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Williamson TJ, Garon EB, Irwin MR, Choi AK, Goldman JW, Stanton AL. Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden. Psychosom Med 2024; 86:334-341. [PMID: 38436657 PMCID: PMC11081853 DOI: 10.1097/psy.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer. METHODS Lung cancer patients on active oncological treatment ( N = 108; 74.1% stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep. RESULTS Higher discrimination ( b = 5.52, 95% confidence interval [CI] = 2.10-8.94) and constrained disclosure ( b = 0.45, 95% CI = 0.05-0.85) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress ( b = 0.19, 95% CI = 0.09-0.29) and physical symptoms ( b = 0.28, 95% CI = 0.17-0.40) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI = 0.13-1.96) and physical symptoms (indirect effect = 1.58, 95% CI = 0.37-2.79) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI = < 0.01-0.17) and physical symptoms (indirect effect = 0.13, 95% CI = 0.01-0.25). CONCLUSIONS Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.
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Affiliation(s)
- Timothy J. Williamson
- Department of Psychological Science, Loyola Marymount University
- Department of Psychology, University of California, Los Angeles
| | - Edward B. Garon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Michael R. Irwin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Alyssa K. Choi
- Department of Psychology, University of California, Los Angeles
- Department of Psychology, San Diego State University
| | - Jonathan W. Goldman
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
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2
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Karademas EC, Roziner I, Mazzocco K, Pat-Horenczyk R, Sousa B, Oliveira-Maia AJ, Stamatakos G, Cardoso F, Frasquilho D, Kolokotroni E, Lemos R, Marzorati C, Mattson J, Pettini G, Spyropoulou E, Poikonen-Saksela P, Simos P. The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer. Psychol Health 2023; 38:1635-1648. [PMID: 35147473 DOI: 10.1080/08870446.2022.2038157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa. DESIGN AND MAIN OUTCOMES MEASURES Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6. RESULTS Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high. CONCLUSION The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.
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Affiliation(s)
- E C Karademas
- Department of Psychology, University of Crete, Rethymno, Greece
- Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - I Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - K Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - R Pat-Horenczyk
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - B Sousa
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - G Stamatakos
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - D Frasquilho
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
| | - E Kolokotroni
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - R Lemos
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - J Mattson
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - E Spyropoulou
- Department of Psychology, University of Crete, Rethymno, Greece
| | - P Poikonen-Saksela
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - P Simos
- Foundation for Research and Technology - Hellas, Heraklion, Greece
- Medical School, University of Crete, Rethymno, Greece
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3
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Dietrich MS, Gaitatzis K, Koelmeyer L, Boyages J, Abramson VG, McLaughlin SA, Ngui N, Elder E, French J, Hsu J, Hughes TM, Stolldorf DP, Shah C, Ridner SH. Prospective Surveillance with Compression for Subclinical Lymphedema: Symptoms, Skin, and Quality-of-Life Outcomes. Lymphat Res Biol 2022. [PMID: 36126315 DOI: 10.1089/lrb.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients underwent a compression (sleeve and gauntlet) intervention for subclinical breast cancer-related lymphedema (S-BCRL). Physical, emotional, and quality-of-life (QoL) outcomes were examined. Associations of change in extracellular fluid alone through bioimpedance spectroscopy (BIS) or change in whole-arm volume through tape measure with the outcomes at time of S-BCRL were explored. Methods and Results: We enrolled newly diagnosed nonmetastatic breast cancer patients for surveillance up to 36 months postoperatively. Upon detection of S-BCRL, a 28-day compression intervention was initiated. Data were obtained through physical examination/measurement and self-report instruments: skin examination, Lymphedema Symptom Intensity and Distress Survey-Arm, and Functional Assessment of Cancer Therapy General (FACT-G), Breast (FACT-B), and FACT-B+4. Improvements with intervention were observed in the proportion of patients reporting symptom scores ≥3 in function (Cohen's d = -0.46, p < 0.01), in biobehavioral (Cohen's d = -0.30, p < 0.05), maximum number of skin conditions (Cohen's d = -0.34, p < 0.05. 3), FACT-B (Cohen's d = 0.52, p < 0.01), and FACT-B + four (Cohen's d = -0.42, p < 0.01). At the study endpoint, compared with those who did not progress, chronic breast cancer-related lymphedema (C-BCRL) progressing patients had higher overall symptom scores (p = 0.037), more skin conditions (p = 0.009), and lower total FACT-G and FACT-B scores (p < 0.05). At the time of S-BCRL, detection of greater BIS unit change correlated with higher symptom, skin condition, and QoL values. Greater whole-arm volume change correlated with higher FACT-B+4 scores (all p < 0.05). Conclusions: Prospective surveillance, symptom assessment, and compression intervention promote low progression rates from S-BCRL to C-BCRL and as such reduce symptom burden. This closed study is registered with ClinicalTrials.gov NCT02167659.
