1. Diana Jeleč Kaker, Ph.D., Soc. Work Institute of Oncology Ljubljana, Slovenia FIFTEENTH EASOM SUMMER SCHOOL 2015: Teaching Trainees in Occupational Medicine about Psychosocial Risk Factors at work, Bled, Slovenia, 26th – 29th August 2015 PATIENT WITH BREAST CANCER – A CASE STUDY

2. DIAGNOSIS: BREAST CANCER Brings about changes: Patient X: temporary permanent metastatic breast cancer born in 1965 married two daughters employed as a cook lives in a block of flats

3. THE DISEASE Influences: physical – own attitude towards health, appearance psychological distraction (anxiety, depression) partner relationship Patient X: Suffers from feelings of inferiority and low self- image Depression Has a great support from the family (husband and two daughters)

4. COPING AND ACCEPTING THE DISEASE Methods: fighting avoiding stoical acceptance helplessness anxiety Patient X The patient choses fighting as a way of coping with the disease

5. REHABILITATION Approach: team work Patient Discussions and consultation Encouraged to actively participate in the treatment, strengthening the abilities Family The whole family is affected. It is an important factor in support Society Self-help groups Patient X Addresses the professionals (doctor, nurse and social worker) Offered a lot of support by the family Refuses to participate in the self-help group

6. REHABILITATION Returning to the working environment Sick leave The possibility to gradually return to work Work at home The option of training / professional retraining Purpose Achieving the desired work efficiency Return/inclusion into society Patient X Loses her job Has difficulties in finding new employment Takes sick leave

7. MEDICAL DEVICES Medical devices: Temporary breast prosthesis Silicone breast prosthesis Self-adhesive breast prosthesis Orthopaedic bra Wig Elastic glove

8. TEMPORARY BREAST PROSTHESIS Temporary breast prosthesis Designed to be worn immediately after surgery, until the operative wound heals

9. SILICONE BREAST PROSTHESIS AND ORTHOPAEDIC BRA Silicone breast prosthesis Self-adhesive breast prosthesis

10. ORTHOPAEDIC BRA FOR THE BREAST PROSTHESIS Wide and adjustable straps Comfortably sewn under the armpit The bottom border for additional support

11. MEASUREMENTS TO DETERMINE THE BRA SIZE Measure the chest circumference directly under the bust. Round the measured value to the nearest multiple of number 5. Example: measured 78 cm = bra size 80 cm. This is the bra size. Measure distance from the middle of sternum across the healthy breast to the centre of the spine. Multiply the measured value by two to obtain the cup size. Example: 48 cm x 2 = 96 cm. This is the cup size.

12. BRA / CUP SIZE The difference between the cup circumference and the bra size determines the size of the cup: 96 cm (cup circumference) - 80 cm (bra size) = 16 cm Example: 80 C Difference in cm Cup size 8 -10 AA 10 - 12 A 12 - 15B 15 - 18C 18 - 20D 20 - 23DD

13. WIG, ELASTIC COMPRESSION GLOVE Alopecia Lymphoedema

14. PROGRESS OF DISEASE Social assistance services Help at home Institutional care Patient X Refused by the patient Receives help from the family

15. Thank you for your attention