Psychosocial factors and psychophysiological mechanisms in the aetiology and development of cancers

Psychological, physical, and interpersonal correlates of emotional expressiveness, conflict, and control

This article examines the relations between emotional expression, conflict over expression, and emotional control and psychological and physical distress. Fifty married couples completed two mail‐in surveys containing the Emotional Expressiveness Questionnaire (EEQ), the Ambivalence Over Emotional Expression Questionnaire (AEQ), and the Emotional Control Questionnaire (ECQ), as well as measures of psychological and physical well‐being. They also made expressiveness and well‐being ratings of their spouses. AEQ and ECQ scores were significantly positively correlated with measures of psychological distress and questionnaire measures of physical discomfort. In addition, AEQ scores for items dealing explicitly with anger predicted visits to health‐care provider for illness. EEQ scores did not predict either psychological distress or physical symptoms. AEQ scores were also positively correlated with spouse's symptoms and alcohol use. Wives' expressiveness ratings for their husbands were negatively correlated with a number of indices of psychological distress, while husbands' ratings of wives' expressiveness were positively correlated with measures of distress. Generally, expressiveness, inhibition, and conflict over expression in one spouse did not consistently predict well‐being of the other. Implications of these findings for future research in the area of emotion and illness as well as in relationship satisfaction are discussed.

Disclosing Daydreams versus Real Experiences: Attitudes, Emotional Reactions, and Personality Correlates

Clinical observations and anecdotal reports suggest that many people are more reluctant to disclose daydreams than thematically similar real past events. Two studies of daydream disclosures examined choices to disclose daydreams versus real experiences, imagined emotional and attitudinal reactions to such disclosures, the effects on these of experimentally varied thematic content and mood, and personality correlates. In a realistic choice situation, 79% of participants preferred to disclose real experiences versus 14% to disclose daydreams. Imagining disclosing daydreams evoked more negative emotions than imagining disclosing similar real events, and this was moderated by theme and mood. Those who felt less distressed after revealing daydreams as compared with past experiences scored lower on trait measures of negative emotionality, higher on positive emotionality, and lower on rumination.

Effects of psychological nursing intervention on personality characteristics and quality of life of patients with esophageal cancer

OBJECTIVE

This study examined the effects of a psychological nursing intervention on personality characteristics and quality of life of esophageal cancer patients.

METHODOLOGY

Esophageal cancer patients (n=86) were randomized into either an intervention group (n=45) or a control group (n=41). Patients in the control group were given routine nursing care, and those in the intervention group were provided with psychological nursing interventions in addition to routine nursing care. Personality characteristics, assessed through Eysenck Personality Questionnaire, and quality of life, assessed through EORTC QLQ-C30, were compared between the two groups.

RESULTS

The results showed that personality characteristics were closely related to quality of life. After the psychological nursing intervention, the main factors were neurosis, psychosis or mood instability, and personality stability. However, introverted and extroverted personality characteristics were not associated with quality of life. The psychological nursing intervention was associated with decreased P-scale and E-scale scores of personality characteristics and improved quality of life in each dimension scored.

CONCLUSIONS

A psychological nursing intervention can affect the personality characteristics of esophageal cancer patients and improve their quality of life; this approach is worthy of further study and clinical application.

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.

Association between stress and breast cancer in women: a meta-analysis

The objective of the current meta-analysis was to verify the association between stressful life events and primary breast cancer incidence in women. A total of 618 studies from 1982-2007 were found in the PubMed, LILACS, and Cochrane Library databases. Methodological quality was evaluated according to the Downs & Black criteria. Eight studies were selected (six case-controls and two cohorts). The studies were grouped in three analyses, two of which based on the categories widowhood and divorce and the other based on self-rated intensity and frequency of stressful events. Relative risks were: widowhood 1.04 (95%CI: 0.75-1.44; p = 0.800); divorce 1.03 (95%: 0.72-1.48; p = 0.850); and intensity/frequency of stress 1.73 (95%CI: 0.98-3.05; p = 0.059). We conclude that stressful life events as a whole are not associated with risk of breast cancer in women. However, it is not possible to rule out high-intensity stress as a risk factor for breast cancer.

