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

The role of resilience and coping strategies as predictors of well-being in breast cancer patients

PURPOSE

This study investigated the role of resilience and coping strategies on breast cancer patients' well-being using a structural equation model. To achieve this objective, a model previously developed by Mayordomo's group was partially replicated using a longitudinal study design in an oncological sample.

METHODS

The study was a longitudinal observational survey. Patients with breast cancer were recruited (N = 166). Resilience was measured with the Mexican Resilience Measurement Scale, coping strategies with the Forms of Coping and Dimensions Scale and perception of the psychological well-being with a short-form of Ryff's Scales of Psychological Well-Being at the start and end of adjuvant chemotherapy (T1 and T2 respectively).

RESULTS

The results showed stability in the variables over time and revealed differences with respect to Mayordomo's model. The best predictor of well-being at T2 was well-being at T1. In addition, the model indicated that resilience had a direct impact on well-being through problem-focused coping. Indeed, resilience and problem-focused coping best explained well-being at T2.

CONCLUSIONS

Both at the start and end of adjuvant chemotherapy for breast cancer, problem-focused coping positively predicted resilience, which in turn was a positive predictor of well-being. On the other hand, emotion-focused coping showed no association with resilience or well-being. As part of the multidisciplinary cancer team, oncology nurses have a key role to play in promoting resilience and problem-focused coping as an important goal of psychosocial interventions in breast cancer patients.

Characterizing the post-traumatic growth trajectory in gastric cancer survivors: a population-based longitudinal study

OBJECTIVES

Post-traumatic growth can improve the quality of life of cancer survivors. The objective of this study was to investigate post-traumatic growth heterogeneity trajectory in perioperative gastric cancer survivors, and to identify characteristics that predict membership for each trajectory.

METHODS

Gastric cancer survivors (n = 403) were recruited before surgery, their baseline assessment (including post-traumatic growth and related characteristics) was completed, and post-traumatic growth levels were followed up on the day they left the intensive care unit, at discharge, and 1 month after discharge. Latent growth mixture mode was used to identify the heterogeneous trajectory of post-traumatic growth, and the core predictors of trajectory subtypes were explored using a decision tree model.

RESULTS

Three post-traumatic growth development trajectories were identified among gastric cancer survivors: stable high of PTG group (20.6%), fluctuation of PTG group (44.4%), persistent low of PTG group (35.0%). The decision tree model showed anxiety, coping style, and psychological resilience-which was the primary predictor-might be used to predict the PTG trajectory subtypes of gastric cancer survivors.

CONCLUSIONS

There was considerable variability in the experience of post-traumatic growth among gastric cancer survivors. Recognition of high-risk gastric cancer survivors who fall into the fluctuation or persistent low of PTG group and provision of psychological resilience-centered support might allow medical professionals to improve patients' post-traumatic growth and mitigate the impact of negative outcomes.

Women's Experiences after Hormone Positive Breast Cancer: Beginning of Radiation to 3-4 Years Post-Radiation

This study found that a breast cancer survivor cohort who were 3-4 years post-treatment returned to near baseline activity levels, and their important activity categories were nearly evenly distributed among instrumental activities of daily living, high-demand leisure, and social participation. When describing their experiences, three themes emerged: exercise is important physically and emotionally, participating in important activities feels good, and plans have been made to continue engaging in important activities. Further research is needed to compare activity resumption among those receiving or not receiving occupational therapy-at different timepoints-to understand when occupational therapy can make the greatest impact.

Effects of Resilience and Emotion Regulation on Perceptions of Positive and Negative Life Changes in Cancer Survivors: A Longitudinal Study

BACKGROUND

While many studies have investigated the sociodemographic, clinical, and psychosocial factors associated with perceived positive change after cancer, longitudinal work examining how emotion regulation, and resilience impact perceptions of life change among newly diagnosed cancer survivors is lacking.

PURPOSE

This study examined the prevalence of perceived positive and negative life changes following cancer and explored the role of emotion regulation and resilience on perceived change over 6 months.

METHODS

Data from 534 recent survivors of breast, prostate, or colorectal cancer (Mage = 59.3, 36.5% male) collected at baseline (Time 1) and 6-month follow-up (Time 2) were analyzed. Multivariate linear regressions were estimated separately to examine if resilience or emotion regulation were associated with perceived change at Time 2 after controlling for relevant sociodemographic and psychosocial measures.

RESULTS

At both time points, greater than 90% of participants reported at least one perceived positive change while fewer than a third reported a negative change. Indices of emotion regulation and resilience were positively related to perceived positive change at both time points and negatively related to perceived negative change at Time 1. Emotion regulation but not resilience was negatively associated with perceived negative change at Time 2.

CONCLUSIONS

Findings suggest that cancer survivors who are less resilient and struggle with emotion regulation are more susceptible to perceptions of fewer positive and greater negative life changes after cancer. As such, psychosocial interventions should be developed to promote resilience and emotional regulation in cancer survivors.

Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study

BACKGROUND

We explored the relationship between benefit finding (BF)/posttraumatic growth (PTG) at baseline and health-related quality of life (HRQOL) at baseline and follow-up in long-term cancer survivors (LTCS; ≥5-year post-diagnosis).

MATERIALS AND METHODS

HRQOL was assessed in LTCS in 2009-2011 (5- to 16-year post-diagnosis, baseline) and re-assessed in 2018/2019 (14- to 24-year post-diagnosis, follow-up). BF and PTG were measured at baseline; mean scores were dichotomized into 'none-to-low' (<3) and 'moderate-to-high' (> =3). Linear regression models and linear mixed regression models were employed to assess the association of BF/PTG with HRQOL.

