomas--arise
from surface tissues
such as skin or
mucus membranes in
our body.
B. Sarcomas--arise
from connective
tissues.
c. Blood forming
tissues--leukemia.
D. Lymphomas (in the
lymph glands).
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will identify the
definitions of four types of
cancer and where they
originate.
w
U1
TOPIC:
FEMALE BREAST CANCER:
SUB-TOPIC:
CONCEPT II:
TRAINING MATERIALS FOR MEN
Signs, Symptoms and Causes:
What about Lumps and Bumps?
Tumors have characteristics that can be seen, felt and detected.
OBJECTIVE: Following instruction, the student will describe several signs, symptoms and
possible causes of breast cancer (interpretation).
EVALUATIVE CRITERIA: The student will be able to list two signs of each: symptoms and
possible causes of breast cancer in a classroom test in a questions matching answer
form.
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
I. Types of breast
disorders
A. Many breast
disorders are life
threatening and
others are not.
B. Some benign
disorders are:
1. Fibrocystic
Disease
2. Fibroadenoma
Students will follow along
on a handout of the human
female breast.
II. Malignant breast cancer
A. Signs and symptoms
1. Lump or
thickness
Students will describe six
signs and symptoms of
malignant breast cancer.
SUGGESTED RESOURCES
Ackerman, L., Pathology
of Tumors, published by
ACS, No. 72-25M-3378,
1972, pp. 1-21.
w
0'\
SUGGESTED CONTENT OUTLINE
SUGGESTED RESOURCES
2.
3.
B.
Swelling
Puckering and
dimpling
4. Redness or skin
irritation
5. Whitish scab,
nipple discharge, or
distorted shape
of nipple, area,
areola
6. Pain and tenderness, most often
in the upper,
outer quadrant
portion of the
breast.
Breast cancer spread
from its original site
via the lymph nodes to
the armpit, neck and
chest.
SUGGESTED LEARNING OPPORTUNITIES
III. Risk factors
A. Past history of
breast cancer
B. Family history
c. Age
Students will follow along
with the instructor and
circle the areas that breast
cancer cells usually spread
to initially.
Students will be asked to
discuss their feelings on why
women should be concerned about
a family history of breast
cancer.
w
-...!
SUGGESTED CONTENT OUTLINE
D.
E.
F.
G.
H.
I.
SUGGESTED LEARNING OPPORTUNITIES
Rubin, P., Clinical
Oncology for Medical
Students and
Physicians: A MultiDisciplinary Approach,
ACS, 1978, pp. 63-75.
Menstruation
(especially before
age 12)
Having no children
Having had benign
breast disease
X-ray exposure
Diet
a. Obesity
b. Fat-rich diet
Estrogen (is used
to relieve menopause symptoms)
IV. Development and
Composition
A. At puberty the
breast is flooded
with hormones each
month and during
pregnancy
B. The breast is
composed of lobes
which contain fat
and drainage
canals called
ducts. Each
menstrual cycle
brings hormonal
SUGGESTED RESOURCES
Students will be asked to
discuss how monthly
exposure to hormones could
alter a cell.
w
00
SUGGESTED CONTENT OUTLINE
c.
increases and a
slight change
(hyperplasia)
1. Some forms of
benign hyperplasia are:
(a) Mazoplasia
(b) Mastitis
(c) Fibrous
hyperplasia
(d) Sclerosing
adenosis
(e) Tubercular
mastitis
(f) Papillomas
(g) Mesenchymal
(lipoma,
fibroadenoma,
myoma,
chondroma)
Malignant
Hyperplasias
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
The student will follow along
and list all the hyperplasias
from a-g, as well as the two
types of lobules.
w
\.0
SUGGESTED CONTENT OUTLINE
1.
2.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Mammary duct
(noninfiltrating
carcinoma)
(a) Papillary
carcinoma
(b) Comedo
carcinoma
Infiltrating
carcinoma
(a) Paget's
disease
(b) Papillary
carcinoma
(c) Comedo
carcinoma
(d) Carcinoma
with productive
fibrosis
(e) Adrenocarcinoma
(f) Medullary
carcinoma
(g) Colloid
carcinoma
~
0
SUGGESTED CONTENT OUTLINE
D.
E.
Mammary Lobules
1. Noninfiltratingin-situ
2. Infiltratinglobular
adenocarcinoma
Epithelial or
Mesencymal Origin
1. Physicians
examine cells
to determine
their degree
of malignancy
by the degree
of cell differentiation
(a) Size
(b) Shape
(c) Arrangement
(d) Staining
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Rubin, P., Clinical
Oncology for Medical
students and Physicians
ACS, 1979, pp. 63-79.
The students will describe
what physicians are looking
for when examining cells to
determine their degree of
malignancy.
Anderson, w., Synopsis
of Pathology, published
by c.v. Mosby, New
York, 1978, pp. 777794.
~
I-'
SUGGESTED CONTENT OUTLINE
v.
Classifications of
Breast Cancer
A. Scirrhous
carcinoma (hard
nodules)
B. Medullary
carcinoma
c. Adenocarcinoma
D. Intraductal
carcinoma
carcinoma
Mucoid
E.
F. Inflammatory
carcinoma
G. Lobular carcinoma
H. Paget's Disease
(of the nipple)
I. Sarcoma
J. Adenosarcoma
K. Cystosarcoma
phyllodes (very
large tumors)
L. Carcinosarcomas
VI. Spread of Breast
Cancer
A. Direct invasion
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will discuss the
differences between the 12
classifications of breast
cancer.
Anderson, w., Synopsis
of Pathology, published
by c.v. Mosby, New
York, 1978, pp. 777794.
Students will explain the two
routes via which cancer
spreads.
Ackerman, Pathology of
Tumors, published by
ACS, 1972, No. 72-25m3378, pp. 1-210.
~
N
SUGGESTED CONTENT OUTLINE
B.
SUGGESTED LEARNING OPPORTUNITIES
Through the
drainage ducts to
the lymph nodes
VII. Diagnosis of Breast
Cancer
A. Clinical
(screening)
1. History
2. Physical
examinations
3. Lab tests
4. X-ray
B. Diagnostic (for
true confirmation
of breast cancer)
1. Exfoliative
cytology
2. Biopsy
(a) Excision
(b) Incision
3. Aspiration
biopsy
(location)
Students will describe four
types of screenings used to
detect cancer. Students will
explain how screening differs
from diagnostic testing.
SUGGESTED RESOURCES
Townsend, c., "Breast
Lumps," Clinica
Symposia, 1980, No. 2,
Vol. 32, Ciba, New
Jersey, pp. 1-3.
,c:..
w
SUGGESTED CONTENT OUTLINE
SUGGESTED RESOURCES
(a)
c.
