THE INFLUENCE OF SOCIAL FAMILY SUPPORT ON DEPRESSION, ANXIETY AND QUALITY OF LIFE AMONG WOMEN WITH BREAST CANCER : LITERATURE REVIEW

Background: Breast cancer is the second type of cancer diagnosed in women and is the first cancer in women worldwide. Breast cancer also causes high morbidity and mortality in women and becomes a heavy burden due to the incidence of disability due to the disease. Purpose: This literature review aims to examine how social support affects anxiety, depression and quality of life in breast cancer sufferers. Method: The data were obtained by searching for reputable and trustworthy journals. have high quality criteria, namely Scopus, Proquest, Science Direct, Elsevier, Pubmed. Journals or articles used in this review literature are searched using keywords and Boolean operators (AND, OR NOT, or AND NOT).


INTRODUCTION
The number of cancer sufferers is currently increasing and the existence of new development program innovations for prevention such as early detection by screening and treatment has been able to increase the successful life expectancy of cancer sufferers, especially those who are still diagnosed with cancer at an early stage, however, most of them are survivors. continues to experience a decline in the quality of life related to Health even years after the completion of cancer treatment. Decreased quality of life includes chronic pain, fatigue, sexual dysfunction, and psychosocial problems such as depression, anxiety, and decreased social support. 1 Breast cancer is the second type of cancer that is often diagnosed in women and is the number one cancer in women worldwide. Breast cancer also causes high morbidity and mortality rates in women and becomes a heavy burden due to the incidence of disability due to the disease. 2 A conviction of being diagnosed with breast cancer not only affects the woman who is diagnosed but also has a big impact on those who are involved in the woman's life. 3 Obtaining information related to this cancer diagnosis is a very sad thing in his life and feels that this is very likely to be close to death and suffering. 4 Breast cancer patients can also experience both physical and psychological disorders or problems such as anxiety depression can be mild or severe this varies depending on the type and stage of cancer, prognosis, perception of post-treatment body image. 4 relating to the illness and treatment they receive, so that it has an impact on aspects of life including work, finances, the future, activities and other social activities as well as the quality of their life 2 .
This cancer is also one of the causes of crisis for both the patient and the family, and is a major health problem which is generally fatal unless diagnosed early. 5 Cancer diagnosis and early treatment can also reduce the quality of life for patients and their families. 5 Quality of life is a multidimensional and complex concept that reflects patients' perceptions of the effect of diagnosis and initiating treatment on their daily lives. Quality of life is also related to how patients view subjectively from physical, psychological, social and spiritual aspects including well-being. High quality of life in breast cancer patients is associated with longer survival, besides that several factors such as self-readiness, financial, marriage, education level, age, hope for the future and social support are factors that affect the quality of life in breast cancer sufferers. 6 One of the efforts that can be made to improve the quality of life in patients with breast cancer is social support. Social support is an experience received by someone related to the perception of support or voluntary support from others, from family, spouses, friends, relatives and social networks. 7 Some forms of social support, namely informational support, are advice, suggestions, and information. Appraisal support is useful information for self-evaluation. Emotional support is classified as an expression of empathy, love, and care. Instrumental support is tangible assistance and services. 7 Research results prove that there is a significant relationship between social support given to improving physical and psychological conditions in breast cancer patients reducing stress, depression, mortality and improving the quality of life of patients with cancer. 8 Literature review This attempt to explain and analyze the effect of social support on improving the quality of life in breast cancer patients.

METHOD
The literature review relating to the social support provided to cancer patients to improve the quality of life is summarized thoroughly which will be presented in an article in the form of a Literature review. Completion of predetermined studies that are in accordance with the objectives of the literature review uses the PRISMA approach as a protocol and evaluation. Literature review is a summary based on several studies or studies that have been carried out previously with certain predetermined themes. The data used in this review literature is secondary data using sources of research results in previous studies. The data is obtained by searching for reputable and trustworthy journals. The search for journals is carried out from February to March 2021 using several databases that have high quality criteria, namely Scopus, Proquest, Science Direct, Elsevier, Pubmed,. The journals or articles used in this review literature are searched using keywords and Boolean operators (AND, OR NOT, or AND NOT) this is done to expand the detail or specific search for articles according to the purpose and can make it easier to determine the articles or journals used . Keywords in this review literature are as follows: social support OR family support, quality of life OR Quality, anxiety OR depression, AND Cancer OR cancer treatment OR Chronic The inclusion criteria are full text, from 2019 to 2021, after going through the screening process, there were 57 articles and journals and journal searches using the PICOS framework strategy, namely: found 13 journals that match the criteria consisting of Population / Problem, namely cancer patients undergoing care in a hospital or health service center, Intervention is a patient who gets family or social support, Comparation is no comparison., Outcome is the quality of life in cancer patients who get social or family support, Study design is Quasi experimental studies, randomized control and trial , crossectional studies The results of this literature review show that social support provided to patients with breast cancer can improve their quality of life and reduce anxiety and depression. Physical activity and perceived stress also have a significant effect on quality of life. 9 Results Previous studies found that the problems identified in many cancer patients were depression, anxiety and pain or discomfort. The existence of this condition should be handled not only aimed at overcoming physical problems but also the impact of the sick conditions suffered by cancer patients such as anxiety, depression and discomfort should be a concern and an important factor for getting good care that involves collaborative health workers. 10 Social stigma was also associated with worsening quality of life in cancer patients. 11 The findings in this study also indicate that age has a direct positive effect on comorbidity, and that comorbidity as a biologically mediating variable has a significant negative effect on quality of life. 12 Patients with advanced cancer also show a decrease in quality of life due to the impact of cancer, such as decreased physical function. 13 Providing social support after treatment for patients with cancer also affects their quality of life.