RESULTS

Of the 6057 baseline participants, 4373 were alive in 2019, of whom 2704 completed the follow-up questionnaire. Cross-sectionally, LTCS with none-to-low BF reported better HRQOL at baseline and at follow-up than LTCS with higher BF. Longitudinally, no difference was found between none-to-low and moderate-to-high BF on the HRQOL change from baseline to follow-up. HRQOL differences between the PTG groups were not statistically significant cross-sectionally and longitudinally, except those participants with moderate-to-high PTG reported higher role functioning and global health status/QOL.

CONCLUSIONS

Cross-sectionally, BF was significantly negatively related to subscales of HRQOL, while PTG was positively correlated to role functioning and global health status/QOL. The results add further evidence that BF and PTG are two different positive psychological concepts.

Enablers, barriers and strategies to build resilience among cancer survivors: a qualitative study protocol

Cancer is a life-threatening illness affecting all dimensions of a person's health. Cancer survivors must build resilience to face this adversity and continue their life projects. The present study explores the enablers, barriers, and strategies to build resilience among cancer survivors. This qualitative, descriptive exploratory study will use purposive sampling to recruit cancer survivors and healthcare professionals from two hospital centers in Lisbon and Tagus Valley. Interviews will be conducted until data saturation occurs. Data analysis will be performed using an inductive content analysis process with the help of the QDA Miner Lite database. The findings from this study will generate knowledge that may help stakeholders to identify effective strategies to build resilience among cancer survivors. By implementing strategies to foster resilience, healthcare professionals can potentially promote positive adaptations to cancer by strengthening resilience enablers and reducing the impact of barriers.

Determinants of Life Satisfaction and Quality of Life Among American Indian Women Cancer Survivors: The Role of Psychosocial Resources

PURPOSE

This study assessed the relationship of spirituality, social support, and sense of mastery to life satisfaction and quality of life to identify viable psychosocial coping resources among American Indian (AI) women cancer survivors.

METHOD

We conducted a cross-sectional survey of 73 AI women cancer survivors residing in South Dakota. A series of multivariate hierarchical regression analyses was conducted.

RESULTS

Findings indicated that lower self-rated physical health was consistently associated with lower levels of life satisfaction and quality of life. Spirituality was found to be the most influential predictor for life satisfaction, while social support and sense of mastery were two significant predictors for quality of life.

DISCUSSION

Our data underscored the importance of spirituality, social support, and sense of mastery to the well-being of AI women cancer survivors and as effective coping strategies to mitigate life stressors. Implications of this evidence for the design of cancer preventions and interventions are discussed.

Effects of a Post-Traumatic Growth Program on Young Korean Breast Cancer Survivors

Background: This study aimed to enhance post-traumatic growth in young breast cancer patients by providing them with self-disclosure and social support resources, to reduce intrusive rumination and increase deliberate rumination. This study was conducted at a university-based cancer center in Seoul, South Korea. The study included a four-week group-based psychoeducational program, which supported the post-traumatic personal growth of breast cancer patients. The primary outcome was increased post-traumatic growth, and the secondary outcomes were rumination, distress, and traumatic perception. Methods: The study included 38 young breast cancer patients, with a mean age of 42.21 years and mean time since diagnosis of 13.84 months. Results: Results of the study revealed statistically significant improvements in total post-traumatic growth and all subdomains, after the intervention (p < 0.001) and one month later (p < 0.001), as compared to the baseline. A significant improvement was also observed in deliberate rumination after the intervention (p = 0.038). Furthermore, the patients had a statistically significant decrease in anxiety, after the intervention (p = 0.035) and one month later (p = 0.005), as compared to the baseline. Conclusions: Overall, the program encourages activities that promote post-traumatic growth, enabling young breast cancer patients to return to their normal lives. Specifically, the growth allows patients to return to work and maintain a healthy body and mind. The results of this study indicate that this program can be used as an effective psychological intervention for young breast cancer patients.

Pathways to post-traumatic growth in Korean female cancer patients: the mediation effects of coping strategies and resilience

ABSTRACTBackground: Cancer is a life-threatening disease in Korean women. Female cancer patients in Korea have reported poor physical functioning and psychological distress after diagnosis. However, some patients experience post-traumatic growth (PTG), which includes positive feelings and changes.Objective: The main purpose of this study was to examine the relationships between PTG and its associated factors in Korean female cancer patients to understand how female cancer patients achieve PTG while experiencing cancer diagnosis and treatment. This study aimed to improve the quality of life of many Korean female patients with cancer.Methods: This study investigated the structural model of the paths from the disruption of core beliefs (CBD), coping strategies, and resilience to PTG in a sample of female cancer patients. In total, 164 middle-aged women diagnosed with cancer were included in the final sample.Results: First, it was determined that the proposed structural model was substantial and had high fit indices. Second, problem-solving was positively associated by the CBD routes. Third, it was also favorably expected that problem-solving would lead to resilience and resilience would lead to PTG. These findings are important for developing future interventions for Korean female cancer patients and can be considered as an important variable to improve their PTG.

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.

Relationships between satisfaction with life, posttraumatic growth, coping strategies, and resilience in cancer survivors: A network analysis approach

OBJECTIVE

Cancer survivors' satisfaction with life should be seen through the psychological factors related to a person's capabilities to face and handle the situation. This study aimed to (1) examine the relationships of satisfaction with life, posttraumatic growth, resilience and coping strategies in a global network model, (2) find the bridge indicators between satisfaction with life and the other constructs, and (3) test for the invariance of the network structures across several moderating variables.