Emotion regulation, affect, psychosocial functioning, and well-being in hemodialysis patients

BACKGROUND

Emotion regulation refers to the psychological strategies people use to cope with such stressors as hemodialysis therapy. These strategies are associated with a range of physical and psychological variation that may be related to kidney disease and its management. This study explores the associations of 2 emotion regulation strategies, reappraisal and suppression, and considers their impact on patient well-being and kidney disease management.

STUDY DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

106 hemodialysis patients undergoing renal replacement therapy and 94 friends or relatives.

PREDICTORS

Reappraisal and suppression, measured by using the Emotion Regulation Questionnaire.

OUTCOMES

Outcome parameters were measures of affect, psychosocial functioning, and well-being, measured using the Positive and Negative Affect Scale, the Brief COPE questionnaire, the Kidney Disease Quality-of-Life Short Form, and the Brief Symptom Inventory.

RESULTS

The Emotion Regulation Questionnaire measured reappraisal and suppression. Greater use of reappraisal was associated with lower levels of anxiety (r = -0.22; P = 0.03) and greater acceptance of the disease (r = 0.20; P = 0.04). It was also associated with more experience (r = 0.26; P < 0.01) and expression (r = 0.23; P = 0.02) of positive emotion and less experience (r = -0.35; P < 0.01) and expression (r = -0.29; P < 0.01) of negative emotion. Suppression was associated with less positive emotional expression (r = -0.28; P < 0.01), greater levels of depression (r = 0.22; P = 0.03) and somatization (r = 0.25; P < 0.01), and greater dissatisfaction with the time spent dealing with their kidney disease (r = -0.21; P = 0.04). Suppression also was associated with less emotional coping (r = -0.29; P < 0.01) and greater dissatisfaction with the support received from other people (r = -0.34; P < 0.01).

LIMITATIONS

The study focuses on emotion regulation strategies and well-being rather than clinical parameters; therefore, extensive medical data were not recorded.

CONCLUSION

Reappraisal has more positive clinical and psychosocial associations than suppression. The emotion regulation strategy used by hemodialysis patients has important implications for well-being and disease management.

Stress and breast cancer: a systematic update on the current knowledge

A vast body of research has been carried out to examine the relationship between psychological stress and the risk of breast cancer. Previous reviews on this issue have mainly focused on stressful life events and have included both prospective and retrospective studies. The results from these reviews have revealed conflicting data. We evaluate whether stressful life events, work-related stress, or perceived global stress are differentially associated with breast cancer incidence and breast cancer relapse in prospective studies. Systematic and explicit methods were used to identify, select, and critically appraise relevant studies. The substantial variability in the manner in which stress was conceptualized and measured did not allow for the calculation of a quantitative summary estimate for the association between stress and breast cancer. Despite the heterogeneity in the results obtained, it is concluded that stress does not seem to increase the risk of breast cancer incidence. Whether stress affects the progression of breast cancer is still unclear. Studies with more thorough adjustment for confounding factors and larger studies on stress and breast cancer relapse are required to address this issue.

Emotional control in Chinese female cancer survivors

Chinese persons are not known as strong in expressing emotions, especially negative ones. However, being diagnosed with cancer and going through treatment can be an emotionally traumatic experience and cancer patients are supposed to have a stronger need to express these negative feelings. The control of expression of negative emotions such as anger, anxiety and depression in Chinese female cancer survivors (n=139) was examined in the present study using the Chinese version of the Courtauld Emotional Control Scale (CECS). The reliability, internal consistency and validity of the Chinese CECS were comparable to the original English scale. Correlation analyses suggested that cancer survivors with higher emotional control tended to have higher stress, anxiety and depression levels and to adopt negative coping with cancer. Regression analysis showed that emotional control would positively predict stress level even after the effect of depressed mood was under control. Further investigations are suggested in order to elucidate the causal relationships and specific cultural factors affecting emotional control in Chinese cancer survivors and, most importantly, its effect on health outcomes.

Interleukin-1 may link helplessness-hopelessness with cancer progression: a proposed model

A model of the relations between psychological factors and cancer progression should include brain and systemic components and their link with critical cellular stages in cancer progression. We present a psychoneuroimmunological (PNI) model that links helplessness-hopelessness (HH) with cancer progression via interleukin-1beta (IL-1beta). IL-1beta was elevated in the brain following exposure to inescapable shock, and HH was minimized by antagonizing cerebral IL-1beta. Elevated cerebral IL-1beta increased cancer metastasis in animals. Inescapable shock was associated with systemic elevations of IL-1beta and peripheral IL-1beta was associated with escape from apoptosis, angiogenesis, and metastasis. Involvement of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis are discussed. Future studies need to identify the role of additional factors in this PNI pathway.