Upper
outer
quadrant
(50%)
(b)
Central
(20%)
(c) Lower
outer
quadrant
(10%)
(d) Medial
half
(20%)
Breast cancer
is also:
1. More common
common in outer
outer than
inner quadrant
2. More common in
women without
children
3. More prevalent
in those with a
familial history
4. More left-sided
than right-sided
SUGGESTED LEARNING OPPORTUNITIES
Hogenson, c., Diseases
of the Breast,
published by W.B.
Sanders, New York,
1962, pp. 24-40.
~
~
SUGGESTED CONTENT OUTLINE
5.
6.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will discuss the
five additional examinations
and how they differ from one
another. ·
"Breast Cancer: Where
We Are,• ACS, Code
2352, 1980.
If the lump in
the breast is
present one
month, auxiliary
nodes are positive in 50%
If lump in
breast is
present six
months auxiliary nodes are
positive 68%
VIII.Additional
Examinations
A. Mammography
B. Xeromammography
c. Thermography
D. Translumination
E. Estrogen-receptor
assay
IX. Divisions, Stages of
Breast Can.cer
A. Less than 2 em.
B. Between 2-5 em.
c. More than 5 em.
"'"
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SUGGESTED CONTENT OUTLINE
X. Additional Stages
(information)
A. If pregnancy is
desired, a three
year wait is
suggested following treatment for
breast cancer
B. Four to 10 percent
of cancer patients
will develop
cancer in the
opposite breast
C. The majority of
lumps in the
breast are benign
growths and
hyperplasias
D. It is important
to remember that
in the breast,
fatty tissue
tumors and other
benign tumors tend
to be soft to the
touch, while
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Instructor will ask students
to discuss reasons why a woman
should wait three years to
have a baby after treatment
for breast cancer.
Students will be asked to
explain why the opposite
breast may be a site in
which cancer may develop.
Students will be asked to
describe the difference
between how a malignant tumor
differs from a benign tumor.
Strothers, J., If You
Find a Lump in Your
Breast, published by
the u.s. Dept. of
Health and Human
Services, Bethesda,
Maryland, 1981,
pp. 1-5.
~
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SUGGESTED CONTENT OUTLINE
malignant tumors
tend to be hard,
with little give
when pressed.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will break into small
groups and discuss how they
think a woman would feel while
undergoing this severe treatment and rehabilitation.
Students will be asked to
imagine how their mate may look
after removal of one or both
breasts, how they will feel
about it, and how they can help
give her the support she needs
during this period. Students
will be asked how they think
they would view themselves
after removal of one or both
testicles due to cancer.
would they feel physically or
sexually inadequate?
~
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TOPIC:
FEMALE BREAST CANCER:
SUB-TOPIC:
Oncology:
TRAINING MATERIALS FOR MEN
The Science that Combats Cancer
CONCEPT III: Medicine has created a special branch which focuses on special treatments
for breast and other cancers.
OBJECTIVE: Following instruction, the students will list several modern treatments for
breast cancer (recall).
.I
EVALUATIVE CRITERIA: The students will be able to explain what medical specialty oncology
is and identify at least three forms of treatment its practitioners perform in a
classroom test in essay form (interpret/analyze).
SUGGESTED CONTENT OUTLINE
I. The medical specialization that treats all
types of cancer.
Treatment phases:
II. Treatment may consist
of three phases:
A. Diagnosis and
initial treatment
B. Treatment for
recurrent cancer
(metastasis)
SUGGESTED LEARNING OPPORTUNITIES
i•
SUGGESTED RESOURCES
Students will describe, in
small groups, their experience
with an oncologist.
Students will the discuss
the three phases of cancer
treatment.
Green, M., Muggia, F.,
"Treatment of Disseminated Breast Cancer,"
Hospital Medicine, May
1986, pp. 25-52.
~
(X)
SUGGESTED CONTENT OUTLINE
c.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Palliation (relief
of pain) and use
of experimental
techniques in the
terminal advanced
stage
Surgery:
III. Surgical treatment is
one of the means
used to cure cancer
by removing it totally
A. The types of surgery
used are:
1. Halsted Radical
Mastectomy
(removal of
breast, lymph
nodes and chest
muscles.
2. Simple Mastectomy (removal
of the breast)
3. Quadrectomy
(partial mastectomy), a
section of the
breast tissue
is excised)
Students will be asked to
discuss why surgery is a
viable way to get rid of a
tumor.
Public Attitudes Toward
Cancer and Cancer Tests
published by the ACS,
1980, pp. 1-3.
Students will be asked why
so much tissue is cut away
in a mastectomy.
Lasser, L., Reach to
Recovery, published by
the ACS, 1974,
pp. 10-46.
Students will be asked how
such surgery would limit how
much a woman could move her
arm after surgery.
,j::o.
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SUGGESTED CONTENT OUTLINE
SUGGESTED RESOURCES
Students will be asked to
discuss how they feel about
surgery in general. Did
they ever have any sort of
surgery? How did they feel
about the tests and the
surgery itself?
Wallis, c., "Easing
Women's Constant Fear,"
Time, November 21,
4.
B.
Lumpectomy
excision (tumor
only treated
with radiation)
A new form of surgery is used to
destroy tumors that
are inoperable. The
technique cuts off
the arteries and
veins feeding into
the tumor.
1. surgery can also
be used to cut
nerve endings
if the tumor is
pressing against
them
(palliation)
SUGGESTED LEARNING OPPORTUNITIES
Radiation
IV.Another form of treatment that can cure,
slow the tumor's
growth, and offer pain
relief is radiation
1983, p. 85.
students will be asked to
describe the difference
between a radical mastectomy,
a quadrectomy, and a
lumpectomy.
Students will be asked to
discuss lthy a woman might
choose one of three types of
of surgery.
Grady, D., "To Starve a
Tumor," Discover,
November 1983,
pp. 102-104.
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SUGGESTED CONTENT OUTLINE
A.
B.
It is used with
lumpectomy as a
means of saving the
breast tissue while
killing the tumor
cells
Radiation damages
cells' makeup-normal cells can
repair themselves,
while cancer
cells cannot
Immunotherapy
V.This technique acts to
directly and indirectly
stimulate the woman's
immune response. Some
drugs used are:
A. Interferon
B. BCG Vaccine
c. Thymosin
D. Retinoids (Vitamin
A derivative)
E. Monoclonal antibodies
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will be asked how
surgery could be used to
kill pain.
Students will be asked to
discuss how immunotherapy
could be used to prevent
new growths after treatment
for breast cancer.
McKhann, c., Yarlott,
M., Tumor Immunology,
published by the ACS,
1975, pp. 1-11.
Students would, in small
groups, discuss feelings
and concerns about
immunotherapy.