METHODS

In a heterogeneous sample of 696 cancer survivors (69% female; mean age = 53.1 ± 15.44 years; median time from being diagnosed = 4 years; breast cancer was the most frequent type of cancer) their satisfaction with life, resilience, coping strategies and posttraumatic growth was measured. In order to account for their complexity, the relationships between the constructs were explored using a network analysis approach.

RESULTS

The network analysis shows that satisfaction with life is strongly connected to resilience, moderately connected to coping strategies, and has a weak connection with posttraumatic growth. In the separate networks, the relationships between the psychological constructs were examined in greater detail. Besides some exceptions observed in the degree of disability, the networks were invariant across gender, age, years since being diagnosed, cancer type and treatment type.

CONCLUSION

The findings suggest that interventions focused on cancer survivors' coping strategies and resilience could help increase their satisfaction with life. However, further replication of the proposed and/or modified model is needed.

The Experiences of Cervical Cancer Patients During Follow-Up Care in Ethiopia: A Qualitative Study

Purpose

The purpose of the study was to explore the experiences among cervical cancer patients during follow-up care.

Patients and Methods

A qualitative study was conducted with purposively selected cervical cancer patients receiving follow-up treatment at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were collected using semi-structured interviews and analyzed via thematic analysis.

Results

The results obtained in this study indicated that women experienced a variety of physical and psychosocial difficulties in the context of cervical cancer care. The data analysis resulted in five themes. Women have undergone difficulties indicated as lack of satisfaction with the health care experience, dealing with treatment side effects, struggle in work and daily life, having stress, disruption in social relationships, and financial difficulties incurred because of their illness and treatment.

Conclusion

This study highlights that cervical cancer patient’s experience is the outcome of a complex interplay by personal, clinical, psychological, and social spheres. Thus, interdisciplinary approach between health and psychosocial professionals is needed during follow-up care in order to help women experience better psychosocial adjustment.

Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates?

PURPOSE

Cancer is a stressful life event that can lead to specific posttraumatic reactions. Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are two main posttraumatic reactions that are related to each other, and both have different correlates.

METHODS

The linearity of the relationship between PTG and PTSS and the different socio-demographic, cancer-related, emotional, and psychological correlates were analyzed in patients with cancer (N = 126).

RESULTS

The relationship between PTG and PTSS was found to be more curvilinear than linear. PTSS was more strongly related to psychological factors (e.g., anxious preoccupation, hope-helplessness, and resilience) while PTG was strongly related to existential factors (e.g., self-transcendence and religiosity).

CONCLUSION

The results show that cancer-related PTSS and PTG are specifically related constructs which are related differently to particular correlates. Specifically, the greatest differences were observed in the psychological variables. In the early phases, therapeutic interventions focused on variables related to PTSS can lead to the reduction of PTSS. In follow-up phases, the therapeutic intervention focused on the increase of the level of variables related to PTG can help the development of PTG.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Perceived trajectory of psychological and physical states after breast cancer: An optimistic perception

BACKGROUND

In cancer research, studying the quality of life trajectory helps us understand the complaints but also the cognitive, physical, and emotional aspects that can evolve positively. Examining both the suffering and the improvements expressed by the patients facilitates their care and their recovery knowing that an optimistic perception of the future is important for adaptative functioning after cancer. Through retrospective, present and prospective measures, we sought to characterize the subjective trajectory perceived by women with breast cancer about their cognitive, emotional and physical states, as it relates to quality of life.

METHODS

Nine hundred ninety women survivors of breast cancer (after curative treatments) described, on the appropriate scales, their perceived cognitive, emotional and physical states over three periods of time: from past care (i.e., retrospective analysis) to the future (i.e., projective analysis), including the present period, as a function of their treatment (chemotherapy vs. no chemotherapy) and surgery (lumpectomy vs. mastectomy) using ANCOVA.

RESULTS

The 732 women who had received chemotherapy perceived the most significant consequences, regardless of the type of surgery (η²= .01). Moreover, all survivors expressed an optimistic perception of the change in their states in the anticipated future as a normative optimistic perception.

CONCLUSIONS

Results are discussed in terms of the benefits of specific and early interventions that enable patients to cope better with the disease and its treatments by taking into account their more or less optimistic perception of the future.

Resilience and coping strategies in relation to mental health outcomes in people with cancer

Considering the importance of psychological variables on health-related processes, this study investigated the role of resilience and coping strategies in relation to health. The aim of this research was to explore the underlying association between these aspects for the better understanding of the effect of psychosocial variables on mental health in cancer. This information could lead to the design of adapted psychological interventions in cancer. Participants with different diagnosis of cancer were recruited (N = 170). They came from the Spanish Association Against Cancer of Biscay. Resilience was measured with the 10 items Connor-Davidson Resilience Scale, coping with the Cognitive Emotion Regulation Questionnaire and mental health was measured as a global indicator through the SF-12 and the GHQ-12. A structural equation model (SEM) was conducted to test the effects between the constructs. Results showed that resilience and coping were significantly associated. Results reflected an absence of significant correlation between adaptive and disadaptive coping strategies. Resilience was the factor that most correlated with health outcomes (β = –.45, p < .001). However, disadaptive coping strategies did not correlate with resilience or mental health indicators. Findings in this study underscore the positive contribution of high levels of resilience and an adaptive coping on participants´ level of health. Disadaptive coping strategies did not reflect any positive relation with resilience or health indicators. Thus, promoting resilience and adaptive coping could be a significant goal for psychosocial and educational interventions in people with cancer.