The association between stressful life events and breast cancer risk: a meta-analysis

Breast cancer is the most prevalent cancer in women in Western societies. Studies examining the relationship between stressful life events and breast cancer risk have produced conflicting results. The purpose of this meta-analysis was to identify studies on this relationship, between 1966 and December 2002, to summarize and quantify the association and to explain the inconsistency in previous results. Summary odds ratios and standard errors were calculated, using random effect meta-regression analyses, for the following categories: stressful life events, death of spouse, death of relative or friend, personal health difficulties, nonpersonal health difficulties, change in marital status, change in financial status and change in environmental status. The presence of publication bias has been explored, and sensitivity analyses were performed to identify heterogeneity, using calculation of the percentage of variability due to heterogeneity, meta-regression analyses and stratification. Only the categories stressful life events (OR = 1.77, 95% CI 1.31-2.40), death of spouse (OR = 1.37, 95% CI 1.10-1.71) and death of relative or friend (OR = 1.35, 95% CI 1.09-1.68) showed a statistically significant effect. Publication bias was identified in both stressful life events (p = 0.00) and death of relative or friend (p = 0.02). Sensitivity analyses resulted in the identification of heterogeneity in all categories, except death of spouse. The results of this meta-analysis do not support an overall association between stressful life events and breast cancer risk. Only a modest association could be identified between death of spouse and breast cancer risk.

Low prebiopsy state irritability scores at the clinical onset of invasive breast carcinoma

OBJECTIVE

The research findings regarding the role of psychiatric illness in breast cancer are not yet clear. This report investigates the differences between patients with invasive breast carcinoma (IBC) and patients with benign breast disease regarding the psychiatric history and the current prebiopsy psychopathology.

METHODS

The psychiatric history of 124 females, aged 70 or less, was evaluated by interview and the DSM-IV criteria were used to establish the diagnoses. The Present State Examination (PSE)-Index of Definition (ID)-CATEGO computer program was used to define current psychopathology. Known risk factors of breast cancer were included in the analyses.

RESULTS

After biopsy, 59 patients had IBC and 65 had benign breast diseases. Multiple logistic regression analyses showed that low psychiatric history and low irritability were independent predictors of IBC regarding the DSM-IV and the PSE-ID-CATEGO, respectively.

CONCLUSION

Low psychiatric history and low prebiopsy state irritability differentiates IBC patients from noncancer patients.

Psychological profile in patients with Stages I and II breast cancer: associations of psychological profile with tumor biological prognosticators

We have earlier shown that breast cancer patients with moderately or well differentiated tumors seem to be able to inhibit stress evoked from anger in a successful manner, while those with poorer prognosis do not. We now report a study with an enlarged group of patients, investigating associations between tumor biological factors and psychological profile. 129 patients with Stages I and II breast cancer undergoing adjuvant radiation therapy were interviewed and tested with three projective personality tests assessing attitude to aggression and coping with stress and anxiety. Creative functioning was also tested. Patients with Stage I (smaller) tumors reported a "fighting spirit" attitude toward the disease, but they also showed depressive reaction patterns. Moreover, if the patient could successfully avoid or inhibit the stress evoked from perceiving an aggressive motif in the picture shown in the aggression test, the tumor biological situation was better. Patients who did not inhibit stress reactions on the aggression test and also on the anxiety test had a poorer tumor biological situation. Surprisingly, low speed of tumor cell proliferation (DNA S-phase fraction) correlated with high scores on the creativity test. Successful denial or inhibition of stress evoked by aggression combined with a creative, flexible attitude was associated with a better tumor biological situation.

Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients

PURPOSE

The aim of this study was to investigate the hypothesis that, independent of other known prognostic factors, pessimistic head and neck (H&N) cancer patients have a greater risk of being dead 1 year after diagnosis than do optimistic patients.

