Pathways for psychological adjustment in breast cancer: A longitudinal study on coping strategies and posttraumatic growth

A cross-sectional study of anxiety and marital quality among women with breast cancer at a university clinic in western Saudi Arabia

Objectives:

To examine relationship between the quality of marital relationship and anxiety among women with breast cancer (BC) in the Kingdom of Saudi Arabia (KSA).

Methods:

This cross-sectional study recruited a consecutive series of 49 married women with BC seen in the Al-Amoudi Breast Cancer Center of Excellence at King Abdulaziz University, Jeddah, KSA in early 2013. Participants completed the Hospital Anxiety and Depression Scale, Spouse Perception Scale, and Quality of Marriage Index forms, and answered questions on demographic and cancer characteristics.

Results:

Anxiety symptoms indicating “possible” anxiety disorder were present in 10.4% and “probable” anxiety disorder in 14.6% (25% total). No significant relationship was found between the quality of marital relationship and anxiety symptoms (B=-0.04, standard error=0.05, t=-0.81, p=0.42). Anxiety was primarily driven by low education, poor socioeconomic status, and young age.

Conclusion:

Anxiety symptoms are prevalent among married women with BC seen in a university-based clinic in the KSA. Further research is needed to determine whether a diagnosis of BC adversely affects marital relationship, and whether this is the cause for anxiety in these women.

Psychosocial correlates of benefit finding in breast cancer survivors in China

Breast cancer is number one in incidence and sixth in mortality among all cancers of women in China. Prior work identified positive consequences following diagnosis and treatment, including benefit finding among breast cancer survivors from Western countries. This study evaluated psychosocial correlates of benefit finding in breast cancer survivors in China. A total of 148 participants completed measures of coping, perceived stress, depressive symptoms, social support, and benefit finding. Results indicated that benefit finding was positively related to active coping and negatively related to depression. Future research may evaluate whether interventions to enhance active coping will improve outcomes among Chinese breast cancer survivors.

Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship

Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

Coping response following a diagnosis of breast cancer: A systematic review

Introduction

Coping with breast cancer is an important health issue that results in adjustments to the disease in survivors. The present systematic review aims to synthesize the evidence about the coping strategies used by women who are primary breast cancer survivors to adjust to their new situations in their lives.

Methods

Searches were conducted using Google Scholar, PubMed, Scopus, Wiley Online Library, and PsycINFO, using the terms “breast cancer,” “breast malignancy,” “coping strategies,” “coping behaviors,” and “adjustment” from January 2000 to July 2015. Only relevant studies in English were selected at the end of the search. Only those papers were selected that focused on coping strategies/behaviors that were used by breast cancer survivors.

Results

Searching the electronic databases resulted in 2390 articles. Ultimately, 20 studies met the inclusion criteria of the present study and were included in the review. Two reviewers independently reviewed all relevant articles using the same inclusion criteria. The reviewers completed a quality assessment using the Newcastle–Ottawa Quality Assessment scales for observational studies. The more frequent coping strategies that patients with breast cancer used in the studies were 1) seeking social support (9 studies), 2) positive reframing and reappraisal behaviors as problem focused strategies (7 studies), 3) religious/spirituality-focused efforts (8 studies), 4) emotional expression as positive emotion-focused strategies (3 studies), and 5) avoidance and distraction as avoidance orientated strategies (6 studies). Women with different ethnicities and educational levels used different coping strategies with breast cancer, and they used different strategies in different phases of the disease.

Conclusion

This systematic review revealed that seeking social support and emotion-focused efforts were the main coping strategies that women with breast cancer diagnosis used, especially in the early phase of breast cancer diagnosis. This information about the coping responses of patients may be useful in designing interventional programs to assist other women in dealing with the various challenges imposed upon them by their illness.

The Mediating Role of Mental Adjustment in the Relationship between Perceived Stress and Depressive Symptoms in Hematological Cancer Patients: A Cross-Sectional Study

Background

Depression is a particularly common psychological disorder that affects cancer patients. Diagnosed with hematological malignancies constitute a serious unpredictable and uncontrollable medical stress situation and patients are susceptible to suffer from depressive symptoms. The aims of the study were to explore the correlation between perceived stress and depressive symptoms in patients with hematological malignancies, and assess the mediating role of mental adjustment between these variables.