Moderating Effect of Posttraumatic Growth on the Relationship Between Social Support and Quality of Life in Colorectal Cancer Patients With Ostomies

BACKGROUND

Little research has examined the moderating influence of posttraumatic growth (PTG) on the relationship between social support and quality of life.

OBJECTIVES

This study examined the relationship between social support and quality of life by the level of PTG in colorectal cancer patients with ostomies.

METHODS

Using a cross-sectional design, colorectal cancer patients with ostomies (n = 140) were recruited using convenience sampling. The City of Hope Quality of Life-Ostomy, the Multidimensional Scale of Social Support, and the Posttraumatic Growth Inventory measured quality of life, social support, and PTG, respectively.

RESULTS

Social support and PTG were positively related to psychological and social well-being. Higher social support was associated with better psychological and social well-being. Posttraumatic growth moderated the relationship between psychological and social well-being. At a low and moderate level of PTG, social support was more strongly associated with psychological and social well-being, whereas at high levels, this association was not significant.

CONCLUSIONS

Findings highlight the significance of social support to improve the quality of life for colorectal cancer patients with an ostomy, particularly those with low levels of PTG.

IMPLICATIONS FOR PRACTICE

Screening for patients' positive cognitive adaptations while living with an ostomy could identify those who might need further social support to improve their quality of life. Further, intensive social support programs might promote the quality of life for colorectal patients with an ostomy, which was found to be effective for those with low levels of PTG.

Nursing strategies to support psychological adaptation in adult cancer patients: a scoping review

OBJECTIVE

To map the scientific evidence published in the literature about nursing strategies and intervention programs directed at supporting psychological adaptation in adult cancer patients.

METHOD

A scoping review based on Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews was conducted. Twelve databases were searched between 1 January 2012 and 31 January 2019.

RESULTS

From 2203 studies, 32 were included. Evidence was grouped in five subjects: procedures, outcome assessment measures, nursing feasibility, effectiveness and cost-effectiveness. The cognitive-behavioral therapy was most frequent intervention. These interventions were developed between 5 to 10 weeks, included 3 to 6 sessions and lasted up to 60 minutes. Despite a wide range of outcome measures employed, three main areas were identified, adjustment and coping; stress, anxiety and fear of recurrence; and quality of life.

CONCLUSION

This review allowed to identify nursing strategies to support psychological adaptation in adult cancer patients, to assess vulnerabilities and difficulties related to nurse interventions and to recognize the need for further insights into the effectiveness and cost-effectiveness.

Effects of psychosocial factors on posttraumatic growth among lung cancer patients: A structural equation model analysis

OBJECTIVE

The purpose of this study was to investigate how locus of control, coping strategies, emotion regulation strategies and social support affect posttraumatic growth.

METHODS

A cross-sectional study design was adopted. A convenience sample of 540 patients with lung cancer was recruited from November 2016 to July 2017 at two tertiary grade A hospitals in China. The participants completed a series of questionnaires. Structural equation modelling was used to explore the effects of psychosocial factors on posttraumatic growth.

RESULTS

Social support had a direct positive effect on posttraumatic growth (β = 0.318, SE = 0.071, BC 95% CI = 0.252/0.390), and it also had indirect effects on posttraumatic growth (β = 0.112, SE = 0.023, BC 95%CI = 0.088/0.135) through mediating psychological factors. Coping strategies and the cognitive reappraisal emotion regulation strategy were the main mediating variables, explaining approximately 73.1% of the indirect effect between social support and posttraumatic growth.

CONCLUSIONS

Our study suggests that Chinese lung cancer survivors can show relatively high posttraumatic growth. There are many mediating paths between social support and posttraumatic growth. These results may help healthcare professionals to identify the psychosocial factors that may benefit lung cancer patients and develop interventions to promote posttraumatic growth.

The relationship between posttraumatic growth and health-related quality of life in adult cancer survivors: A systematic review

BACKGROUND

Studies have reported mixed findings on the relationship between posttraumatic growth (PTG) and health-related quality of life (HRQOL) in cancer survivors. This review aims to give an overview of these studies and to identify potential study- and sample-level factors that could contribute to the heterogeneity of those findings on the relationship between PTG and HRQOL in cancer survivors.

METHODS

Multiple electronic databases were systematically searched using the concepts 'posttraumatic growth', 'cancer', and 'health-related quality of life'. Eligible studies (published until 2018) were reviewed, quality-assessed, and effect sizes were extracted and synthesized.

RESULTS

Of the 37 included articles, 22 received a rating of 'weak', 11 'moderate' and 4 'strong' in study quality assessment. The overall sample comprised 7954 individuals, mean age of 55.30 years, >50% females, predominantly breast cancer, and survivors mainly within 5 years post-diagnosis. The synthesized results revealed a positive association between PTG and HRQOL (Fisher's z= 0.16) on a total scale, with significant high heterogeneity (I²=75%). Variations in HRQOL measurement and methodological inconsistency contributed to study-level differences of effect sizes. Sample-level characteristics such as geographic region, smaller sample sizes (n < 100) and so on contributed to heterogeneity.

LIMITATIONS

Studies assessing the relationship between PTG and HRQOL were heterogeneous, of weak study quality generally, and results were difficult to combine.

CONCLUSIONS

Most studies found a positive relationship between the factors suggesting that PTG may play a role for successful coping following cancer. However, studies of higher quality and longitudinal design are needed.

Two brief group interventions for individuals with tinnitus in Israel

Background/Aims

Subjective tinnitus is a common impairment throughout the world and typically cannot be cured. Coping strategies are cognitive, affective, and behavioural approaches for managing stressors like tinnitus. The aim of this study was to investigate the effects of two brief interventions on coping and tinnitus-related distress.