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Affiliation(s)
- Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Katrina Gaitatzis
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Department of Health Sciences, Macquarie University Macquarie Park, Sydney, Australia
| | - Louise Koelmeyer
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Department of Health Sciences, Macquarie University Macquarie Park, Sydney, Australia
| | - John Boyages
- Australian Lymphoedema Education, Research, and Treatment (ALERT) Program, Department of Health Sciences, Macquarie University Macquarie Park, Sydney, Australia.,Sydney Adventist Hospital Integrated Cancer Centre, ICON Cancer Centre, Wahroonga, Australia
| | - Vandana G Abramson
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | | | - Nicholas Ngui
- Northern Surgical Oncology, Sydney Adventist Hospital, Wahroonga, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Center Institute, Westmead Hospital, Westmead, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia.,Lakeside Specialist Breast Clinic, Lakeview Private Hospital Norwest, Norwest, Australia
| | - James French
- Westmead Breast Cancer Center Institute, Westmead Hospital, Westmead, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia.,Lakeside Specialist Breast Clinic, Lakeview Private Hospital Norwest, Norwest, Australia
| | - Jeremy Hsu
- Westmead Breast Cancer Center Institute, Westmead Hospital, Westmead, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia.,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia
| | - T Michael Hughes
- Northern Surgical Oncology, Sydney Adventist Hospital, Wahroonga, Australia.,Sydney Adventist Hospital Clinical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Chirag Shah
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sheila H Ridner
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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Fisher HM, Taub CJ, Lechner SC, Antoni MH. Greater Post-Surgical Pain Predicts Long-Term Depressed Affect in Breast Cancer Patients. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021; 28:171-182. [DOI: 10.1027/2512-8442/a000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Depressed affect is observed during primary treatment for early-stage breast cancer and often persists into survivorship. Pain can influence the long-term emotions of women with breast cancer. Behavioral mechanisms explaining this relationship are less clear. Coping during primary treatment may play a role in the association between pain and depressed affect. Aims: Our observational study examined a longitudinal mediation model testing whether post-surgical pain intensity predicted depressed affect 5 years later via disengagement and/or engagement coping at the end of treatment. Method: Women ( N = 240) with stage 0–III breast cancer completed measures of pain, coping, and depressed affect 4–10 weeks post-surgery, and 12 months and 5 years later. Results: Structural modeling yielded measurement models of 12-month disengagement and engagement coping. Direct effects emerged between post-surgical pain intensity and 12-month disengagement (β = .37, p < .001) and engagement coping (β = .16, p < .05). Post-surgical pain intensity was also related to 5-year depressed affect (β = .25, p < .05). Disengagement and engagement coping were not associated with depressed affect at 5-year follow-up, and there was no evidence of mediation. Limitations: This is a secondary analysis of data from a trial conducted several years ago, and may not generalize due to a homogenous sample with attrition at long-term follow-up. Conclusions: Greater post-surgical pain intensity predicts more disengagement and engagement coping at the end of primary treatment, as well as depressed affect during survivorship. Managing post-surgical pain may influence the emotions of survivors of breast cancer up to 5 years later, possibly through coping or non-coping processes.
