Cancer, personality and stress: Prediction and prevention

Blaming in Women with Breast Cancer Subjected to Intimate Partner Violence: A Hermeneutic Phenomenological Study

Objective

The present study was conducted to determine the blaming experiences of women with breast cancer subjected to intimate partner violence (IPV).

Methods

This hermeneutic phenomenological study explored blaming experiences of women with breast cancer subjected to IPV. Nine women with a mean age of 47.5 years referred to oncology hospitals in Tabriz (Iran) were interviewed using semi-structured in-depth interviews. Data analysis was performed based on Van Manen's thematic analysis method.

Results

The main theme emerged from the data is "blaming as a shifting cognitive judgment" with three subthemes of patient blaming partner, partner blaming patient, and self-blame.

Conclusions

The findings of the present study revealed that cognitive judgment shifting could be emerged as different types of blaming in the patients with breast cancer exposed to IPV. It is suggested that oncology nurses heed the psychological needs of women with breast cancer through holistic nursing considering couple and family-centered care.

Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review

Research has shown that personality is associated with anxiety levels in the general population. However, little is known about the relationship between personality and preoperative anxiety and the subsequent health outcomes in patients undergoing surgery. Therefore, this review aimed to identify studies that explored the relationship between personality traits and preoperative anxiety, as well as their association with postoperative outcomes. Existing literature shows that anxiety may play an intermediary role in the relationship between personality and postoperative outcomes. Severe anxiety may partially explain the adverse effects of certain personality traits, such as neuroticism, on postoperative outcomes. However, the relationship between personality traits, preoperative anxiety, and postoperative outcomes remains unclear. Interventions such as clinical evaluation, preoperative counseling, and management strategies can be of great value in identifying and resolving patients' anxiety and negative emotions to improve postoperative outcomes.

Personality coherence as a personality dynamics-related concept

Extant theoretical models of personality coherence/incoherence do not sufficiently address the challenge of explaining personality coherence dynamics and the role of psychological mechanisms, including temperament and attention. To overcome these limitations, the Complex-System Approach to Personality (C-SAP) postulates that personality coherence is a within-person structure that arises from the functional consistency/inconsistency between personality traits/types, underlain by specific attentional and temperament mechanisms that have integrative and regulatory potential. The dominant (reactive, regulative) function of stimulation processing in temperament types is the foundation for assessing personality coherence. This paper presents a revised, fine-grained model of personality coherence - originally arising from the C-SAP - that is enriched by a focus on personality coherence dynamics in relation to behavioral consistency. The methodological principles necessary for studying personality coherence dynamics are outlined in detail. This paper also addresses: (i) research methods for relating personality coherence/incoherence to behavioral consistency/inconsistency, and (ii) situational contexts that are important to these personality dynamics. In addition, personality coherence dynamics in relation to the self and character and the impact of the C-SAP assumption that behaviors are more stable than traits/types on the relation between personality coherence and behavioral consistency are discussed.

From blocked flows to suppressed emotions: the life of a trope

Internal blockages and build-ups cause disease: traditionally, this principle seemed intuitive both to professionals and the laity, explained conditions as diverse as melancholy and scurvy (among many others), and justified the use of evacuative treatments to get rid of noxious matter. With the collapse of humoral medicine and the establishment of the concept of specific causation, one might have expected time-honoured tropes of obstruction to die off. They did not die off, but moved with the times and adapted to new conditions. Emphasis swung from the noxious character of retained substances to the harms of suppressed urges and emotions-harms including disabling maladjustments as a result of sexual inhibition, and cancer as a result of emotional inhibition. In both cases the causal mechanisms resemble traditional blockages. Theories of noxious inhibitions or psychological blocks, which have a familiar and perhaps even intuitive sound because they have so much history behind them, can easily lead patients into fanciful methods of prevention and treatment.

Type D Personality and Big Five Personality Traits and the Risk of Breast Cancer: A Case-Control Study

OBJECTIVE

The goal of this study is to establish the differences in Type D personality and Big five personality traits between a group of newly diagnosed breast cancer patients and a group of controls.

METHODS

A comparative study of breast cancer patients and women without previous history of cancer was carried out. We used Type D Scale-14 as an instrument for the assessment of the type-D personality pattern and NEO-FFI for the assessment of the Big Five personality traits. Conditional logistic regression models were used to estimate odds ratios and 95% confidence intervals were applied for breast cancer by personality trait factors.