Methods

A total of 45 individuals with tinnitus in Israel were allocated into one of three groups: acceptance and commitment therapy, coping effectiveness training, or a waitlist control group. Outcomes were assessed at three time points by the Brief Coping Orientation to Problems Experienced scale and the Tinnitus Handicap Inventory, a measure of tinnitus-related distress.

Results

There was a significant difference among the groups on post-intervention Tinnitus Handicap Inventory assessment, but not on coping, when controlling for baseline scores. Pairwise comparisons indicated that the coping effectiveness training group scored significantly lower on the Tinnitus Handicap Inventory than the waitlist control group.

Conclusions

While the results are promising, a larger study is needed to further explore the efficacy of the brief coping effectiveness training intervention.

Expression of resilience, coping and quality of life in people with cancer

Considering the importance of coping strategies and resilience in adapting to the stress caused by cancer, the objective of this research is to explore which coping strategies are the most used, in order to know whether different groups of levels of resilience and an appropriate coping style are related to a higher quality of life and better adaptation to the disease. There were 74 participants with cancer in this study (79.7% of them were women) ranging in age from 29 to 85 years (M = 50.9). Different instruments were used to measure the resilience construct (ER-20 items Resilience Scale), coping strategies (Cognitive Emotion Regulation Questionnaire-Short) and quality of life (General Health Questionnaire). People with higher resilience showed higher scores in the use of adaptive strategies, being acceptance and positive revaluation the most frequent ones. Regarding perception of quality of life, people with lower resilience showed statistically significant differences in the dimensions of pain and general health, which were likewise the most common ones for people with lower resilience. A significant association has been demonstrated between resilience and an adaptive coping, which at the same time are positively linked to quality of life of people with cancer. This study provides information about how different groups of resilience levels are related with coping and quality of life in people with cancer. It could be useful information for psychologists in the oncological area who have to take decisions in the clinical context. A practical consequence would involve trying to modify the type of coping, as well as increasing the level of resilience in people with cancer, in order to achieve a better adjustment to the disease.

Role of neuroticism and extraversion in the emotional health of people with cancer

The impact that cancer disease can have on individuals varies depending, among other things, on their personal characteristics, so it is important to explore aspects such as the personality traits in relation to mental health in people with cancer. The aim of this study was to analyse the relationship between neuroticism, extraversion and mental health in people with cancer. Besides, this study also explored differences in mental health when combining extraversion and neuroticism levels. One hundred and seventy people who had been diagnosed with different types of cancer (breast cancer, lung, colon, gynaecological cancer and others) composed the sample. Almost all of them (92.9%) had received oncological treatment. The GHQ-12 scale was used to assess the mental health and the 60-item NEO Five-Factor Inventory was applied in order to measure neuroticism and extraversion in participants. A hierarchic lineal regression model was conducted. Neuroticism and extraversion did not show any interaction effect, although a partial mediation was observed in relation to mental health outcomes. Given the significant correlation between neuroticism and extraversion with mental health (r = .59, p < .001; r = −.41, p < .001), both personality traits were combined, resulting in a classification of four different personality profiles (F_(4;165) = 19.85; p < .001). Results in this study have shown that low levels of neuroticism and high levels of extraversion are related to positive health outcomes. They seem to be protective factors with respect to the mental health in people with cancer. The knowledge of the positive effects of these aspects contributes to the comprehension of mental health in the oncological sample, which should be considered in order to design and guide particular therapeutic interventions adapted to each person.

Mediating effect of interpersonal coping on meaning in spirituality and quality of life and the influences of depression and anxiety thereon in cancer patients

OBJECTIVE

This study aimed to investigate associations among spirituality, coping strategies, quality of life (QOL), and the effects of depression and anxiety thereon in cancer patients.

METHOD

In total, 237 cancer patients referred to a psycho-oncology clinic at a university hospital in Korea were enrolled. After identifying predictors of patient QOL in a stepwise regression model, we developed a hypothetical path model wherein interpersonal coping was considered as a mediating variable between spirituality (meaning/peace) and QOL and wherein depression and anxiety affected each of these three variables.

RESULT

The direct effect of spirituality (meaning/peace) on QOL was 36.7%. In an indirect model, interpersonal coping significantly mediated the relationship between spirituality (meaning/peace) and QOL. Depression exerted the largest negative effect on spirituality (meaning/peace), interpersonal coping, and QOL. Anxiety had negative effects on spirituality (meaning/peace) and QOL, but a positive effect on interpersonal coping.

SIGNIFICANCE OF RESULTS

Interpersonal coping strategies work as a partial mediator of the relationship between meaning/peace subscales of spirituality and QOL. Effective management of depression may help in achieving better outcomes associated therewith. Greater attention and efforts to improve social connectedness and meaning of life in spiritual well-being may improve the QOL of cancer patients.

Challenges, Coping Strategies, and Social Support among Breast Cancer Patients in Ghana

Background. Despite the high incidence and mortality rate of breast cancer (BC) in Ghana, little attention has been given to the issue of how adult women cope with having BC. The aim of this study was to explore the challenges, coping strategies, and support systems among women diagnosed with BC in Ghana. Methods. A descriptive cross-sectional study was conducted from February to August 2017 at the Komfo Anokye Teaching Hospital (KATH), Ghana. A systematic random sampling technique was used to select 202 women with a confirmed diagnosis of BC. Coping strategies of women with BC were assessed using the Brief-COPE. The associations between sociodemographic characteristics, social network/support, and coping strategies were assessed using linear regression models. Results. The most and least adopted active coping strategies were religious coping and humors, respectively. Self-distraction and substance use were the most and least adopted avoidant coping strategies, respectively. Spouses and children offered the most support to women with BC; having support from 5 or more sources was associated with higher mean active coping (beta [β] 1.14; 95% CI 0.66 to 1.62) and avoidant coping (β 1.46; 95% CI 0.98 to 1.94), as compared with having <2 sources of social support. Conclusion. This study demonstrates that women diagnosed with BC in Ghana adopt varied coping strategies to deal with these challenges. The forms of coping strategies adopted by women diagnosed with BC are influenced by the extent of social support received. Psychosocial counseling and support should be an integral part of BC management. Exploring and including social networks could play an important role in the management of BC in Ghana.