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SUGGESTED CONTENT OUTLINE
Chemotherapy
VI.A. A physician will use
various chemicals if
there is a high risk
of metastasis
B. Radiation is used for
pain relief (by tumor
shrinkage), cure and
prolongation of life
by slowing the
tumor's growth
c. Several chemotherapeutic drugs and
their trade names
used in the treatment of breast
cancer are:
1. Cyclophasphamids
(Cytozan,
Endoxin)
2. A-phenylalanine
mustard
(Alkeran,
L~Pam, Melphalan)
3. Chlorambucil
(Leukeran)
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will write two ways
that radiation is used besides
killing tumor cells.
Students, in small groups,
will discuss their concerns
and fears about radiation
therapy and chemotherapy in
cancer treatment.
Krokoff, I., Cancer
Chemotherapy Agents,
published by the ACS,
1983, pp. 1-35.
Rollins, B., First You
Cry, published by
Bantam Books, New York,
1980, pp. 1-122.
Green, M., Muggia, F.,
"Treatment of DisseminBreast Cancer in
Women," Hospital
Medicine, May 1986,
pp. 25-52.
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SUGGESTED CONTENT OUTLINE
Side Effects
VII.These drugs, and others
like these, have
several, generally
temporary, side effects:
A. Hemorrhagic cystitis
(bladder infection)
B. Nausea and vomiting
c. Hair loss
D. Lowered blood counts
E. Mouth sores
F. Diarrhea
G. Loss of appetite
H. Urinary retention
I. Constipation
J. Abdominal pain
Hormones
VIII.Hormones are used to
shrink and possibly
cure tumors. Some
tumors are hormonedependent and hormones
are used to counteract
those the tumor needs.
Some hormones used are:
SUGGESTED LEARNING OPPORTUNITIES
The student will discuss ten
side effects of chemotherapy,
explaining how they might
effect the quality of life of
the patient.
students will discuss why good
nutrition is so important
while taking chemotherapy.
Students will be asked to
discuss their concerns about
the use of hormones in
cancer treatment.
SUGGESTED RESOURCES
Home Nursing Handbook,
published by the Health
and Welfare Division,
Metropolitan Life
Insurance Co., New
York, 1980, pp. 1-33.
Green, M. Muggia, F.,
"Treatment of Disseminated Breast Cancer in
women," Hospital
Medicine, May 1986,
pp. 25-52.
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SUGGESTED CONTENT OUTLINE
A.
B.
Adrenocorticoides
(cortisone-like)
1. Prednisone
2. Decadron
3. Medrol
Estrogens (female
hormones)
Diethylstilbestrol (DES)
2. Tace
3. Tamoxifen (if
estrogen
receptor,
protein assay,
reveals a
tumor sensitive
to estrogen)
Androgens (male
hormones)
1. Nalotestin
2. Deca-durabolin
3. Depo-testosterone
Progestationals
(female hormone)
1. Megace
2. Delabutin
3. Depo-provers
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
students will discuss why
they think hormones may cure
or slow down tumor growth.
"Journey Into
Darkness,"
film, ACS, 1979.
1.
c.
D.
What could happen to a woman
who is given male hormones in
the treatment of her breast
cancer? students will be
asked to discuss what
changes they think a woman
would go through if she were
given male hormones for a long
period of time.
Roses, D., Harris, M.,
"Male Breast Cancer,"
Hospital Medicine, October 1985, pp. 23-39.
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SUGGESTED CONTENT OUTLINE
Side Effects
IX. A.
Increased appetite
B.
Sleeplessness
c. Fluid retention
D.
Increased blood
E.
Stomach and
intestinal ulcers
F.
Increased
susceptibility to
infection
Nausea and vomiting
G.
Masculinization
H.
Oncologists Define
Two Tumors
X. A. Non-invasive
{in-site)
B.
Invasive
{metastatic)
Comprehensive Cancer
Care Centers
XI. A. Oncologists have
established 23
national cancer
centers, three
are in California:
1. Breast Screening Center,
Oakland
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
If a male were given hormones
what changes could he be
expect if he were given male
or female hormones? Students
will discuss how they would
feel about being given
hormone therapy for cancer.
students will write the
difference between in-site
and invasive tumors.
Rosenbaum, E., For You
the Patient: An
!Introduction to Cancer
Cure, published by Bull
Publications, New York,
1980, pp. 1-15.
Students will write the name
and location of the
Comprehensive Cancer Center
nearest them.
students will be asked why it
is best to seek treatment at
a Comprehensive Cancer Center.
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SUGGESTED CONTENT OUTLINE
2.
3.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
John Wesley
County
Hospital,
Los Angeles
West Coast
Cancer Foundation, San
Francisco
Experimental Treatments
XII. Oncologists may use new
research techniques
when:
A.
The patient is
terminal
B.
The patient does
not respond to
traditional
treatment
modalities
c. The patient
requests it.
Students will be asked when a
physician may decide to use
an experimental technique in
treatment.
Students will generate a list
of questions they should have
answers to prior to consenting
to experimental techniques.
Students will be asked to
discuss why an oncologist is
the best informed person about
the use of experimental treatment techniques.
U1
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TOPIC:
FEMALE BREAST CANCER:
SUB-TOPIC:
Breast Self-Exam:
TRAINING MATERIALS FOR MEN
To Save a Life
CONCEPT IV: We need to be familiar with our bodies so we can recognize any changes which
may indicate a disease process.
OBJECTIVE: Following instruction, all students will be able to perform breast self-exam
on a demonstration model (comprehension).
EVALUATIVE CRITERIA:
The student can plan a program of breast self-exam for his mate.
SUGGESTED CONTENT OUTLINE
I. Breast Self-Exam
A. Women should begin BS
at age 20
B. Do BSE 7-10 days after
a cycle
c. Post-menopausal women
should do it the first
week of each month
D. 80% of all lumps are
benign
E. Only 60% of women can
detect breast cancer
in their breasts.
Men who can do BSE
may likely increase
that percentage.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will discuss why both
men and women should begin
examining their breasts at
age 20.
Facts on Breast Cancer,
ACS, No. 2003, 1978,
pp. 1-3.
Students will discuss why a
lump will more likely be felt
if both the male and his
partner perform BSE on
themselves and each other.
How to Examine Your
Breasts, ACS,
1975, p. 2.
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SUGGESTED CONTENT OUTLINE
II. Basic Steps for BSE
A. Basic Step 1
1. Raise one hand in
the air while
standing.
2. Using the pads of
two or three finger
tips of the hand,
apply continuous
firm pressure to
explore (palpate)
the opposite breast
while at the same
time feeling for
any unusual lump
under the skin.
3. Move in a circular
clockwise motion
from the outside
inward. Include
all the breast
tissue from under
the arm to the
nipple.
4. Squeeze the nipple
to see if there is
any discharge.
5. Repeat the same
procedure for the
other breast.
SUGGESTED LEARNING OPPORTUNITIES
Students will view "How to
Examine Your Breasts," film,
6 1/2 minutes, color, ACS,
1979. They will then be
asked to discuss why they
think they should learn BSE.