PATIENTS AND METHODS

A prospective observational study design was used with a cohort of H&N cancer patients diagnosed during the period from March 1, 1997, to August 31, 1998, at the Centre Hospitalier Universitaire, Clermont-Ferrand, France. Dispositional optimism (DO) was evaluated at baseline using a French version of the Life Orientation Test translated and validated for this study. One-year survival status was collected on all subjects. The analysis of the hypothesized association between DO and 1-year survival was performed using multiple logistic regression analysis, controlling for other sociodemographic and clinical variables.

RESULTS

The sample size was 101 patients, representing all but one of those patients fitting the inclusion criteria who were diagnosed during the recruitment period. Of these, 51 were alive at 1 year after diagnosis, 45 were dead, and five were lost to follow-up. The multivariate analysis was performed on the data from the 96 subjects in whom 1-year survival status was known. Controlling for known predictors of H&N cancer survival, pessimistic subjects (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01 to 1.24) and those living alone (OR, 4.14; 95% CI, 1.21 to 14.17) were more likely than optimistic subjects and those living with others to be dead at 1 year.

CONCLUSION

The results of this study of a cohort of French H&N cancer patients indicate that dispositional optimism predicts 1-year survival independent of other sociodemographic and clinical variables.

Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories

STUDY OBJECTIVE

The extent of social inequalities in children's hospitalisation risks was examined in terms of socioeconomic status and parents' nationality. This was considered in terms of inpatient treatment attributable to a number of diagnoses (ICD-9), especially infectious diseases and psychiatric disorders.

DESIGN AND SETTING

Analyses were performed with records of a German statutory health insurance comprising 48 412 (52.8% male and 47.2% female) children and adolescents of 15 years of age or younger who were co-insured between 1987 and 1996. Classification of socioeconomic position was based on parental occupational position.

RESULTS

Social inequalities in terms of hospital admissions attributable to acute diseases were rather small. The only exception were infections of the respiratory organs: in the highest status positions as compared with the lowest one the relative risk for being admitted was RR=0.22 (95% CI 0.06 to 0.89). However, length of stay in hospital was significantly related to socioeconomic position for infections of the upper respiratory tract and infections of the respiratory organs, with children and adolescents with the lowest socioeconomic background having spent the longest periods in hospital. With regard to nationality, pneumonia/flu was the only diagnostic category where relative risks for being admitted were higher in non-German children and adolescents (RR=1.5; 95% CI 1.2 to 1.8). Conversely, hospital admissions attributable to psychiatric diagnoses were significantly lower among non-German patients (RR=0.43; 95% CI 0.30 to 0.61), thus suggesting differential utilisation patterns according to nationality.

CONCLUSIONS

Health inequalities in children's and adolescents' hospital admissions in Germany are small and inconsistent if parents' socioeconomic status and nationality are taken as criterion. Yet, children of lower status background stay longer in hospital if suffering from highly prevalent infectious diseases. This last observation may be attributable to more severe disease conditions.

Widespread body pain and mortality: prospective population based study

OBJECTIVE

To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess.

DESIGN

Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location.

SETTING

North west England.

PARTICIPANTS

6569 people who took part in two pain surveys during 1991-2.

MAIN OUTCOME MEASURES

Pain status at baseline and subsequent mortality.

RESULTS

1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78).

CONCLUSION

There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.

Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: results of a prospective study

BACKGROUND

To investigate associations between coping strategies and length of survival in a sample of 52 adult leukemia patients receiving allogeneic bone marrow transplantation (BMT).

METHODS

52 adult patients, diagnosed with acute (AML) and chronic myeloid leukemia (CML) admitted for allogeneic BMT to a university hospital BMT unit in preparation for a transplantation of genotypically matched HLA donor marrow, were interviewed immediately after informed consent and prior to preparatory treatment for transplantation. Semistructured interviews were conducted and recorded for analysis to assess coping styles and were evaluated by a new content analytic coping measure [Ulm Coping Manual (UCM)]. Patients were a random sample of all eligible patients on the BMT unit between May 1990 and May 1994.

RESULTS

Complete audiotaped interviews were rated by blind raters, employing a newly developed content analysis for the identification of patients' coping strategies. Multivariate analysis using a Cox model revealed three pretransplant variables that demonstrated a statistically significant influence on 5-year survival: Stage of Disease at transplant (P < .012), Distraction (P < .007), and Fighting Spirit as coping modalities (P < .013).