Methods

A single center, cross-sectional study was performed by convenience sampling between July 2013 and April 2014 in a hospital of China. The Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and Mini-Mental Adjustment Scale, as well as questions about demographic and clinical factors was distributed to 300 hematological cancer patients. Completed questionnaires were received from 227 inpatients.

Results

The results showed that perceived stress was positively correlated with depressive symptoms. The mental adjustment significantly mediated the relationship between perceived stress and depressive symptoms.

Conclusions

Among hematological cancer patients perceived stress may be a risk factor for depressive symptoms, whereas positive coping style might be protective against depressive symptoms. Results showed that medical managers could support the development of mental adjustment in the patients to alleviate psychological disorders.

Resilience among patients across the cancer continuum: diverse perspectives

Each phase of the cancer experience profoundly affects patients' lives. Much of the literature has focused on negative consequences of cancer; however, the study of resilience may enable providers to promote more positive psychosocial outcomes before, during, and after the cancer experience. The current review describes the ways in which elements of resilience have been defined and studied at each phase of the cancer continuum. Extensive literature searches were conducted to find studies assessing resilience during one or more stages of the adult cancer continuum. For all phases of the cancer continuum, resilience descriptions included preexisting or baseline characteristics, such as demographics and personal attributes (e.g., optimism, social support), mechanisms of adaptation, such as coping and medical experiences (e.g., positive provider communication), as well as psychosocial outcomes, such as growth and quality of life. Promoting resilience is a critical element of patient psychosocial care. Nurses may enable resilience by recognizing and promoting certain baseline characteristics and optimizing mechanisms of adaptation.

‘I have learned from my pain’: post-traumatic growth in breast cancer patients

SUMMARY 

In this report, we highlight the positive psychological changes that may occur in the aftermath of breast cancer, known as post-traumatic growth (PTG). Assuming Tedeschi and Calhoun's conceptualization, we present the main dimensions of PTG and the prevalence in women with breast cancer. We address the issue of the adaptative significance of PTG and summarize some of the most relevant empirical studies, based on a selective review. We also reflect on the role of therapist in fostering PTG in clinical practice.

Coping with early stage breast cancer: examining the influence of personality traits and interpersonal closeness

The study examines the influence of personality traits and close relationships on the coping style of women with breast cancer. A sample of 72 Italian patients receiving treatment for early stage breast cancer was recruited. Participants completed questionnaires measuring personality traits (Interpersonal Adaptation Questionnaire), interpersonal closeness (Inclusion of the Other in the Self Scale), and adjustment to cancer (Mini-Mental Adjustment to Cancer Scale). We hypothesized that diverse personality traits and degrees of closeness contribute to determine the coping styles shown by participants. Multiple regression analyses were conducted for each of the five coping styles (Helplessness/Hopelessness, Anxious Preoccupation, Avoidance, Fatalism, and Fighting Spirit) using personality traits and interpersonal closeness variables (Strength of Support Relations, and Number of Support Relations) as predictors. Women who rated high on assertiveness and social anxiety were more likely to utilize active coping strategies (Fighting Spirit). Perceived strength of relationships was predictive of using an active coping style while the number of supportive relationships did not correlate with any of the coping styles. Implications for assessment of breast cancer patients at risk for negative adaptation to the illness and the development of psychosocial interventions are discussed.

The Mediating Role of Resilience on Quality of Life and Cancer Symptom Distress in Adolescent Patients With Cancer

Understanding how cancer symptom distress and resilience contribute to quality of life (QoL) in adolescent cancer and may potentially help these patients achieve better health-related outcomes. The objective of this study was to describe cancer symptom distress, QoL, and resilience in adolescents with cancer and to determine whether resilience is a mediating variable. Forty adolescent cancer patients were recruited, and data were collected via a demographic questionnaire, the Cancer Symptom Distress Scale, the Resilience Scale, and the Minneapolis-Manchester Quality of Life Scale. Pearson's correlation, multiple regressions, and the Sobel test were conducted. Both resilience and cancer symptom distress were regressed against QoL, accounting for 62.1% of observed variation in QoL scores. The bootstrap result estimated the true indirect effect between -.0189 and -.0024, with a 95% confidence interval. Resilience mediates the relationship between cancer symptom distress and QoL. Clinical use of a resilience measure, for example to use in developing and evaluating interventions focused on enhancing resilience, may be practical for nurses.