SUGGESTED RESOURCES
How to Examine Your
Breasts, The Women's
Health Committee of
Milex Products,
Indianapolis, IN,
1982, pp. 1-32.
Teaching Breast SelfExam, ACS, 1977,
pp. 1-19.
Students will watch the
instructor perform BSE on
the "Betsy" model.
"Betsy" is a model used
to train persons to
learn BSE. It can be
borrowed from the ACS.
Students will break into
small groups and then perform
BSE on a "Betsy" model or
describe the steps used in
BSE.
Keep in Touch with
Yourself, The Harlem
B~east Examination
Center, Harlem State
Office Bldg., New
York, 1982, pp. 1-3.
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SUGGESTED CONTENT OUTLINE
B. Basic step 2
1. Check both breasts
for any puckering,
dimpling or scaly
skin while standing
before a mirror.
2. Lean forward and
look for any abnormalities in shape.
3. Few women's left and
right breasts match
exactly.
c. Basic Step 3
1. Repeat the fingertip
inspection while
lying on the back
with one arm behind
the head.
2. Place a folded towel
under the breast, on
that same breast
side, as it is
examined by the
other hand.
D. BSE is best done:
1. After each menstrual
flow. A woman's
breasts may be
swollen and tender
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
A few students will be
personally guided by the
instructor to perform BSE on
"Betsy" and then these students
will help the groups perform
BSE on "Betsy."
Students will be asked why a
woman should perform BSE the
same day each month.
Bates, B., A Guide to
Physical Examinations,
J.P. Lippincott, New
York, 1979, pp. 189194.
Ul
1.0
SUGGESTED CONTENT OUTLINE
to touch due to
hormonal influence.
2. Postmenopausal
women should examine
their breasts on the
same day each month.
3. Breast cancer frequently occurs on
the upper outer
portion of the
breast. Pain,
tenderness, and all
lumps should be
reported to a
physician.
E. Optimal, systematic
BSE pattern
1. Covers the entire
chest.
(a) start at the
12:00 position
(b) use your hand
extended and
your thumb
pointed toward
her face
(c) Make small,
circular movements with your
index fingers
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Each student will perform BSE
on "Betsy," or will draw on a
chart the steps in BSE.
Baker, R., Current
Trends in the Management of Breast Cancer,
Johns Hopkins
University Press,
Baltimore, MD, 1977.
One male student or the
instructor will perform BSE
on himself or one of the male
students.
Self-Defense for the
Woman You Love,
New York State Health
Dept., Office of Health
Communications, Albany,
New York, 1979,
pp. 1-6.
m
0
SUGGESTED CONTENT OUTLINE
(d)
(e)
(f)
(g)
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
and middle
fingers
Move your
fingers in a
clockwise
direction,
making a series
of small circles
as you move
around the outer
edge of the
breast.
After you have
gone around the
periphery, move
your fingers in
about an inch
toward the center of the
breast and use
the same small,
circle movement
Continue to
follow this
pattern until
you reach the
nipple
Depending on size
of the breast
it may take four
0'1
1-'
I
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SUGGESTED CONTENT OUTLINE
to five passes
before you cover
the entire area
(h) When you get to
the areola and
nipple, you
should spend a
little more time
examining the
area because it
feels different
than the rest of
the breast. It
feels different
because there
are often a
number of
enlarged, slippery glands and
ducts at the
rim of the
areola.
(i) You should then
place one hand
under the one
that is on the
same side as
the breast you
are examining
and use the
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
A. Moreno, La Responsabilidad de Usted:
Aprendar Como Examinarse Sus Pechos, (It's
Your Responsibility:
Learn Breast Self-Exam)
UCLA-USC Comprehensive
Cancer Center, Office
of Cancer Communications, Los Angeles,
CA, pp. 1-3.
Students would be asked to plan
a routine that would include
performing BSE on both himself
and his partner.
0'\
tv
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
opposite hand to
make a small,
circular movement until you
have felt the
breast between
both hands.
(j) Then use the
top hand to keep
the breast held
toward her chest
wall and examine
the bottom half
with the same
movement.
F. Another technique is the Students will be asked to
perform the 12-stroke "clock"
12-stroke "clock"
method.
method.
1. Start by having the
woman raise her left
arm over her head.
(a) Examine the left
breast with the
right hand.
(b) Start at the
middle of the left
collarbone, using
gentle pressure,
moving the tips of
your fingers in
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SUGGESTED CONTENT OUTLINE
small, circular
patterns downwar
toward the cente
of the nipple.
(c) Have her place
hands on her
hips, pressing
her elbows back
and look for any
lumps, or change
in size or shape
of the breast.
G. Alternative Technique
1. Have the woman lay
down on a flat
surface.
(a) Using the flat
portion of your
fingers compress
the breast
tissue between
your fingers and
her ribs.
(b) Do not squeeze
the breast
tissue between
your fingers and
your thumb
{unless you are
checking the
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
"Breast Cancer: Where
We Are,n 28 minutes,
Code 2352, ACS, 1980.
Students will form small
groups and one will be chosen
to take the role of a patient.
The others will take turns
following the steps in
nAlternative Technique.n
Students will write at least
two reasons why males may be
embarrassed to perform BSE
in front of other males or
with their mate.
nHow to Examine Your
Breasts,n film, 16mm,
6 1/2 minutes, ACS,
1979.
Teaching Breast SelfExam, ACS, 1977,
pp. 1-15.
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SUGGESTED CONTENT OUTLINE
nipple) because
you will create
artificial
lumps.
(c) In the same
position you
want to make
sure the breast
lies evenly over
her chest.
(d) If the breasts
are large there
is a tendency
to flop on the
outside. You
can correct for
this by placing
a pillow under
her shoulder on
the side you
are examining.
(e) Raising her
shoulder can
make it easier
for you to keep
the breast
situated on top
of her chest.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
students will be asked if
they think that a state of
sexual arousal could affect
how the breast feels to the
touch.
Students will be asked if they
think that malnutrition could
affect how a breast may feel to
the touch.
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SUGGESTED CONTENT OUTLINE
(f) Divide her chest
into four quadrants and carefully examine
each one using a
gentle circular
motion or the
12-stroke method
(g) Examine the
tissue between
the breast and
the underarm
because there
are lymph nodes
where lumps are
commonly located
(h) Next, compress
the nipple
between your
thumb and index
finger to see if
there is any
thickening or a
lump there.
III. Early Detection
A. Essential for curing
the womanr five year
survival rate for early
detection. Localized
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will individually
explain how their ethnic
culture deals with a male
performing BSE on themselves
and their mates.
Some cultures have social
taboos and students will be
asked how a male could deal
with such a taboo.
Speaker's Guide to
Breast Cancer, ACS,
1981, pp. 1-15.