Coping Among Breast Cancer Survivors: A Confirmatory Factor Analysis of the Brief COPE

BACKGROUND AND PURPOSE

Cancer survivors continue to cope with significant stressors after completing treatment. The Brief COPE (Carver, 1997) is frequently used to measure coping; however, its factor structure remains unclear. The purpose of this study was to determine the best factor conceptualization of the Brief COPE for use among breast cancer survivors.

METHODS

Breast cancer survivors (N = 1,127) completed the Brief COPE. We conducted confirmatory factor analyses comparing several a priori models based on research in cancer-relevant populations.

RESULTS

Of the eight models examined, the 14-factor model of the Brief COPE showed the best fit.

CONCLUSIONS

Despite efforts to simplify the structure of the Brief COPE, our results suggest coping among breast cancer survivors is best assessed using Carver's (1997) original 14-factor conceptualization.

Mental adjustment to cancer and quality of life among women living with breast cancer in Ghana

OBJECTIVE

This study examined whether cancer-specific coping strategies have any significant influence on the quality of life of 205 women living with breast cancer in Ghana.

METHODS

Using a cross-sectional survey design, participants were administered questionnaires which measured their cancer-specific coping strategies and health-related quality of life.

RESULTS

Correlation analysis showed that helplessness-hopelessness negatively correlated with physical wellbeing, emotional wellbeing, functional wellbeing, and breast cancer additional concerns. Anxious preoccupation negatively correlated with all the domains of quality of life, whereas fighting spirit was positively correlated with emotional and functional wellbeing. Cognitive avoidance was positively correlated with functional wellbeing, while fatalism was positively related with all the domains of quality of life. Regression analysis revealed that anxious preoccupation predicted significant decreases in all the domains of quality of life, while helplessness-hopelessness predicted significant decreases in emotional and functional wellbeing domains. However, cognitive avoidance predicted significant increase in the functional domain of quality of life.

CONCLUSION

These findings underscore the need for psychosocial support for breast cancer patients to adopt effective coping strategies to deal with their challenges in managing their illness.

Hispanic Male Cancer Survivors’ Coping Strategies

Cancer survivors manage their new status using a multitude of coping mechanisms. Coping strategies vary by individual, but are also socioculturally mediated. Scarce evidence on coping strategies adopted by Hispanic male cancer survivors (HMCS) is available to date. The purpose of this study was to explore the reaction to diagnosis and subsequent coping strategies employed by HMCS. Data were gathered through focus groups ( n = 18), cognitive interviews ( n = 12), and phone interviews ( n = 84). Coping strategies included positive attitudes, humor, optimism and social support, use of home remedies, lifestyle changes, and faith. Findings are consistent with research on non-cancer-related coping showing that HMCS use active coping strategies, such as religion and support from family and friends. The analysis of existing strategies and needs points to the need to develop evidence-based psychosocial services that build on strengths and coping behaviors already employed by HMCS.

The Traumatic Experience of Breast Cancer: Which Factors Can Relate to the Post-traumatic Outcomes?

Background: Post-traumatic growth (PTG) is considered a positive outcome of struggling with a traumatic event, distinct, and opposite from negative outcomes, i.e., psychological distress. The present study aimed to shed light on the relationship between potentially relating factors (i.e., coping strategies, perceived social support, and attachment style) and both positive and negative psychological outcomes. Methods: A total of 123 breast cancer survivors were recruited, who completed a battery of self-report questionnaires, assessing PTG, psychological distress, coping strategies, perceived social support, and attachment style. Three regression analyses were run to evaluate whether relating factors were significant predictors of the positive and negative psychological outcomes. Results: The regression analyses showed that the "Fatalism" coping strategy and perceived social support were two significant predictors of PTG. Instead, the "Helpless-Hopeless" and "Anxious Preoccupation" coping strategies, as well as an insecure attachment style, were significant predictors of depression, while the "Anxious Preoccupation" coping strategy and an insecure attachment style were significant predictors of anxiety. Conclusions: The present findings showed that the factors underlying a positive or negative outcome are different and specific. While perceived social support and a fatalistic attitude seem to play a key role in the positive outcome, dysfunctional coping strategies, together with an insecure attachment style, appear to be related with negative psychological outcome. Considering these factors in clinical practice would help patients to give meaning to their traumatic experience, enhancing psychological growth.

An exploration of posttraumatic growth, loneliness, depression, resilience, and social capital among survivors of Hurricane Katrina and the Deepwater Horizon Oil Spill

The aim of this study was to examine the relationships among posttraumatic growth (PTG), loneliness, depression, psychological resilience, and social capital among survivors of Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010. The survey was administered to a spatially stratified, random sample of households in the three coastal counties of Mississippi. A total of 216 participants were included in this study who lived in close proximity to the Gulf of Mexico coastline during both disasters. Results from structural equation modeling analyses indicated that there was a significant and inverse relationship between PTG and loneliness. Conversely, a direct relationship was not found between PTG and depressive symptoms; instead, the results revealed an indirect relationship between PTG and depressive symptoms through loneliness. Social capital was related to loneliness only indirectly through PTG, while psychological resilience was related to loneliness both directly and indirectly through PTG. Understanding the relationships among these factors, particularly the importance of PTG, can provide insight into the long-term adaptation among those who have survived multiple disasters. Further, these findings may lead to nuanced methods for behavioral health practitioners in assessing and treating individuals with symptoms of depression in disaster-prone communities.