CONCLUSIONS

The results of this prospective study document the impact of certain psychological variables, notably coping style on survival with BMT. This suggests the necessity of utilizing psychosocial interventions to address stress and anxiety in patients awaiting transplantation in order to reduce anxieties and to employ more effective coping techniques to deal more appropriately with their situation and to enhance Fighting Spirit. The effects on survival of such psychosocial interventions need to be tested in a randomized controlled study.

Aggression: destructive and constructive aspects

The concept of aggression was long relegated to the shadow of the libido in psychoanalytic theory, placed among the negative affects by some theoreticians, denied the role of a primary drive among leading writers in clinical psychology, brought to the fore as an adaptive force in ethology, and proved to be a decisive factor in the development of psychosomatic ailments. The second part of the paper reviews experiments using projective techniques, showing that highly creative subjects as opposed to ones low in creativity seem inclined to accept their aggressive impulses. A total denial of these impulses has been typical of women with breast cancer.

Psychosocial factors in the etiology of breast cancer: review of a popular link

Breast cancer is the most frequently occurring type of cancer in women in the western world. The etiology of a large proportion of breast cancers is still unexplained, and the possibility that psychosocial factors could play a role is not ruled out. Already in pre-Christian times, it was assumed that psychological factors might play a significant role in the development of breast cancer. However, studies have failed to produce conclusive results. There is still a lack of knowledge on the relationship between breast cancer development and psychosocial factors such as stressful life events, coping styles, depression, and the ability to express emotions. The results of this review show that there is not enough evidence that psychosocial factors like 'ways of coping' or 'non-expression of negative emotions', play a significant role in the etiology of breast cancer.

Psychological profile related to malignant tumours of different histopathology

In a previous preoperative study of patients with gliomas, we made the original observation that patients with high grade as opposed to those with low-grade gliomas have a psychological profile marked by extreme emotional reactivity. In this postoperative study of the psychological profiles of patients with breast cancer, the main funding was unexpectedly analogous with the findings in the brain tumour study. The patients with poorly differentiated ductal carcinomas showed a specific and, compared to the patients with well differentiated carcinomas, outstanding psychological profile marked by extreme emotional reactivity as well as by genuine creativity. Some of the present patients with well differentiated carcinomas showed personality profiles marked by compulsive inhibition, also described earlier in the literature of patients with breast cancer. The psychobiological relations between emotional reactivity and aggressiveness of tumour growth are discussed.

Attitude towards aggression and creative functioning in patients with breast cancer

Three projective personality tests were used to assess attitude to aggression (The Identification Test), anxiety and defenses (The Meta-Contrast Technique) and creative functioning (The Creative Functioning Test) in 70 patients with breast cancer. Discriminant analyses were applied pro primo to characterize psychologically patients with a better prognosis and patients with a poorer prognosis. A second aim was to characterize psychologically older (postmenopausal) and younger (premenopausal) women. Generally, high scores on the Identification Test indicated maladaptive attitudes towards aggression among all the patients. Patients with a poorer prognosis showed responses that in healthy subjects indicate acknowledgement of aggressive impulses, perhaps suggesting lack of "defenses" against such impulses among those patients. Another way to describe it would be that patients with a better prognosis seem to have (normally nonadaptive) "defenses" against aggressive impulses while those with poorer prognosis have not. Surprisingly, the patients with a better prognosis (but not those with a poorer prognosis) gave responses classified as depression in the Meta-Contrast Technique. Typical of premenopausal patients were responses classified as anxiety as well as reaction formation on the Identification Test. Responses classified as adaptive defenses (isolation) were seen in the Meta-Contrast Technique. A surprising finding was that many of these patients were characterized by high scores on the creativity test. These original statistically significant findings of attitudes towards aggression and creative functioning in breast cancer patients are discussed in relation to the underlying nature of aggression and creativity.