RESULTS

Negative affectivity (NA) (OR = 4.45 95% CI: 1.96-10.61), neuroticism HIGH (OR = 3.97, 95% CI: 1.08-15.81), openness to experience HIGH (OR = 3.47 95% CI: 1.11-11.49), were associated factors significantly related to an increased risk of breast cancer, whereas Social Inhibition (SI) was associated factor with a decreased risk of breast cancer (OR = 0.40 95% CI: 0.16-0.92).

CONCLUSIONS

This was the first case-control study which analyzed NA and SI traits in breast cancer patients. SI as a breast-cancer risk decreasing factor might indicate that expressing negative emotions is not always a healthy mechanism of their regulation.

Personality Traits and Cardiotoxicity Arising From Cancer Treatments: An Hypothesized Relationship

Thanks to the evolution in medical and pharmaceutical research, to date, the number of cancer treatments is increasingly on the rise. Despite this, several side effects related to cancer treatments can exacerbate patients’ physical and psychological conditions, such as cardiotoxicity. Over the years, researchers have explored the possible relationship between psychological variables and physical diseases. Even though some authors examined the relationship between personality and specific diseases, no scientific attention has been paid to the role of personality in the development of cardiotoxicity arising from cancer treatments. Yet this is an important objective, given that determining whether personality influences cardiac toxicity of anticancer treatments could inform the processes by which stable psychological factors influence health. This contribution summarizes and analyzes the available scientific evidence about the association between personality and main cardiotoxicity-related-diseases of anticancer therapies, including cancer and cardiovascular diseases, in order to sketch a hypothetical model of the relationship between personality traits and cardiotoxicity.

Analysis of Personality Traits in Patients with Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a highly-curable malignancy mostly affecting young people. As far as we know, there is no published study that has analyzed personality profiles in HL nor their potential role in lymphomagenesis, natural history, or response to treatment. We aim to explore the personality traits of HL patients, as well as the prevalence of mental disorders and suicide ideas. We retrospectively identified all alive HL patients from three centers (Son Espases and Son Llatzer University Hospitals and Hospital del Mar of Barcelona) for using NEO Five-Factor Inventory (NEO-FFI) and Personality Inventory for DSM-5 Brief Form. Patients with HL showed significantly higher neuroticism scores and lower conscientiousness, extraversion, and openness. Considering maladaptive personality traits, HL patients showed higher levels of detachment and psychoticism. All of these translated into the fact that HL patients showed more than double the prevalence of mental illnesses (41%) and more than triple the prevalence of suicidal ideation or attempts than the general population (15 and 6%, respectively). An exploratory analysis of biomarkers associated with HL personality traits showed that higher scores of neuroticism correlated with more elevated erythrocyte sedimentation rate (ESR) and red cell distribution width (RDW), suggesting a potential link between neuroticism and proinflammatory activity in HL.

Type C Personality: Conceptual Refinement and Preliminary Operationalization

In this paper, we have presented our proposal for reconceptualization and operationalization of Type C (cancer-prone) personality. Based on theoretical analyses, taking into account both the literature on Type C and models of personality structure, we have proposed a two-facet structure of Type C, comprising Submissiveness (the interpersonal aspect) and Restricted Affectivity (the intrapersonal aspect). The study devoted to the validation of the measure of Type C involved 232 participants aged 18-70 (M = 29.35, SD = 8.93; 54% male). We used (a) our proposed measure of Type C personality and (b) the Circumplex of Personality Metatraits Questionnaire (CPM-Q-SF; Strus and Cieciuch, 2017), assessing personality metatraits. The measure of Type C proved to have acceptable internal consistency (Cronbach's alpha was 0.85 for Submissiveness and 0.78 for Restricted Affectivity). The measurement model in confirmatory factor analysis with two latent variables proved to be well-fitted to the data. We have also confirmed the hypothesis concerning the location of the two facets of Type C personality close to each other in the theoretically predicted area between the Delta-Plus/Self-Restraint and Beta-Minus/Passiveness metatraits (in the Circumplex of Personality Metatraits). The clinical value of the theoretically refined Type C can be tested in the next step in research on patients with cancer.

Status of the Trait Concept in Contemporary Personality Psychology: Are the Old Questions Still the Burning Questions?