Spirituality, Distress and Posttraumatic Growth in Breast Cancer Patients

Breast cancer is the most common type of cancer for women and is associated with increased distress. Spirituality and posttraumatic growth (PTG) have been associated with illness adjustment, but the relationship between these variables is still not well understood. A sample of 100 breast cancer patients completed a demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Spiritual and Religious Attitudes in Dealing with Illness, and the Hospital Anxiety and Depression Scale. Results showed an association between PTG, spirituality and distress. Women with a longer diagnosis and recurrence showed more distress. Younger age, recurrent cancer and spirituality predicted higher PTG. Patients' spirituality should be part of intervention with breast cancer patients since it seems to be related to greater growth and adjustment to the illness.

Longitudinal Development of Primary and Secondary Posttraumatic Growth in Aging Veterans and Their Wives: Domain-Specific Trajectories

Posttraumatic growth (PTG), the positive psychological transformations that follow traumatic events, affects both direct survivors (primary PTG) and their significant others (secondary PTG). Though primary and secondary PTG have been widely investigated in the literature, their long-term trajectories decades after a traumatic event, especially as survivors enter older age, remain largely uninvestigated. Furthermore, it remains contested whether PTG adds up to a monolithic construct or rather consists of relatively independent components. Addressing these issues, we assessed a sample of Israeli male veterans from the 1973 Yom Kippur war (N = 349) and their wives (N = 156) at three time points over the course of nearly three decades. Both the veterans (primary survivors) and their wives (secondary survivors) reported PTG relating to the veterans' experiences during the war and/or captivity. Latent growth mixture modeling was conducted to identify trajectories of PTG on the five subscales of the Posttraumatic Growth Inventory. Long-term trajectories of PTG followed heterogeneous patterns of fluctuation over time and particularly as participants entered older age. On most subscales, decreasing PTG scores were evident, a trend that was more pronounced among the primary survivors than the secondary survivors as primary and secondary PTG fluctuate considerably in the long-term and seem to decrease as individuals enter older age. Furthermore, it would seem that PTG should not be considered a holistic concept but rather a conglomeration of positive changes. Implications of the findings are discussed within the context of limitations and potential intervening factors.

A Pilot Randomized Clinical Trial Comparing Three Brief Group Interventions for Individuals With Tinnitus

Background

Tinnitus (ie, ear or head noises not caused by external sounds) is common among the general population and is the most prevalent service-connected disability in the United States’ Department of Veterans Affairs system. While numerous clinical interventions have been created to systematically address the range of issues caused by tinnitus, only a few tinnitus interventions have focused on both teaching and assessing coping strategies. The present pilot study involved a randomized clinical trial comparing 3 brief group interventions to a usual-care (UC) group (ie, a wait-list control group): the first intervention based on acceptance and commitment therapy (ACT), a second based on cognitive-behavioral therapy (CBT), and a third based on coping effectiveness training (CET). Each intervention group also received tinnitus-related audiological education.

Participants

Forty individuals met the eligibility requirements and were randomized into 1 of the 4 groups (ACT, CBT, CET, or UC). An intent-to-treat analysis was used in this study.

Measures

The Brief COPE scale was used to assess coping. Coping was assessed at 3 time points (pre-intervention, post-intervention, and at 4-week follow-up). The outcomes were 3 coping factors (engagement coping, disengagement coping, and social support coping).

Results

When examining differences among the groups on mean coping scores over time, significant group differences were found on social support coping, with the CET group scores significantly higher than the UC group.

Discussion

While all 3 brief interventions teach stress-reduction techniques, ACT and CBT focus primarily on managing one’s unwanted thoughts and emotions. CET teaches participants both a range of coping strategies (eg, stress-management approaches) to more effectively manage stressors that cannot be changed, as well as coping strategies (eg, such as problem-solving) that can be used to eliminate stressors that can be changed. CET also teaches communication skills for telling others about one’s tinnitus-related issues. CET instructs individuals on how to select coping strategies that are appropriate for different kinds of stressors and how to seek social support, which is a skill not explicitly taught by ACT or CBT. Results of this study were derived from a small sample size, and thus, future research should focus on replicating the results among a larger sample. In addition, future research could focus on adapting the CET intervention to a different delivery format.

Body-Mind Healing Strategies in Patients with Cancer: a Qualitative Content Analysis

Background: Cancer is a major health problem around the world. The use of coping strategies among patients with cancer depends on several issues. This study was conducted to determine coping strategies used by patients with cancer in south-east Iran. Methods: This study is a conventional, qualitative content analysis with a descriptive explorative approach. Data saturation achieved after interviewing 13 participants in 15 interviews. Using an in-depth individual semi-structured approach the participants were asked to narrate their experiences of strategies that they used to cope with cancer. The following were considered: unit of analysis, meaning unit, condensation, code, sub-category, category, and main category. Results: Data analysis led to extraction of two main categories of body-mind healing strategies: being connected to the body and mindfully reconnected to the self. The first category was explained with reference to two sub-categories, being aware of intelligence and body nurturing. The second category was explained with the three sub-categories of using embodying knowledge, living for the moment, and being connected to nature. Conclusion: According to the results of this qualitative study, it is possible to form discussion groups with peers or to have self-reflective practice learning groups to reflect patients’ questions and strategies that they use for body-mind healing.