Substance P promotes lymphocyte-endothelial cell adhesion preferentially via LFA-1/ICAM-1 interactions

Substance P (SP), an 11 amino acid peptide, is released by C and A delta sensory nerve fibers during tissue insult and inflammation. We investigated the effect of SP on the expression and avidity of adhesion molecules, on lymphocytes and endothelial cells, which are central to the inflammatory cascade. Using in vitro adhesion assays we found that pretreatment of murine endothelial cells with SP enhanced their adhesiveness to splenocytes, the murine T cell hybridoma EL4 and nylon-enriched primary murine T cells in a dose and time dependent manner, the optimum dose being 10(-10) M and the optimum time 6 h. SP at 10(-10) M was also able to stimulate the splenocytes, EL4 T cells and primary T cells to enhance their adhesiveness for endothelial cells. The increased adhesiveness was associated with enhanced expression of ICAM-1 on endothelial cells and increased avidity of LFA-1 on lymphocytes. Further SP was chemotactic for T cells. These data suggest that SP modulates lymphocyte-endothelial cell interactions by preferentially upregulating LFA-1 and ICAM-1 interactions.

Psychological assessment and intervention: future prospects for women with breast cancer

During the last decade, there has been a growing interest in the psychosocial aspects of breast cancer. Studies have addressed multifarious aspects, including the possible importance of personality factors and stress in the onset and progression of malignancy, the psychological impact of diagnosis and treatment, the incidence and nature of psychological and psychiatric problems, the development and evaluation of psychological interventions to ameliorate treatment side effects and to enhance quality of life, the psychological effects of screening for breast cancer and of counselling women at high risk, the organization of services, training, and psychoneuroimmunology. These and other studies are reviewed and possible directions for future research are indicated. It is clear that psychosocial factors are becoming increasingly important components of the assessment and management of patients with breast cancer.

Colon cancer: personality factors predictive of onset and stage of presentation

This study examined premorbid personality correlates of colon cancer and stage of presentation of colon cancer to health care providers. Sixty-one male veterans who completed the MMPI between 1947 and 1975 and were then diagnosed with colon cancer between 1977 and 1988 were matched with control patients. A 21-factor solution of the MMPI [1] was used to seek potential personality differences between colon cancer cases and their controls in terms of presence of colon cancer and stage of presentation for this disease. A stepwise conditional regression analysis found significant differences between the colon cancer and control groups on the Aggressive Hostility variable (p < 0.018). A multivariate analysis of variance conducted across the stages of colon cancer presentation found that patients who presented later on for colon cancer had higher Phobia scores (p < 0.05). Religious Fundamentalism was also related to presentation (p < 0.05), but in a nonlinear manner. Discussion is related to previous findings regarding the relationship between personality and development of cancer, as well as to implications for patient screening.

Occupational life course and lung cancer risk in men. Findings from a socio-epidemiological analysis of job-changing histories in a case-control study

Psychosocial factors in general, and the social and psychological conditions of work and occupation in particular, have attracted little attention to the epidemiological investigation into the occupational-related causes of lung cancer. There is some evidence available concerning the impact of loss events--including job losses--on cancer development. During our research presented in this article, we examined job changes and job transitions in the occupational biography of men with regard to their circumstances in terms of (in-)voluntariness both as individual events and the job-changing histories of individuals. We expected the job-changing histories of lung cancer cases to be more involuntary than those of population controls, and vice versa. Our sample contains 391 male case-control pairs. Cases are defined as newly-diagnosed men of German nationality with a histologically- or cytologically-confirmed diagnosis of primary lung cancer. Population controls were drawn randomly from the municipality records of residents and individuals matched to cases 1:1 by age and region. Occupational histories were reconstructed, and information about other classical and suspected risk factors was collected during standardized interviews by trained interviewers. We categorized the reported reasons for job changes, and classified them with respect to voluntariness on a seven-stepped rating scale from -3 'very involuntary' to +3 'very voluntary', defining relations within the empirically established categories. The job-changing histories of individuals are described by using the average score of voluntariness. We measured the degree of voluntariness for the occupational history: (1) by the rounded average score; and (2) by the quintiles of the average score. On the basis of individuals matched odds ratios (OR) estimates are derived for the score of voluntariness unadjusted and adjusted for smoking, asbestos exposure and socio-economic group by conditional logistic regression. The investigation into job-changing histories using the average score of voluntariness lead to similar results for both measuring methods for the total study group. When the rounded score was used, job-changing histories which were assessed as 'very involuntary' and 'involuntary' (score -3 and -2) showed an elevated odds ratio of adjusted 1.41 (95%-CI: 0.57; 3.48), and when they were assessed as 'moderately involuntary' (score -1) the adjusted odds ratio was 1.59 (95%-CI: 1.02; 2.48), as compared with job-changing histories assessed as neutral (score 0). When the degree of voluntariness was measured by quintiles, the first quintile (score -3- < -0.6) showed an elevated risk of adjusted OR 1.36 (95%-CI: 0.79; 2.36) as compared to the third quintile (score -0.2- < -0.1).(ABSTRACT TRUNCATED AT 400 WORDS)

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.