This special issue of Journal of Personality addresses one of the cardinal concerns of personality psychology, namely, the status of traits in contemporary personality science. Trait theory is a major scientific model for personality explanation and research. Although there have been critiques of traits, typically formulated from the point of view of the social-cognitive perspective, the trait approach can be viewed as a continuously developing paradigm. However, personality psychology persists in tackling burning questions concerning the status of traits that need to be answered. Modern trait approaches confront problems such as constructing an objective personality traits assessment, connecting the descriptive traits with explanatory processes, applying traits for understanding the individual person, clarifying the relation of traits to behavior, and using traits for solving cardinal concerns of personality psychology (e.g., personality organization). This special issue presents examples of contemporary trait theories that attempt to provide possible solutions to these issues and/or delineate other main issues to be resolved by future research and theorizing. We have asked contributors to portray their approach and describe in what way their trait theory continues a historic tradition and in what respect it breaks with the past and moves trait models to more mature scientific levels.

Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer

PURPOSE

The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer.

METHODS

A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death.

RESULTS

After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time.

CONCLUSIONS

Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.

Personality and fatal diseases: Revisiting a scientific scandal

During the 1980s and 1990s, Hans J Eysenck conducted a programme of research into the causes, prevention and treatment of fatal diseases in collaboration with one of his protégés, Ronald Grossarth-Maticek. This led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature with effect sizes that have never otherwise been encounterered in biomedical research. This article outlines just some of these reported findings and signposts readers to extremely serious scientific and ethical criticisms that were published almost three decades ago. Confidential internal documents that have become available as a result of litigation against tobacco companies provide additional insights into this work. It is suggested that this research programme has led to one of the worst scientific scandals of all time. A call is made for a long overdue formal inquiry.

Personality Typology in Patients with Traumatic Limb Fractures

The notion that personality impacts health is not new. According to Grossarth-Maticek and Eysenck’s theoretical approach, the main factor for health is the ability for self-regulation, which seems to moderate the effects of some physical risk factors.

The aim of this study was to evaluate personality characteristics of patients hospitalized for traumatic limb’s fractures which have been operatively treated. To our knowledge, it is the first study of this type in the region.

The evaluated sample comprises two groups of examinees: patients hospitalized at the Traumatology Clinic for surgery after fractured limbs (N=30) and healthy people (N=120) as control, previously examined. Two psychometric tests were used: Grossarth-Maticek questionnaire and Eysenck Personality Questionnaire (EPQ).

Obtained results showed that the personality characteristics of patients with traumatic limb fractures belong generally to the “healthy type 4” of Grossarth-Maticek typology, similarly as the control. It correlates to the low N (neuroticism) and moderate E (extraversion) scales in the Eysenck typology.

We showed that gender and age highly influence the scores obtained from the questionnaire.

The type of personality could influence reactions in life situations, coping with stress and consequently to be a trigger for any disorder, even traumatic fractures

[The pain experience according to a phenomenological view on palliative care]

In palliative care, people with advanced or terminal phase cancer represent a significant proportion of patients. Persuaded that the pain and suffering they experience will never disappear from their daily life, patients are exposed to successive fracture triggered by psychosocial/physical factors. Furthermore, the difficulty in palliative care is that the pain is also a subjective phenomenon. However, the only information available to indicate pain remains the quantitative assessment of the patient or the observation of his/her behaviour. Pain caused by cancer optimally exhibits the difficulty of pain assessment, where a patient may properly assess, through their somatic pain, their own experience of pain expressed according to the consequence of illness on their history and personality.

OBJECTIVES

This exploratory study aims to show how the development of analogical subjective speech has an effect on the pain experience in patients with cancer. Indeed, the hypothesis is that one can reduce the sensation of pain by transforming the emotional experience via a figurative/discursive activity due to an elaboration work and clarification of the painful experience. Method-Four terminally ill patients passed the "L'Épreuve des Trois Arbres" (three-tree test) (ETA), which consisted in drawing trees and telling their story. The ETA aims to facilitate the expression of the overall experience according to a person's perspective on a specific situation. In this experiment, quantitative and qualitative data were collected. More specifically, the quantitative data was based on the assessment of somatic pain using the visual analog scale (VAS) of 1 to 10 (0 = no pain, 10 = unbearable pain) and a qualitative analysis assessed with the ETA, which focused on the meaning of pain, a subjective component that can increase the expression of somatic pain. The pain experience is assessed before and after the execution of the ETA using the VAS.

RESULTS

The results show a reduction of painful sensation and its behavioural expression. This could be due to the refocusing of attention and transformation of emotional experience through a figurative and discursive activity.