RESULT AND DISCUSION
The study results also showed a positive relationship between social support received and the improvement of the patient's quality of life, such as physical and psychological aspects. Support has an important mediating role in improving the readiness and quality of life of breast cancer patients, patients who report that the support they receive can be obtained forever and does not end. 14 The research in this literature also explains the findings of low social support for decreased quality of life. 15 provided among them, namely emotional support, informational, and instrumental and real support. Their social support comes from various sources, namely family, hospitals, friends, places of worship and various other sources. 16 The results shown in an important study of the social support received by patients with breast cancer are nurses. The nurse provides important information regarding the condition of the disease and provides motivation and encouragement and this makes the patient feel calmer. Informational support is also obtained from health workers, namely doctors related to the therapy to be undertaken, nutrition that must be consumed, medication and self-care that can be done. They also received information about the effect or impact that would be received from cancer therapy or treatment, such as hair loss, weight loss and appetite. 16 The findings in this study are in line with the results of a qualitative study that provided the informational support found in women with breast cancer receiving endocrine therapy. This informational support is provided by health workers by providing information related to the duration and duration of treatment, the effects of treatment and the benefits that will be received from the treatment being carried out. 7 Emotional support provided by health workers to women with breast cancer can also provide a positive outlook. on current therapies and their future. Instrumental support is also received from the family of friends and friends by offering responsible assistance and having a commitment to providing support, including financial. 7 Social support is perceived as a feeling of worth being loved and respected. Social support can reduce the adverse effects of quality of life and depression. 17 The results of research in this literature review also describe patients with breast cancer who experience problems with anxiety and depression, as well as the physical and psychological burdens they receive from the treatment they are given and the presence of a sense of concern for their future health and the fate of their close family. 18 This has an impact on the deteriorating quality of life. Women with breast cancer tend to have mental health problems with a high prevalence such as depression and anxiety. 10 Factors of anxiety and depression experienced by women with breast cancer are one of the factors that significantly reduce the overall quality of life. 10 Breast cancer is one of the factors The causes of changes in sufferers include daily activities, social relationships, work, family roles and psychological stress. This situation has an impact on the lack of personal and social control, decreased physical health and death. This situation can lead to depression and social isolation so that support from family, friends, social networks and health service providers is needed by breast cancer sufferers. Empiric evidence shows that social support provided by family, relatives, friends is able to improve behaviors such as diet, physical activity and adherence to treatment. 19 Social support can help improve self-protection in dealing with stressful conditions, stress, depression due to cancer. them. 20 The research results also prove that the support provided by nurses is able to improve resilience in women who suffer from cancer. 21 Cancer patients with an age of more than 50 years are proven to have an increase in the quality of life with the social support they receive. 22 Breast cancer sufferers who experience metastases reveal the meaning of life and hope for the acceptance of social support and spirituality. 23 Quality of life is related to complex health problems which are viewed from various multidimensional aspects, both physical, psychological and social. 24 Subjective quality of life has been recognized as an indicator of health status for cancer sufferers. The lack of social support is one of the factors that worsens it. The quality of life for people with cancer. 25 Is breast cancer and this is influenced by several factors such as values, norms, culture, ethnicity and their experiences. Some of the successes of cancer treatment have been shown to improve the survival of cancer patients, but it still raises concerns about the side effects of treatment such as infertility, menopausal symptoms, recurrence and recurrent malignancy. Health perceptions in terms of quality of life are also influenced by several factors such as social demographics. , biological factors, spiritual, social support, psychological conditions and lifestyle. 12

CONCLUSION
Breast cancer is still the most common cause of death in women. Various effects of the disease are felt by breast cancer sufferers both physically, such as pain and discomfort, psychological in the form of anxiety and depression, and social, for example in work, relationships with family, relatives and friends. These various impacts have been shown to significantly affect the quality of life for breast cancer sufferers. One of the efforts that can be made to improve the quality of life for breast cancer sufferers is to provide social support. The social support received by the sufferer is felt as a form of appreciation, affection is valued and respected. The social support provided can be in the form of emotional support, informational support and instrumental support. Nurses have an important role in improving the quality of life, reducing anxiety and depression in cancer patients by providing support to breast cancer sufferers.