Students will role play a
male and his partner, and the
students will then be asked
individually to explain to
his nmaten the need for BSE.
How to Examine Your
Breasts: A Guide to
Breast Health Care,
Women's Health
Committee of Milex
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SUGGESTED CONTENT OUTLINE
cancer is 87% for
white women, 79% for
black women.
B. If the cancer has
metastasized or
infiltrated other
tissues the five year
survival rate is 47%.
If the tumor has
spread to auxiliary
lymph nodes the five
year survival rate
is 56%.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Products, IN, 1982,
pp. 1-15.
Students will be asked to
individually state how they
would feel if they found a
lump in their or their mate's
breast.
Students will describe how
they would tell their mate
that they found a lump in
their mate's breast.
Teaching Breast SelfExam, ACS, 1977,
pp. 1-19.
Fight Cancer with Your
Bare Hands, Community
Cancer Control, Los
Angeles, 1978, pp. 1-6.
Breast Self--Exam, Dept.
de Salud, Programa
Central del Cancer,
Santurco, Puerto Rico,
1979, pp. 1-6.
~
-....]
TOPIC:
FEMALE BREAST CANCER:
TRAINING MATERIALS FOR MEN
SUB-TOPIC:
Personal Responsibility to One's Mate
CONCEPT V:
Men have a responsibility to protect their mate's level of wellness.
OBJECTIVE: Following instruction, the student can discuss his responsibility in
maintaining his mate's level of wellness.
EVALUATIVE CRITERIA: The student will be able to compare the value of standard treatment
techniques compared to nonproven methodsn (evaluation). The student will list two
reasons why he has a responsibility to help maintain his mate's level of optimal
health (synthesis).
_./
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES j
Laetrile: Cancer
Quackery, ACS, 1977,
pp. 1-2.
It is important for men to
realize that women who have
breast cancer are often the
victim of quacks who promise
a 100% cure.
Treatments that cannot be
proven through testing for
many years are called
nonproven methods.n These
types of treatments have
little or no rigorous
research behind them to prove
they are of any value in
treating breast cancer. Some,
like Laetrile, have been
tested for many years but
SUGGESTED RESOURCES
Students will write what the
difference between nprovenn
and nunprovenn cancer treatments consists of.
The Unproven Cancer
Cure: Don't Bet
Your Life on It,
ACS, 1979, pp. 1-3.
Students will be asked to
orally describe some
nonproven methodsn they may
know about not discussed in
the lecture.
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SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
have not shown any positive
results. Quacks are very
convincing in that they
usually produce supposed
patients who were "cured."
Their research does not
measure up to what a treatment must prove to be considered "therapeutic" and
of real worth in the
treatment of cancer.
Some quacks even have famous
scientists and movie stars
vouch that their product
really cures women of breast
cancer. These quacks cannot
produce hard, time-tested
research to justify their
claims.
Several "unproven" treatment
methods are:
1) Laetrile (Vitamin s 17 ,
amygdalin)
2) Vitamin C (may help in
the prevention of
cancer but cannot cure
it or slow it down). No
research has shown any
benefit in the preven-
Students will be asked if they
have heard of any of the 13
listed unproven methods of
cancer treatment.
Students will be asked if they
think that the best use of
vitamins is for prevention and
rehabilitation after cancer
treatment.
Eating Habits: Recipes
for Better Nutrition
During Cancer Treatment
Office of Cancer Communications, National
~
1.0
SUGGESTED CONTENT OUTLINE
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
tion or treatment of
breast cancer.
Antineoplastin
Krebiozen
Megavitamins/enzymes
(they may be of benefit
in the prevention of
cancer, but research has
not demonstrated they do
any good in cancer
treatment).
Animal embryo extracts
Hydrazine sulfate
Poltice therapy
Koch synthetic antitoxins
(Malonide, Glyoxilide,
Parabenzoquinone)
Hoxsey herbs
Chymotrypsin
Genson therapy
Immuno-augmentative
therapy
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Cancer Institute,
Bethesda, MD, 1979,
pp. 1-14.
Students, in small groups,
will be asked to come up
with several reasons why
they think a person would
use an unproven cancer
treatment.
Students can be asked if they
had cancer, would they use an
unproven method of cancer
treatment?
Students will be asked if they
think that the lack of side
effects makes unproven methods
more appealing to the cancer
patient.
Cancer in America is greatly
feared because many people do
not know what takes place
during cancer treatment.
This ignorance breeds feelings
of fear and isolation. Women
are especially fearful of
....]
0
SUGGESTED CONTENT OUTLINE
breast cancer because of the
side effects of the standard
treatments for breast cancer.
Women, because of fear and
ignorance often believe the
quacks' claims and often pay
high prices for a "cure" that
does not cure nor delay the
growth of the cancer.
SUGGESTED LEARNING OPPORTUNITIES
Students will be asked to
orally respond to the question, "Do most Americans
feel cancer is an automatic
death sentence?
Women have a great fear of
losing a breast(s) if they
are told they might need a
mastectomy to save their life.
The instructor may ask
a health professional
.to come and briefly
describe what some of
the quack cure are in
the community. This
could be a social
worker who works for
the ACS or another
health agency or
hospital.
Ideally, the instructor
could have an
oncologist attend the
class and offer additional information.
Males have a responsibility
to be aware of the many
"unproven methods" that in our
society. These "unproven"
treatment methods only offer
psychological reassurance to
a woman. This need for
assurance makes them very
vulnerable when they need all
the support they can get.
How does a male find about
what an •unproven" method is?
By talking to a physician,
but preferably to an
SUGGESTED RESOURCES
Students will be asked to
discuss the question, "Should
a male initiate a discussion
about "unproven methods" or
-...]
1-'
SUGGESTED CONTENT OUTLINE
oncologist. Oncologists are
very aware of what the current
quack treatments are.
Oncologists themselves are
usually participating in
experimental research and may
recommend your mate for the
treatment. The oncologist
may refer your mate to a
Comprehensive Cancer Cure
Center for more intensive
therapy.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
wait until his mate asks to
discuss it?
Students will list each of the
responsibilities a male has to
his partner.
Males have other responsibilities to their mates:
1) Economic sole support or
co-support of one's mate.
2) Help maintain the mate's
level of optimum health
and assist in achieving
the mate's level of
optimum health and assist
in the mate's recovery
from an illness.
Helping maintain a mate's level
of optimum health and wellbeing includes helping the mate
discover any disease processes
that may occur over time.
Students will discuss the question, "If I'm afraid of cancer
can this affect how I treat my
partner during her breast
cancer treatment?"
Taking Time: Support
for People with Cancer
and the People who Care
for Them, u.s. Dept. of
Health and Human
-....]