DISCUSSION

The ETA seems to reduce somatic pain by allowing verbalization. The emotional repression of some patients who inhibited the expression of their pain would explain the increase of painful sensation. The psychological approach associated with the theme of the tree offers an opportunity to expound upon the experience of pain in an analogical mode, situating the current painful personal experience in a specific biography. Furthermore, part of the suffering highlighted in protocols was the break that makes the announcement of illness. It generated a sense of rupture between the time before and after, sometimes until a real crisis of identity, which can take on one of the facets of depression. ETA encourages the rebuilding of a psychic continuity between before and after the disease.

Is personality associated with cancer incidence and mortality? An individual-participant meta-analysis of 2156 incident cancer cases among 42,843 men and women

Background:

The putative role of personality in cancer risk has been controversial, and the evidence remains inconclusive.

Methods:

We pooled data from six prospective cohort studies (British Household Panel Survey; Health and Retirement Study; Household, Income, and Labour Dynamics in Australia; Midlife in the United Survey; Wisconsin Longitudinal Study Graduate; and Sibling samples) for an individual-participant meta-analysis to examine whether personality traits of the Five Factor Model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) were associated with the incidence of cancer and cancer mortality in 42 843 cancer-free men and women at baseline (mean age 52.2 years, 55.6% women).

Results:

During an average follow-up of 5.4 years, there were 2156 incident cancer cases. In random-effects meta-analysis adjusted for age, sex, and race/ethnicity, none of the personality traits were associated with the incidence of all cancers or any of the six site-specific cancers included in the analysis (lung, colon, breast, prostate, skin, and leukaemia/lymphoma). In the three cohorts with cause-specific mortality data (421 cancer deaths among 21 835 participants), none of the personality traits were associated with cancer mortality.

Conclusions:

These data suggest that personality is not associated with increased risk of incident cancer or cancer-related mortality.

Emotional control, styles of coping with stress and acceptance of illness among patients suffering from chronic somatic diseases

The purpose of this study was to analyse the associations of emotional control with sociodemographic and clinical variables in a sample of patients with a range of chronic somatic diseases. The relationships between emotional control, coping styles and adjustment to the disease were investigated. The sample consisted of 300 patients with the mean age of 54.60 ± 17.57 years. Courtauld Emotional Control Scale was used to measure the patients' tendency to suppress negative emotions, Coping Inventory for Stressful Situations was used to measure coping styles and Acceptance of Illness Scale was applied to determine adjustment to the disease. Patients with neurological conditions showed significantly lower suppression of anger. Levels of emotional control were found to be related to gender, age and educational level but not to the place of residence. Task-oriented style of coping with stress correlated positively with suppression of depression and anxiety, whereas acceptance of illness correlated negatively with suppression of anger. Levels of emotional control are only weakly related to the type of diagnosis; however, some clinical samples may show lower suppression of anger. Suppression of negative emotions is weakly related to adjustment indicators such as certain coping styles and acceptance of illness.

A nationwide population-based cohort study: will anxiety disorders increase subsequent cancer risk?

Background

The aim of this study was to evaluate a possible association between malignancy and anxiety disorders (AD) in Taiwan.

Methods

We employed data from the National Health Insurance system of Taiwan. The AD cohort contained 24,066 patients with each patient randomly frequency matched according to age and sex with 4 individuals from the general population without AD. Cox's proportional hazard regression analysis was conducted to estimate the influence of AD on the risk of cancer.

Results

Among patients with AD, the overall risk of developing cancer was only 1% higher than among subjects without AD, and the difference was not significant (hazard ratio [HR] = 1.01, 95% confidence interval [95% CI] = 0.95–1.07). With regard to individual types of cancer, the risk of developing prostate cancer among male patients with AD was significantly higher (HR = 1.32, 95% CI = 1.02–1.71). On the other hand, the risk of cervical cancer among female patients with AD was marginally significantly lower than among female subjects without AD (HR = 0.72, 95% CI = 0.51–1.03).

Limitations

One major limitation is the lack of information regarding the life style or behavior of patients in the NHI database, such as smoking and alcohol consumption.

Conclusions

Despite the failure to identify a relationship between AD and the overall risk of cancer, we found that Taiwanese patients with AD had a higher risk of developing prostate cancer and a lower risk of developing cervical cancer.