"Trust in the Lord": religious and spiritual practices of African American breast cancer survivors

Few studies have examined the role of religion and spirituality among African American breast cancer patients. This study explored how African American women cope with breast cancer through religious and spiritual practices. Forty-seven African American women who had completed treatment for breast cancer participated in in-depth interviews about their experiences. The majority of the women mentioned using both individual and communal religious and spiritual practices to cope with their breast cancer diagnosis and treatment. The main themes that emerged in terms of the types of religious and spiritual practices included: (1) attendance at religious services, (2) comfort through prayers of others, and (3) encouragement through reading Biblical scriptures. These practices helped women "trust in the Lord" throughout the many challenges of cancer from diagnosis through survivorship. Although this study is exploratory, the findings illustrate how African American women with breast cancer use religious and spiritual practices to cope with their diagnosis and treatment. For clinicians, the findings provides an understanding of spiritual and religious needs in diverse populations and the importance of referring patients onto spiritual and religious resources and support.

Breast cancer and coping among women of color: a systematic review of the literature

Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.

Predictors of posttraumatic growth in women with breast cancer

OBJECTIVE

Posttraumatic growth (PTG) is defined as 'positive psychological change experienced as a result of a struggle with highly challenging life circumstances'. The current study examined change in PTG over 2 years following breast cancer diagnosis and variables associated with PTG over time.

METHODS

Women recently diagnosed with breast cancer completed surveys within 8 months of diagnosis and 6, 12, and 18 months later. Linear mixed effects models were used to assess the longitudinal effects of demographic, medical, and psychosocial variables on PTG as measured by the Posttraumatic Growth Inventory (PTGI).

RESULTS

A total of 653 women were accrued (mean age = 54.9, SD = 12.6). Total PTGI score increased over time mostly within the first few months following diagnosis. In the longitudinal model, greater PTGI scores were associated with education level, longer time since diagnosis, greater baseline level of illness intrusiveness, and increases in social support, spirituality, use of active-adaptive coping strategies, and mental health. Findings for the PTGI domains were similar to those for the total score except for the Spiritual Change domain.

CONCLUSION

PTG develops relatively soon after a breast cancer diagnosis and is associated with baseline illness intrusiveness and increases in social support, spirituality, use of active-adaptive coping strategies, and mental health.

The roles of support seeking and race/ethnicity in posttraumatic growth among breast cancer survivors

Posttraumatic growth (PTG) after cancer can minimize the emotional impact of disease and treatment; however, the facilitators of PTG, including support seeking, are unclear. The authors examined the role of support seeking on PTG among 604 breast cancer survivors ages 40 to 64 from the Health Eating, Activity, and Lifestyle (HEAL) Study. Multivariable linear regression was used to examine predictors of support seeking (participation in support groups and confiding in health care providers) as well as the relationship between support seeking and PTG. Support program participation was moderate (61.1%) compared to the high rates of confiding in health professionals (88.6%), and African Americans were less likely to report participating than non-Hispanic Whites (odds ratio = .14, confidence intervals [0.08, 0.23]). The mean (SD) PTG score was 48.8 (27.4) (range 0-105). Support program participation (β = 10.4) and confiding in health care providers (β = 12.9) were associated (p < .001) with higher PTG. In analyses stratified by race/ethnicity, PTG was significantly higher in non-Hispanic Whites and African American support program participants (p < .01), but not significantly higher in Hispanics/Latinas. Confiding in a health care provider was only associated with PTG for non-Hispanic Whites (p = .02). Support program experiences and patient-provider encounters should be examined to determine which attributes facilitate PTG in diverse populations.