N
SUGGESTED CONTENT OUTLINE
One way to protect one's mate
is to perform breast self-exam
with her each month to see if
any suspicious signs or
symptoms of breast cancer
appear. The male should go
with his mate to the physician
for a closer examination.
If the woman is diagnosed as
having breast cancer the male
has the following responsibilities:
1) Discuss with mate and
physician what will take
place during the treatment phases.
2) Go with one's mate each
time she goes for further
evaluation.
3) Ask questions about
everything so he gets a
more clear understanding
as to why certain treatment techniques will be
used by the oncologist.
During the treatment he should:
1) Become acquainted with any
dressings used and their
application.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Services, Bethesda, MD,
1981, pp. 1-5.
Students will be asked to discuss how a male and his partner
can grow farther apart or even
divorce as a result of her
breast cancer treatment.
Students will be asked to
describe how they would ask
their partner to perform .BSE
together each month (this
could be done by roleplaying).
Holland, J., Understanding the Cancer
Patient, ACS, 1980,
pp. 1-10.
-....]
w
SUGGESTED CONTENT OUTLINE
2)
3)
4)
5)
6)
7)
Become acquainted with any
special foods or food
supplements she is given.
Become aware of the
immediate and long-term
side effects of radiation
and chemotherapies, as well
as those from surgery. Ask
the physician how they may
be countered.
Ask the doctor and nurses
how to take physical care
of his mate (clipping
nails, cleaning the
affected and unaffected
breast(s).
How to recognize any signs
and symptoms of infection
at treatment sites on his
mate's body.
Become acquainted with any
special breathing techniques used and how they
are performed.
Become familiar with
taking "vital signs"
(temperature, pulse and
respiration rate) and know
how to recognize any
abnormal changes in them.
SUGGESTED LEARNING OPPORTUNITIES
Students will indicate 11
things a male can do to assist
his mate after breast
surgery. This information
can be kept as a sort of
"guide book" for the student
to periodically look at to
refresh himself.
SUGGESTED RESOURCES
Dollinger, M., Thoughts
and Feelings About
Cancer Patients--A
Personal Reflection,
personal address, UCLA,
Nov. 1976, pp. 1-3
(Contact UCLA-USC
Cancer Center).
Rosenbaum, E., For You
the Patient: An Introduction to Cancer Care,
Bull Publications, New
York, 1980, pp. 1-15.
-....]
"""
SUGGESTED CONTENT OUTLINE
8)
9)
10)
11)
SUGGESTED LEARNING OPPORTUNITIES
The Columbia University
College of Physicians
and Surgeons, The
Complete Home Medical
Guide, Crown
Publishers, New York,
1986, pp. 398-406,
808-836.
Learn how the staff
positions his mate for the
most comfort (especially
if surgery was done).
Learn how and why ambulation is necessary
following surgery.
Ask the physician and
medical staff what community agencies are available
and their role in helping
one's mate recover from
her treatment.
Seek advice from the staff
on how to maintain the hom
and provide child care
during his mate's treatmen
phase.
Following treatment, a male has
several responsibilities:
1) Conduct BSE as frequently
as the physician directs
so as to observe the
healing or affected
tissues.
2) After chemotherapy to
support his mate by caring
for the side effects she
may experience (hold her
SUGGESTED RESOURCES
Students will be asked to
discuss why BSE should be
continued during and following treatment for breast
cancer.
........
U1
SUGGESTED CONTENT OUTLINE
3)
4)
5)
6)
7)
8)
head so she can vomit,
cover her with blankets
if she's chilled).
Change dressings as
directed by physician.
Take "vital signs" as
directed and report
abnormalities to the
physician.
To help maintain the
home and take care of
children.
To participate by
encouraging the mate
during her exercise
program:
a) Wall climbing
b) Rope turning
c) Ball or washcloth
squeezing
d) Pulley motion
e) Pendulum swing
Discuss with mate the
option of breast
prosthesis (after
surgery).
Accompany mate when she
goes to get a prosthesis
and assist in its
selection.
SUGGESTED LEARNING OPPORTUNITIES
Students will copy these
steps and indicate how they
feel thinking about these
responsibilities.
SUGGESTED RESOURCES
Cancer Related Checkups
ACS, 1980, p. 1.
Home Nursing Handbook,
Health and Welfare
Division, Metropolitan
Life Insurance Co., New
York, 1980, pp. 1-33.
Hollis, D., Self
Examination after
Breast Cancer Surgery,
Cancer Information
Services, USC-UCLA
Comprehensive Cancer
Care Center, Los
Angeles, CA, 1981,
pp. 1-4.
-..]
0'1
SUGGESTED CONTENT OUTLINE
9)
10)
11)
12)
Encourage and accompany he1
when she sees a physician.
Encourage the mate to
dress attractively and
compliment her for it.
Encourage her to touch
the treated parts of her
body. He may touch them
first to show he is not
repelled by the scars,
suture marks or deformed
tissues.
Encourage his mate to
resume her lifestyle the
way it was before her
treatment.
An aware male who has a broad
knowledge of the physical
aspects of his mate's breast
cancer treatment will very
likely be more able to adapt
to the reality of the changes
the treatment has had on his
mate's appearance and
physical well-being.
He will then be better able
to explain what happens in
breast cancer treatment to
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED RESOURCES
Students will be asked to
discuss why they think it is
important for a woman to
return to her pre-treatment
lifestyle after the rehabilitation is over.
Students will answer the question, "How would you feel
about the loss of your
testicles? Might this affect
how you think of yourself as
being sexually desirable?"
The instructor can ask
a male who has had his
partner go through
breast cancer treatment
to speak briefly to the
class about how to be
of most help to one's
mate.
The instructor can also
ask a woman to briefly
discuss how an informed
-..J
-..J
SUGGESTED CONTENT OUTLINE
people who want to know. This
knowledge will lower his level
of fear because he's no longer
ignorant and thus fearful of
what happens during detection,
Breast Self-Exam, diagnosis,
treatment and rehabilitation
that occurs when a woman is
treated for breast cancer.
Most important is the real
likelihood that his mate's
treatment and rehabilitation
phases will be less traumatic
to her because she has an
emotional support that she
desperately needs at this
critical time in her life.
SUGGESTED LEARNING OPPORTUNITIES
Students will break into
small groups and list what
they think are the "five
most important things a male
should know about the physical
aspects of breast cancer."
SUGGESTED RESOURCES
male can be of great
benefit to a woman who
will undergo breast
cancer treatment.
Each student will write five
ways he can be of most help to
his mate in their particular
relationship.
The end result will be a
relationship that's even
closer because both partners
have faced a threat to their
relationship and as a team
have worked together to
combat, and hopefully defeat,
the threat that is female
breast cancer.
.....:J
00
BIBLIOGRAPHY
79
80
Bibliography
A Cancer Sourcebook for Nurses.
1975.
American Cancer Society,
Ackerman, Lauren. Pathology
Society, 1972.