Death of a husband or marital divorce related to risk of breast cancer in middle-aged women. A nested case-control study among Norwegian women born 1935-1954

A topic of general interest is whether important life changes may play a role in the onset of cancer. The hypothesis of this study was that death of a husband or marital divorce, is associated with an increased risk of breast cancer. The study included 4491 incident breast cancer cases and 44,910 controls, matched on age, in a population-based nested case-control study, among Norwegian women born between 1935 and 1954. The risk of breast cancer among widowed compared to married women showed an odds ratio (OR) of 1.13 [95% confidence interval (CI) 0.94-1.36], after adjusting for age at first birth and parity. For divorced women the analogous OR was 0.83 (95% CI 0.75-0.92), after adjusting for age at first birth, parity and place of residence. Thus, the results did not show any clear evidence that death of a husband or marital divorce was associated with an increased risk of breast cancer.

Life events, chronic difficulties and vulnerability factors preceding breast cancer

This study deals with the association between life events, family history of mammary carcinoma and breast cancer. It was guided by a model consisting of events, family disposition and age at the side of the independent variables. In addition to these factors 'lack of social support' was introduced. The latter is conceptualized as a vulnerability factor capable of aggravating the impact of events without having an independent effect. There was no hypothesis on chronic difficulties, so this is exploratory. This research was conducted as a so-called 'limited prospective' design. Women with a suspicious breast lump were interviewed before surgery. After having confirmed the outcome of the surgery the sample was divided into a group with cancer and cases with a benign diagnosis. Women with gall stones were introduced as another control group. The interviews were performed along a semi-structured schedule, tape recorded and analyzed by using Brown and Harris' Life Events and Difficulties Scale. The analyses were made with 33 women with cancer, 59 with a benign tumor and 20 with gall stones. In the 'malignant' group the severest events was four times as high as in controls. All other degrees of threat were equally distributed over the groups. Chronic difficulties of the highest degree of severity also occur more often in the cancer group. They are not independent from events so that analyzing them separately is not useful. The rate of family history of breast cancer does not differ between the tumor groups, but is much lower in the gall stone patients. In the cancer group there is an association between this possibly hereditary factor and severe events, in the 'benign' group both are uncorrelated. The life event effect is explained in context of a higher illness susceptibility due to a hereditary disposition. For events occurring without it an explanation remains unclear.

Magnitude and causes of mortality differences between married and unmarried men

STUDY OBJECTIVE

To determine the effect of marital status on mortality for men. In particular, to examine whether subgroups of unmarried men (widowed, single, and divorced/separated men) have a similar mortality to married men.

DESIGN

Cohort study.

SETTING

Whitehall civil service, London, between 1967 and 1969.

PARTICIPANTS

A total of 18,403 men aged 40-64 years with 18 years' follow up.

MEASUREMENTS AND MAIN RESULTS

Cause-specific mortality rates and risk factors at baseline were determined. Overall mortality was greater for all groups of unmarried men. Patterns of mortality were different in the subgroups of unmarried men. Widowed men had a significantly greater risk of dying from ischaemic heart disease (relative risk (RR) 1.46, 95% confidence interval (CI) 1.08, 1.97) which persisted after exclusion of deaths that occurred in the first two years. Divorced men had greater cancer mortality (RR 1.49; 95% CI 1.06, 2.10) that could not be explained simply by their greater consumption of cigarettes. The initial increased mortality for single men was no longer evident after adjustment for other risk factors, suggesting that single status in itself may not increase the risk. The risk for single men may have been underestimated, however, by over adjustment for possible intermediary factors.

CONCLUSIONS

Previous studies, which have examined total mortality only or have grouped all unmarried men, have masked interesting differences in the cause of death between subgroups of unmarried men. The extent to which the findings are explicable by psychosocial factors or the role of other environmental factors, which may also differ in relation to marital status, is unclear. Future work should not assume that all unmarried men have similar mortality risks and must examine the life course of each subgroup to advance our understanding of the possible causal role of marital status in disease aetiology.