Development and validation of a personality assessment instrument for traditional korean medicine: sasang personality questionnaire

Objective. Sasang typology is a traditional Korean medicine based on the biopsychosocial perspectives of Neo-Confucianism and utilizes medical herbs and acupuncture for type-specific treatment. This study was designed to develop and validate the Sasang Personality Questionnaire (SPQ) for future use in the assessment of personality based on Sasang typology. Design and Methods. We selected questionnaire items using internal consistency analysis and examined construct validity with explorative factor analysis using 245 healthy participants. Test-retest reliability as well as convergent validity were examined. Results. The 14-item SPQ showed acceptable internal consistency (Cronbach's alpha = .817) and test-retest reliability (r = .837). Three extracted subscales, SPQ-behavior, SPQ-emotionality, and SPQ-cognition, were found, explaining 55.77% of the total variance. The SPQ significantly correlated with Temperament and Character Inventory novelty seeking (r = .462), harm avoidance (r = −.390), and NEO Personality Inventory extraversion (r = .629). The SPQ score of the So-Eum (24.43 ± 4.93), Tae-Eum (27.33 ± 5.88), and So-Yang (30.90 ± 5.23) types were significantly different from each other (P < .01). Conclusion. Current results demonstrated the reliability and validity of the SPQ and its subscales that can be utilized as an objective instrument for conducting personalized medicine research incorporating the biopsychosocial perspective.

Does self-regulation and autonomic regulation have an influence on survival in breast and colon carcinoma patients? results of a prospective outcome study

Background

Cancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC). Other patient related outcomes in oncology are measured by new instruments focusing on adaptive characteristics such as sense of coherence or self-regulation, which could be more appropriate as a prognostic tool than classical HRQL. The aim of this study was to assess the association of autonomic regulation (aR) and self-regulation (SR) with survival.

Methods

146 cancer patients and 120 healthy controls took part in an initial evaluation in 2000/2001. At a median follow up of 5.9 years later, 62 of 95 BC, 17 of 51 CRC patients, and 85 of 117 healthy controls took part in the follow-up study. 41 participants had died. For the follow-up evaluation, participants were requested to complete the standardized aR and SR questionnaires.

Results

On average, cancer patients had survived for 10.1 years with the disease. Using a Cox proportional hazard regression with stepwise variables such as age, diagnosis group, Charlson co-morbidity index, body mass index (BMI)) aR and SR. SR were identified as independent parameters with potential prognostic relevance on survival While aR did not significantly influence survival, SR showed a positive and independent impact on survival (OR = 0.589; 95%-CI: 0.354 - 0.979). This positive effect persisted significantly in the sensitivity analysis of the subgroup of tumour patients and in the subscale 'Achieve satisfaction and well-being' and by tendency in the UICC stages nested for the different diagnoses groups.

Conclusions

Self-regulation might be an independent prognostic factor for the survival of breast and colon carcinoma patients and merits further prospective studies.

Personality factors and breast cancer risk: a 13-year follow-up

Consistent scientific evidence on the possible relationship between psychologic variables and breast cancer development is lacking. In 1996, our group first reported on the present prospective, longitudinal study. We found a weak association between a high score on the antiemotionality scale (indicating an absence of emotional behavior or a lack of trust in one's own feelings) and the development of breast cancer. No associations were found between any of the other 10 studied personality traits and breast cancer development. However, the study had a relatively short follow-up and did not investigate interaction effects between various personality traits. Therefore, the current follow-up study was conducted with the same cohort, which included the 9705 women who attended a biennial population surveillance program for breast cancer and completed a self-report personality questionnaire between January 1, 1989, and December 31, 1990. Women who developed breast cancer during the period from May 17, 1995, through January 1, 2003, formed the case group (n = 217) and were compared with age-matched women without breast cancer who formed the control group (n = 868) with regard to personality traits and medical risk factors for breast cancer. None of the personality factors were statistically significantly associated with an increased risk of breast cancer, with or without adjusting for the medical risk factors. Also, the occurrence of a combination of various personality traits (eg, a so-called cancer-prone personality) was not related to breast cancer development.

Baseline psychosocial predictors of survival in localized melanoma

OBJECTIVE

There is no certainty about the contributing factors or the psychological processes involved in cancer progression. Many studies have suffered from poor theoretical basis, methodological flaws, and only one or few psychosocial factors investigated at a time. We examined the simultaneous contribution of several theory-based psychosocial elements to survival time in melanoma.

METHODS

A consecutive sample of patients with localized (Clarke II-IV) melanoma (N=59) were evaluated with validated questionnaires on coping with cancer, anger expression, perceived social support, noncancer life stresses, and domains of quality of life (QOL) 3-4 months after diagnosis. Cox regression analyses were used to determine the predictors of survival time from the date of diagnosis to the date of death or the last follow-up.