Tumors.
of
American
Cancer
American College Health Association. "Recommended Standards
and Practices for a College Health Program." Journal
of the American College Health Association 25(Special
Issue): 1-35, March 1977.
Anderson,
W.A.D.,
and Thomas
Scotti.
Pathology. New York: c.v. Mosby, 1978.
Synopsis
Bates, Barbara.
A Guide to Physical Examinations.
York: J.P. Lippincott, 1979.
of
New
Becker, Marshall.
"Selected Psychosocial Models and
Correlates of Individual Health Related Behaviors."
Medical Care 15(5): 27-29, May 1977.
Brainerd, Henry.
Current Diagnosis and Treatment.
York: Lange Medical Publications, 1970.
Breast
Cancer
Fact
Sheet.
Los
Angeles:
Comprehensive Cancer Care Center, 1985.
Breast Cancer:
1980.
Breast Self Exam.
Where We Are.
New
USC-UCLA
American Cancer Society,
American Cancer Society.
Breast Self Exam.
Santurco, Puerto Rico:
Salud, Programa del Cancer, 1979.
Department de
Brunner, Lillian s., and Doris s. Suddarth.
"Health
Information and the College Student." T~xtbook of
Medical-Surgical Nursing. New York: J.P. Lippincott,
~1~9~8~4~.~~~~~~~~~=
Cancer Facts and Figures,
1984.
Cancer Word Book.
19 84. American Cancer Society,
American Cancer Society, 1980.
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Cancer Related Checkups.
Cooper, Diane.
American Cancer Society, 1980.
Personal interview.
Cutler, Max.
Tumors
Lippincott, 1962.
of
the
August 1982.
Breast.
New
York:
J.P.
Dollinger, Malin.
"Thoughts and Feelings about Cancer
Patients--A Personal Reflection." UCLA. Los Angeles:
Nov. 1976.
Eating Habits:
Recipes for Better Nutrition During Cancer
Treatment. Bethesda: Office of Cancer Communications,
National Cancer Institute, 1979.
Facts on Breast Cancer. American Cancer Society, 1978.
Fight Cancer with Your Bare Hands.
Cancer Control, 1978.
Five Minutes for BSE.
Los Angeles: Community
American Cancer Society, 1980.
Fodor, John, and Gus Dalis. Health Instruction: Theory and
Application, 2nd ed.
Philadelphia: Lea and Febiger,
1981.
From One Cell. American Cancer Society.
Goodrow, Benjamin.
"Does Time Change the Health Concerns
of College Students?" Health Education 8 (3): 34-35,
May-June, 1977.
Grady, Denise.
"To Starve a Tumor." Discover
104, Nov. 1983.
4(11): 102-
Green, Lawrence.
"Health Information and Health Education:
There's a Big Difference Between Them. n Bulletin of
the American Society for Information Science 4(4): 1516, April, 1978.
Hochbaum, Godfrey. Health
Publishing, 1970.
Hoffmann, Robert.
Behavior.
Personal interview.
Belmont:
Wadsworth
August, 1982.
Hogenson, Charles.
Diseases of the Breast. New York: W.B.
Sanders, 1962.
Holland,
Jimmie.
Understanding
American Cancer Society, 1980.
the
Cancer
Patient.
82
Hollis, Dorothy.
Self-Examination After Breast Cancer
Surgery. Los Angeles: Cancer Information Services,
USC-UCLA Comprehensive Cancer Care Center, 1981.
Home
Nursing Handbook.
New York: Health and
Division, Metropolitan Life Insurance, 1980.
How
to Examine Your
1979.
How
to Examine Your Breasts.
1975.
Breasts.
Welfare
American Cancer
Society,
American
Society,
Cancer
How to Examine Your Breasts.
Indianapolis: Women's Health
Committee of Milex Products, 1982.
Journey into Darkness.
Keep
American Cancer Society, 1979.
in Touch with Yourself.
Examination Center, 1982.
New York:
Harlem
Krokoff, Irwin.
Cancer Chemotherapeutic Agents.
Cancer Society, 1983.
Laetrile:
Cancer Quackery.
Breast
American
American Cancer Society, 1977.
La Responsibilidad de Usted:
Aprendar Como Examinarse Sus
Pechos
(It's Your Responsibility: Learn Breast SelfExam).
Los Angeles: UCLA-USC Comprehensive Cancer
Center, Office of Cancer Communications, 1982.
Lasser, Terese.
Reach
Society, 1974.
to
Recovery.
American
Cancer
Lifestyle Assessment Questionnaire. 2nd ed. Stevens Point:
UW-SP Foundation, University of Wisconsin, 1980.
Matthews, Christine.
"A Theory for Predicting Change."
International Journal of the American College Health
Association 18(2): 14-15, April-June, 1975.
Morrow, Gary, and Alice Hoagland.
"Physician-Patient
Communications in Cancer Treatment." Proceedings of
the American Cancer Society Third Annual Conference on
Human Values and Cancer.
American Cancer Society,
1981.
Public Attitudes Toward Cancer and Cancer Tests. American
Cancer Society, 1980.
Reach to Recovery.
American Cancer Society, 1974.
@
83
Roberts, Maxine.
"Health Information and the College
Student." Journal of the American College Health
Association 21(3): 221-23, Feb. 1973.
Rollins, Betty.
1980.
First You Cry.
New York: Bantam Books,
Rosenbaum, Ernest.
For You the Patient:
An Introduction
to Cancer Care. New York: Bull Publications, 1980.
Roter, Debra.
"Patient Participation in the PatientProvider Interraction:
Effects of Patient Question
Asking on Quality of Interraction, Satisfaction and
Compliance.• n Health Education Monographs 5 (4): 281315, Winter 1977.
Rubin, Philip.
Clinical Oncology for Medical Students and
Physicians:
A Multi-Disciplinary Approach. American
Cancer Society, 1978.
Russell, Richard.
"Teaching-Learning Strategies." Health
Education. Washington: National Education Association,
1975.
Self-Defense for the Woman You Love.
Albany: New York
State
Health
Department,
Off ice
of
Health
Communications, 1979.
Speaker's Guide to Breast Cancer. American Cancer Society,
1981.
Strothers, Jacqueline.
If You Find a Lump in Your Breast.
Bethesda: U.S. Dept. of Health and Human Services,
1981.
Taking Time: Support for People with Cancer and the People
Who Care for Them. Bethesda: u.s. Dept. of Health and
Human Services, 1981.
Teaching Breast Self-Exam.
The
American Cancer Society, 1977.
Complete Home Medical
Publishers, 1986.
Guide.
New
York:
Crown
The Unproven Cancer Cure:
Don't Bet Your Life On It.
American Cancer Society, 1979.
Townsend, Courtney.
"Breast
32(2): 1-3, 1980.
Tumor Immunology.
Lumps."