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Affiliation(s)
- Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Chloe J. Taub
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Michael H. Antoni
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Livingston JD, Youssef GJ, Francis LM, Greenwood CJ, Olsson CA, Macdonald JA. Hidden in Plain Sight? Men's Coping Patterns and Psychological Distress Before and During the COVID-19 Pandemic. Front Psychiatry 2021; 12:772942. [PMID: 35069282 PMCID: PMC8766713 DOI: 10.3389/fpsyt.2021.772942] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals cope with stress using multiple strategies, yet studies of coping profiles are rare. We draw data from a longitudinal study of Australian men (n = 272; 30-37 years), assessed before (T1) and during (T2) a nation-wide COVID-19 lockdown. We aimed to: (1) identify men's multi-strategy coping profiles before and during the pandemic; (2) assess cross-sectional (T1-T1, T2-T2) and prospective (T1-T2) associations between profiles and symptoms of psychological distress (stress, anxiety, depression, and anger); and (3) examine relationships between coping profiles and appraisals of pandemic-related stressors and options for coping. In latent profile analyses of 14 coping strategies, three profiles emerged that were largely consistent across T1 and T2: (1) Relaxed Copers (low use of all strategies), (2) Approach Copers, and (3) Dual Copers (high avoidant and moderate-high approach-oriented strategies). Compared to Relaxed and Approach Copers, men who were Dual Copers had elevated psychological distress cross-sectionally before (T1) and during (T2) the pandemic, but not prospectively. Post hoc analyses suggested this was because many men changed coping profiles in the context of the pandemic. Men with stable (T1-T2) or new (T2 only) Dual Coping profiles experienced greater psychological distress and more negative appraisals of pandemic stressors and options for coping. In sum, at the sample level, the composition of men's coping profiles and associations with mental health risk were relatively stable over time and contexts; however, many men appeared to respond to pandemic conditions by changing coping profile groups, with mostly positive mental health outcomes. Of concern were men who adopted more avoidant strategies (e.g., denial, self-distraction, disengagement, substance use, and self-blame) under pandemic conditions. These Dual Coper men also engaged in commonly observable approach-oriented behaviours (e.g., planning, active coping, humour, seeking practical social support) that may mask their vulnerability to mental health risk. Our findings highlight the clinical importance of enquiring about escalating or frequent avoidant coping even in the presence of more active and interactive approach-oriented behaviours.
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Affiliation(s)
- Julianne D Livingston
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Lauren M Francis
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
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6
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Feng LS, Dong ZJ, Yan RY, Tu CL, Zhang LY, Shen JY, Zhang SY. Development and validation of the cancer symptoms discrimination scale: a cross-sectional survey of students in Yunnan, China. BMC Palliat Care 2020; 19:156. [PMID: 33046031 PMCID: PMC7552442 DOI: 10.1186/s12904-020-00662-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023] Open
Abstract
Background This study aimed to devise a Cancer symptoms Discrimination Scale (CSDS) suitable for China based on a cross-sectional survey. Methods The CSDS was developed using the classical measurement theory. A total of 3610 students from Yunnan province, China, participated in the cross-sectional survey. The test version of the scale was modified by the item analysis method, and after the official version of CSDS was developed, its reliability and validity were verified. A univariate analysis of variance and a multiple linear regression model were used to analyze the influencing factors of cancer symptoms discrimination among the university/college students. Results There were 21 items in total for the CSDS, including 3 subscales --- common clinical manifestations (11 items), physical appearance defects (6 items), and drainage tube(s) wearing (4 items). This CSDS had good validity (GFI = 0.930, AGFI = 0.905, RMR = 0.013, I-CVIs> 0.80, and the Pearson correlation coefficient was satisfactory.) and reliability (Cronbach’s alpha = 0.862, spearman-brown coefficient = 0.875). The multiple linear regression showed that certain factors may affect the students’ discrimination level against cancer symptoms (P < 0.05), including gender, major, current education degree, guardian’s highest record of formal schooling, self-rated health status, history of care for cancer patients, family relationship, ways of cancer knowledge acquisition, good/poor understanding of cancer-related information, degree of cancer fear, and their perception of cancer infectiousness. Conclusion This CSDS, with good reliability and validity, can be used for the evaluation of the discrimination risk and levels against cancer symptoms among healthy students.
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Affiliation(s)
- Lin-Sen Feng
- The Sixth Affiliated Hospital of Kunming Medical University (The People's Hospital of Yuxi City), Yuxi, Yunnan, China.
| | - Zheng-Jiao Dong
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Ruo-Yu Yan
- The Sixth Affiliated Hospital of Kunming Medical University (The People's Hospital of Yuxi City), Yuxi, Yunnan, China
| | - Chang-Ling Tu
- The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Lan-Yu Zhang
- No.1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan, China
| | - Jiang-Yun Shen
- No.1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan, China
| | - Shi-Yu Zhang
- The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
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