RESULTS

After controlling for age, gender, and Breslow depth for the tumor, the baseline psychological variables related to the cancer-prone Type C response pattern, namely, anger nonexpression (repression), hopelessness, and better single-item self-reported QOL predicted shorter survival. Before hopelessness was added to the model, the amount of depressive symptoms and heavy perceived impact of diagnosis were also predictive. In addition, longer survival was strongly predicted by Cognitive Escape-Avoidance coping, which included items close to the concept of denial/minimizing.

CONCLUSION

Anger nonexpression, hopelessness, and overpositive reporting of QOL--all proposed to include in the Type C response style or reflect emotional nonexpression--seem to comprise a set of factors that reduce survival, whereas denial/minimizing response to the diagnosis as such predicts longer survival.

Baseline psychosocial predictors of survival in localised breast cancer

Despite the large number of studies on the impact of psychosocial factors on breast cancer progression, there is no certainty about the contributing factors or processes involved. We investigated the relative impacts of socioeconomic, psychological, and psychosocial factors on survival in breast cancer. A consecutive sample of 102 patients (participation 82%) under 72 years of age with locoregional breast cancer completed validated questionnaires on coping with cancer, emotional expression (anger), perceived available support, noncancer life stresses, and quality of life 3-4 months after diagnosis. Survival times were measured from the date of diagnosis to the date of relapse and further to the date of death or date of last follow-up. Cumulative Cox regression analyses were carried out. After controlling for biological prognostic factors, age, and baseline treatment, longer survival was predicted by a long education and a minimising-related coping, while shorter survival was predicted by emotional defensiveness (antiemotionality), behavioural-escape coping, and a high level of perceived support. A shorter event-free time was also predicted by unemployment and depressive symptoms. Cancer survival is affected by a complex combination of psychosocial factors, among which minimising predicts a favourable prognosis and anger nonexpression and escape behaviour an unfavourable prognosis. Higher socioeconomic status is associated with longer survival. High scores in well-being scales may reflect emotional nonexpression.

Stress versus discrete negative emotions in the prediction of physical complaints: Does predictive utility vary across ethnic groups?

Reports of stress and negative emotion are important predictors of health. However, whether discrete emotions or stress measures are more useful, whether they contribute independently to outcome, and whether they relate to health equally across ethnic groups remain unclear. In the current study, 207 US-born European American, US-born African American, Black English-speaking Caribbean, and Dominican men aged 40 years and older completed measures of somatic symptoms, trait emotions, and stress. Sadness and stress independently predicted symptom reports, even when examined concurrently, and with demographics controlled; trait anger did not predict symptoms. Moreover, the relations between trait emotions and symptoms varied across groups. Levels of sadness were associated with greater symptoms among US-born European American and Dominican men, but negatively associated among Black English-speaking Caribbean men, and the relations for anger also differed marginally across groups. The results underscore the importance of differentiating among discrete emotions and stress and considering ethnic interactions when examining reports of somatic symptomology. We suggest that the impact of psychological characteristics on health must be considered within cultural and ethnic contexts to be fully understood.

Predictors of quality of life in newly diagnosed melanoma and breast cancer patients

BACKGROUND

Quality of life (QoL) is a multidimensional construct, and several psychosocial and medical factors can predict a patient's QoL. We investigated the impact of factors in the psychological stress processes on QoL 3 months after diagnosis of melanoma or breast cancer.

PATIENTS AND METHODS

In consecutive melanoma and breast cancer patients with localized disease, cancer-specific social support, coping with cancer, personality trait anger expression, non-cancer stress, sociodemographic variables, cancer and treatment variables, and QoL (evaluated as self-reported psychological and physical symptoms, self-perceived QoL, and depression) were assessed with validated quantitative questionnaires. The associations between QoL and the other factors were investigated with multivariate methods.

RESULTS

Only a few factors differed between melanoma and breast cancer, in terms of treatment modalities and gender. The amount of received social support was higher among breast cancer patients. The predicting power of psychological stress factors on all the QoL measures was strong, but differed between the treatment groups (surgery only versus adjuvant treatment). Psychosocial factors were the strongest predictors of QoL, not cancer type or treatment. Behavioral Escape-Avoidance coping was associated with worse QoL. However, non-cancer life stresses showed the strongest QoL-decreasing influence. QoL-enhancing factors, including social support, were seen clearly only within the breast cancer patients receiving adjuvant treatment.