Clinica
American Cancer Society, 1975.
Symposia
•
84
American
Cancer
Wallis, Claudia.
"Easing Women's Constant Fear."
122(22): 85-86, 21 Nov. 1983.
Time,
Unproven Methods of
Society, 1979.
Cancer Management.
Wallston, Barbara.
"Locus of Control and Health:
of the Literature." Health Monographs 6(2):
Spring 1978.
A Review
107-117,
Wolman, Benjamin.
Dictionary of Behavioral Science.
York: Van Nostrand Reinhold, 1973.
Youth Looks at Cancer.
American Cancer Society, 1982.
New
APPENDIXES
85
APPENDIX A
86
87
APPENDIX A
Survey Participants
Helen L. Brajkovich, R.N., P.H.N, B.S., M.S.
Department of Health Sciences
California State University, Northridge
18111 Nordhoff Street
Northridge, California 91330
Nola Brockway, B.A.
Health Educator
Robert Frost Junior High School
12314 Bradford Place
Granada Hills, California 91344
Ed Buchanan, B.A.
Health Educator
Granada Hills High School
10535 Zelzah Avenue
Granada Hills, California
91344
Dr. Mary Ellen Etherington, B.S., M.S., Ed.D.
Department of Health Education
California State University, Northridge
18111 Nordhoff Street
Northridge, California 91330
Sheldon Fried, B.A.
Health Educator
Chatsworth High School
10027 Lurline Avenue
Chatsworth, California
91311
Gale Jaffe, B.A.
Health Educator
Hollywood High School
1521 North Highland Avenue
Hollywood, California 90028
Don Kobyashi, B.A.
Health Educator
Nobel Junior High School
9950 Tampa Avenue
Northridge, California 91324
Christine Kasparian, B.S.
Health Educator
American Cancer Society
2975 Wilshire Boulevard
Los Angeles, California 90010
88
Patty McGill, R.N., B.S.
School Nurse
Nobel Junior High School
9950 Tampa Avenue
Northridge, California 91324
Lori Mills, B.A.
Health Educator
John F. Kennedy High School
11254 Gothic Avenue
Granada Hills, California 91344
Pat Mitchell, R.N., B.S.
School Nurse
Robert Frost Junior High School
12314 Bradford Place
Granada Hills, California 91344
David Ptashne, B.S.
Health Educator
John F. Kennedy High School
11254 Gothic Avenue
Granada Hills, California 91344
Gary Schur, B.A., M.P.H.
Health Educator
Nobel Junior High School
9950 Tampa Avenue
Northridge, California 91324
Antonius Van Dooremolen, B.A.
Health Educator
Robert Frost Junior High School
13414 Bradford Place
Granada Hills, California 91344
Connie Wiens, R.N., B.S.
School Nurse
Chatsworth High School
10027 Lurline Avenue
Chatsworth, California 91311
APPENDIX B
89
APPENDIX B
Table 1:
Frequency Distribution of the Importance of Inclusion of Subject Area
in the Training Materials
Very
Important
Fairly
Important
Somewhat
Important
Fairly
Unimportant
Very
Unimportant
Total
Overall
11
2
1
1
0
15
Cancer
8
5
1
1
0
15
13
1
0
0
1
15
8
5
1
0
1
15
BSE
10
4
0
1
0
15
Responsibility
to One's Partner
11
3
0
0
1
15
Totals
61
20
3
3
3
90
Percent of Total
67.8
22.2
3.3
3.3
3.3
Subject Area
Signs/Symptoms
Oncology
\0
0
APPENDIX C
91
APPENDIX C
Table 2.
Distribution of Responses by Reviewers on How Well the Subject Areas
are Covered
Very_ Well
Fairly_ Well
Okay
Total
Cancer
8
4
3
15
Signs/Symptoms
8
5
2
15
Oncology
6
6
3
15
BSE
8
6
1
15
Responsibility to
One's Partner
10
3
2
15
Total
40
24
11
75
Percent of Total
53.3
32
14.7
1.0
"'
APPENDIX D
93
94
APPENDIX D
THIS IS A TRAINING
PROGRAM,
TRAINING MATERIAL FOR MEN."
"FEMALE BREAST
CANCER:
THE GOAL OF THE PROGRAM IS TO
INCREASE THE SUPPORT GIVEN TO FEMALES WITH BREAST CANCER BY
THEIR MATES THROUGH INCREASED KNOWLEDGE.
As part of my Master's program,
your input on the project.
I
would appre!=iate
I appreciate the fact that in
order for you to provide an in-depth evaluation, you would
need to review the materials for considerably longer than
either of us have now.
Nonetheless, your initial reaction
to the materials will aid both me and subsequent users of
the training materials.
ANONYMITY IS ASSURED.
YOUR RESPONSES WILL BE TREATED
IN CONFIDENCE.
1.
In your opinion, how important is the topic of
educating males about female breast cancer?
Very
Fairly
Somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
2.
The program has five major components:
I.
II.
III.
IV.
v.
Cancer: From Cell to Tumor
Signs, Symptoms and Causes
Oncology
Breast Self-Examinations
Responsibility to One's Partner
In your opinion, how important is each component when
educating males about female breast cancer?
95
I.
Cancer:
From Cell to Tumor
Very
Fairly
Somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
II.
Signs, Symptoms and Causes
Very
Fairly
somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
III.
Oncology
Very
Fairly
Somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
IV.
Breast Self-Examination
Very
Fairly
Somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
v.
Responsibility to One's Partner
Very
Fairly
Somewhat
Fairly
Very
Important Important Important Unimportant Unimportant
3.
I would like your general reaction to the proposed
curriculum. I reognize that in order to give detailed
feedback, you would need to study the materials.
However, I would appreciate it if you would take a
minute and look over the proposed curriculum for each
section, and give me your initial reaction to it.
Specifically, after you have glanced over each
section, I would like you to judge how well the
proposed materials will contribute to the overall goal
of the program.
96
I.
Very
Well
II.
Very
Well
III.
Very
Well
IV.
Very
Well
v.
Very
Well
4.
Cancer:
From Cell to Tumor
Fairly
Well
Fairly
Poorly
Very
Poorly
Signs, Symptoms and Causes
Fairly
Well
Fairly
Poorly
Very
Poorly
Fairly
Poorly
Very
Poorly
Fairly
Poorly
Very
Poorly
Oncology
Fairly
Well
Breast Self-Examinations
Fairly
Well
Responsibility to One's Partner
Fairly
Well
Fairly
Poorly
Very
Poorly
Given that this program is designed to be completed in
five classroom hours, can you think of any topics or
components that should be substituted for the ones
proposed heret
97
5.
Do you have any other comments about this program that
I should consider?
6.
Are there other persons you know who would be helpful
in reviewing this program?
Name=------------------------------------------------------Affiliation:
Phone:
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