Artifacts in "limited prospective" designs? Testing confounding effects on response behaviour of women prior to breast surgery

Data from a 'limited prospective' study on life events and breast cancer were tested whether they were biased by knowledge of the prospective diagnosis or by related mood states. Data were gathered by semi-structured and tape-recorded interviews. Event classifications were made according to Brown and Harris' Life Events and Difficulties Scale, an interviewer-based rating method. Ratings were performed before the interviewer learned the final diagnosis. Among the women coming to hospital with a suspicious breast lump, 33 had a malignant and 59 had a benign diagnosis. For comparison for mood effects two more control groups (women prior to gall stone surgery and healthy women interviewed at home) were included. Although artifacts may in general play a role for reporting events in 'limited prospective' designs, the present study could not document a sizeable effect of presumed confounding variables on response behaviour.

Psychosocial factors in breast cancer and their possible impact upon prognosis

Breast cancer is the most common cancer form in women. Numerous biological factors have now been identified and accepted as important risk factors and prognosticators. Psychosocial factors are also considered to be of probable importance. A review of the literature studying these factors reveals major methodological problems in evaluating data: small sample size, retrospective design, lack of cross-referencing for other important factors, cross-sectional studies instead of longitudinal studies, and insufficient statistical analysis. Regarding psychosocial factors, some of the most valid studies indicate that the risk of getting breast cancer may be connected with difficulties in expressing feelings, especially ones of aggression; while coping strategy, amount of stress, and level of activity, seem to be of possible influence to the prognosis. A possible connection between psyche and the immunological system has been proposed, but there has been little data so far. Although a series of studies have shown some influence of psychosocial factors on breast cancer, the methodological problems are so large as to leave open the question whether psychosocial factors have any impact upon the disease.

Cancer rates after the Three Mile Island nuclear accident and proximity of residence to the plant

BACKGROUND

In the light of a possible link between stress and cancer promotion or progression, and of previously reported distress in residents near the Three Mile Island (TMI) nuclear power plant, we attempted to evaluate the impact of the March 1979 accident on community cancer rates.

METHODS

Proximity of residence to the plant, which related to distress in previous studies, was taken as a possible indicator of accident stress; the postaccident pattern in cancer rates was examined in 69 "study tracts" within a 10-mile radius of TMI, in relation to residential proximity.

RESULTS

A modest association was found between postaccident cancer rates and proximity (OR = 1.4; 95% CI = 1.3, 1.6). After adjusting for a gradient in cancer risk prior to the accident, the odds ratio contrasting those closest to the plant with those living farther out was 1.2 (95% CI = 1.0, 1.4). A postaccident increase in cancer rates near the Three Mile Island plant was notable in 1982, persisted for another year, and then declined. Radiation emissions, as modeled mathematically, did not account for the observed increase.

CONCLUSION

Interpretation in terms of accident stress is limited by the lack of an individual measure of stress and by uncertainty about whether stress has a biological effect on cancer in humans. An alternative mechanism for the cancer increase near the plant is through changes in care-seeking and diagnostic practice arising from postaccident concern.

Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients

The possible relationship between psychological responses among breast cancer patients and disease outcome continues to be an area of controversy and debate. Two parallel findings are reported separately in the literature: first, that emotional control is more common among women with breast cancer than in women with benign breast disease or in healthy controls and second, that a helpless attitude towards the disease is related to a poor prognosis. These previously unrelated psychological responses are examined here in a group of women (N = 359) with early stage breast cancer, who were seen one to three months after diagnosis. The relationships between emotional control, adjustment to cancer and psychological morbidity were examined. Prevalence levels of 16 and 6% were observed for anxiety and depression respectively, which are lower than reported more generally in the literature. The results indicated a highly significant association between scores for the tendency to control emotional reactions and a fatalistic attitude toward cancer. A significant association was observed between anger control and a helpless attitude. Psychological morbidity was also linked to type of adjustment to cancer. The data are interpreted in terms of a process model of psychological responses which suggests that emotional control (an important component of the Type C behaviour pattern) fatalism, helplessness and psychological morbidity are linked.