CONCLUSIONS

QoL of newly diagnosed cancer patients is highly associated with psychosocial factors. Non-cancer life stresses seem to be very important in the QoL of newly diagnosed cancer patients. Adjuvant treatment may comprise supportive psychosocial factors that enhance QoL in cancer.

Anxiety, Emotional Suppression, and Psychological Distress Before and After Breast Cancer Diagnosis

The authors examined the influence of anxiety and emotional suppression on psychological distress in 21 patients with breast cancer and 72 patients with benign breast tumor. The patients with breast cancer who suppressed emotion and had chronically high levels of anxiety felt higher levels of emotional distress both before and after the diagnosis. Such patients need psychological interventions, including encouragement to express and communicate their emotions, immediately after disclosure of the diagnosis to help maintain psychological adjustment in the face of the disease.

The relation between negative emotional suppression and emotional distress in breast cancer diagnosis and treatment

Our objective was to investigate differences in emotional distress between negative emotional suppression and expression patients in the progress of medical treatment, including the operation. We studied the differences in affective response between patients who suppress negative emotion and those who express negative emotion by using Profile of Mood States (McNair, Lorr, & Droppleman, 1971) at four sessions: (a) at the first visit to the clinic, (b) immediately after being told the diagnosis of breast cancer, (c) after the operation, and (d) at 3 months after discharge. Our results showed that emotional suppression patients tended to report more emotional distress (in particular, anxiety, depression, and anger) than did emotional expression patients on 3 sessions, the exception being after the operation. Also, patients who suppress anger and anxiety felt strong psychological distress. We suggest that it is essential to encourage suppressive patients to express both negative and positive emotion clearly and appropriately.

Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients

OBJECTIVE

To provide a quantitative summary of effects of psychosocial interventions on cancer survival, and to present an overview of methodological and reporting aspects of the studies.

METHOD

Electronic searches and manual searches of reference lists from review articles and retrieved papers. Two coders independently coded study, participant, treatment, and outcome characteristics of the studies meeting selection criteria.

RESULTS

Thirteen journal articles published between 1989 and 2003 reporting results from 14 controlled intervention studies were included. Results are based on data obtained from 2626 subjects. Effect sizes [hazard ratios (HR)] were heterogeneous and random effects models were used in the analyses. The total mean inverse-variance-weighted HR was 0.85 (95% CI: 0.65-1.11). Randomized studies (n=8) showed no overall treatment effect (HR: 0.77, 95% CI: 0.56-1.06), neither did the nonrandomized studies (HR: 1.00, 95% CI: 0.61-1.62). Interventions using individual treatment (n=3) were, however, found to be effective (HR: 0.55, 95% CI: 0.43-0.70) but interventions using group treatment (n=9) were ineffective (HR: 0.97, 95% CI: 0.73-1.27). Group treatments of breast cancer (n=6) were ineffective (HR: 0.95, 95% CI: 0.69-1.31).

CONCLUSION

A definite conclusion about whether psychosocial interventions prolong cancer survival seems premature. Future studies should use randomization to avoid self-selection of patients with poor prognosis. Interventions should focus on a single diagnosis, take into account known risk factors, and describe their interventions thoroughly.

Differences in emotional distress between breast tumor patients with emotional inhibition and those with emotional expression

The differences in affective status between patients who restrain their negative emotion and those who express negative emotion after being given their breast cancer diagnosis were studied using the Profile of Mood States (POMS) at two sessions: (i) at the first visit to the outpatient surgery clinic, and (ii) immediately after being given the diagnosis of breast cancer. Eighty-seven patients completed the POMS and the Courtauld Emotional Control Scale (CECS) at the first visit to the outpatient surgery clinic at Shiga University of Medical Science Hospital. They also completed the POMS immediately after being given the diagnosis of breast cancer. Breast cancer patients who restrain their negative emotion (n = 8) were highly anxious, depressed and confused after being given the diagnosis compared to breast cancer patients who express negative emotion (n = 8). Emotional distress in benign breast tumor patients was reduced after being given the diagnosis regardless of the trend of emotional inhibition. That is, emotional distress in patients who restrain their emotions was considerably increased compared with that of patients who expressed their emotions when they were faced with a life-threatening disease. These results suggest that it may be therapeutic to advise breast cancer patients to express their negative emotion.

Social identity and health: an intergroup communication approach to cancer

This article describes the ways in which group identifications and stereotypes can inform our understanding of cancer prevention and treatment as well as more general social processes surrounding the experience of cancer. From a perspective grounded in social identity theory, we describe the ways in which understanding primary identities (i.e., those associated with large social collectives such as cultural groups), secondary identities (i.e., those associated with health behaviors), and tertiary identities (i.e., those associated with cancer) can help explain certain cancer-related social processes. We forward a series of propositions to stimulate further research on this topic.

Ethnic variation in the impact of negative affect and emotion inhibition on the health of older adults

The relations between patterns of emotional experience, emotion inhibition, and physical health have been little studied in older adults or ethnically diverse samples. Testing hypotheses derived from work on younger adults, the authors examined the relations between negative affect and emotion inhibition and that of illness (hypertension, respiratory disease, arthritis, and sleep disorder) in a sample (N = 1,118) of community-dwelling older adults from four ethnic groups: U.S.-born African Americans, African Caribbeans, U.S.-born European Americans, and Eastern European immigrants. Participants completed measures of stress, lifestyle risk factors, health, social support, trait negative emotion, and emotion inhibition. As expected, the interaction of ethnicity with emotion inhibition, and, to a lesser extent, negative affect, was significantly related to illness, even when other known risk factors were controlled for. However, the relations among these variables were complex, and the patterns did not hold for all types of illness or operate in the same direction across ethnic groups. Implications for emotion-health relationships in ethnically diverse samples are discussed.

Moderators of the Emotion Inhibition-Health Relationship: A Review and Research Agenda

The preponderance of a growing literature suggests that emotion inhibition is associated with poorer health. However, although inhibition and health are clearly related, the “inhibition hyhpothesis” has taken on the flavor of a contemporary dogma. Conceptual bases are accepted uncritically, and developments from other domains of psychology are incorporated in a selective, self-supporting, and unenlightening manner. Theories have been tested in homogenous samples, with little attention paid to possible contributions from ethnic diversity, developmental differences, or period effects. This article presents an evolutionary framework within which to consider these phenomena. It critiques the conceptual underpinnings of inhibition-health theories and provides a rationale for the expectation of moderator effects across cultures, individuals, and emotions. Directions for future empirical work are provided.

Relationship between trait anxiety, brain activity and natural killer cell activity in cancer patients: a preliminary PET study

The purpose of this study is to examine the relationship between psychological factors, regional brain activity and natural killer cell activity (NKA). Eight patients with malignant diseases were studied by FDG-PET under a resting condition. NKA and degree of anxiety and depression were measured using Taylor's manifest anxiety scale (MAS) and Zung's self-rating depression scale (SDS). Linear correlation of NKA and psychological measures to the regional brain metabolism in cancer patients was examined using statistical parametric mapping (SPM). Positive linear correlation between NKA and regional metabolic rate ratios was identified in the visual association cortex, anterior cingulate gyrus (CG) and sensorimotor area, and negative correlation was identified in the inferolateral prefrontal cortex (ILPFC), prefrontal cortex (PFC), orbitofrontal cortex (OFC) and anterior temporal cortex. Positive linear correlation to the MAS score was identified in the visual association cortex, anterior CG, primary sensorimotor area and the posterior parietal cortex, and negative correlation was detected in the ILPFC, PFC, OFC and anterior temporal cortex. The NKA and MAS scores positively correlated with each other (p<0.001). The result might serve as supporting data for a hypothesis that psycho-immune interaction is also mediated by the cerebral cortex and limbic system.

Types of panic attacks and their association with psychiatric disorder and physical illness

The differentiation of three types of panic attacks is proposed to be significant for understanding the course and etiology of panic and other psychiatric disorders and physical illnesses. The present investigation is based on longitudinal data from the Epidemiologic Catchment Area (ECA) Study of 1980 to 1981 and its 1994 to 1996 follow-up. Multidimensional scaling (MDS) of panic symptoms identified three types of panic which were consistent over time and for which reliable scales were constructed to measure derealization, cardiac panic, and respiratory panic. Unlike panic disorder, none of the three types of panic attacks predicted the incidence of depression. Derealization was associated with a broader variety of psychiatric disorders than the other two types of panic, including simple phobias, but was not associated with physical diseases. Cardiac panic attacks were associated with a history of heart disease and predicted the incidence of agoraphobia but were not comorbid with depression, unlike the other two forms of panic. Respiratory panic attacks were consistently symptomatic of dysthymia and predicted a higher risk of hospitalization for breast cancer and myocardial infarction (MI).