Peer Connect for African American breast cancer survivors and caregivers: a train-the-trainer approach for peer support

Racial disparities in breast cancer survivorship are a major concern nationally. How survivors cope with cancer and re-frame their lives is a critical part of survivorship. Community-academic research partnerships may facilitate access to much-needed psychosocial support for African American survivors and caregivers in rural areas, but drivers of successful intervention implementation are not well understood. The purpose of this study was to describe the training and evaluation of Community Coaches and Guides (i.e., peer supporters) using the Peer Connect program for African American breast cancer survivors and caregivers. Community engagement strategies were used to implement the training component of Peer Connect, an evidence-based program grounded in the Diffusion of Innovation Theory utilizing motivational interviewing techniques (MI) and a "train-the-trainer" model. Quantitative and qualitative methods examined implementation outcomes of feasibility, MI fidelity, and acceptability-precursor outcomes that must be achieved before examining intervention impact vis-à-vis changes in support care. Training was feasible to implement and replicable by the trained Community Coaches. Beyond feasibility and replicability, success was modest regarding MI fidelity. Benefits (e.g., serving as role models and having safe sources of support) and lessons learned (e.g., need for additional quality control) were identified as both facilitators and barriers to implementation and as factors that could impact the effectiveness of community-engaged programs to improve survivorship outcomes. Peer Connect, like other programs that employ community-engagement strategies, holds promise to meet the psychosocial support needs of diverse rural cancer survivor populations.

The Affect Regulation in Cancer framework: Understanding affective responding across the cancer trajectory

Affective dimensions of cancer have long been a central concern in the field of psycho-oncology. Recent developments in the field of affective science suggest the value of incorporating insights from the burgeoning literature on affect regulation. Accordingly, the objective of this article is to build on prior work in this area by applying a process-oriented affect regulation framework to the various phases of the cancer trajectory. The Affect Regulation in Cancer framework is adapted from Gross' process model of emotion regulation, and its aim is to integrate recent advances in affective science with work in the field of psycho-oncology. The basic elements of the affect generative and affect regulatory processes are outlined across the various phases of the cancer trajectory. Our proposed model provides a useful heuristic framework in advancing research on the ways people manage their affective responses throughout the cancer trajectory.

Recruitment and retention of a challenging population: Lessons learned and design implications

PURPOSE

The purpose of this article is share the lessons learned from recruiting and retaining adults with type 2 diabetes and solid tumor cancer into a longitudinal study exploring the relationship among chemotherapy, glycemic control, and symptoms.

DESIGN/METHODS

Twelve-week longitudinal study, recruited thirty-four adults 21years or older with pre-existing type 2 diabetes and a solid tumor cancer, from three community based cancer centers who were eligible to receive outpatient chemotherapy.

METHODS

Fisher's Exact Test (categorical variables) and Logistic Regression (continuous variables) were used to evaluate factors associated with participant withdrawal. A dichotomous attrition variable was created to identify those who dropped out of the study before the final week and those who completed.

RESULTS

Thirteen of the 34 participants completed the study. Symptom severity, baseline HbA1c and metastases were all identified as being factors that potentially influenced attrition. Recruitment was improved once recruiters were hired at each of the cancer centers and adjustments made to the inclusion criteria.

CONCLUSIONS/IMPLICATIONS FOR RESEARCH

Several design elements need to be considered to address attrition in future including the use of recruiters, inclusion and exclusion criteria, consent timing, data collection schedules, participant characteristics, participant burden, and support person identification.

Expressed emotion in couples facing breast cancer in women is associated with psychological distress in the first year after surgery

The aim of this study was to assess the links between partners' and women's expressed emotion with the distress of one another during the first year after surgery for breast cancer in women. The design was longitudinal. A sample of 61 couples participated in the study at 2 weeks, 3 months, and 12 months after the surgery. Expressed emotion was assessed with the Five-Minute Speech Sample. Psychological distress was assessed with a self-reported questionnaire. Mixed-model analyses showed that partners' expressed emotion is associated with heightened psychological distress in women during the first year after surgery, even after medical data were controlled for.

Differences in Coping Among African American Women With Breast Cancer and Triple-Negative Breast Cancer

PURPOSE/OBJECTIVES

To determine differences in psychological distress, symptoms, coping capacity, and coping abilities among African American (AA) women with triple-negative breast cancer (TNBC) and non-TNBC and to explore differences in relationships among these variables.
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DESIGN

A prospective, descriptive, comparative, and correlational design.
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SETTING

Johns Hopkins Hospital in Baltimore, Maryland.
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SAMPLE

30 AA women with breast cancer.
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METHODS

Patients completed questionnaires during chemotherapy. The Transactional Model of Stress and Coping was used to guide the research.
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MAIN RESEARCH VARIABLES

Psychological distress, symptoms, coping capacity, and coping ability.
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FINDINGS

Patients with non-TNBC reported more intense present total pain, nausea and vomiting, better emotional functioning, lower cognitive functioning, use of significantly more prayer and hope, and more coping self-statements. A lower coping capacity score was associated with psychological distress in the TNBC group at midpoint and in both groups at completion of chemotherapy treatment. Patients in both groups used a higher level of positive religious coping.
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CONCLUSIONS

AA women with TNBC and non-TNBC might benefit (reduced psychological distress and improved coping skills) from receiving a comprehensive psychological care program. The findings can be incorporated and tested in a comprehensive coping strategy program.
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IMPLICATIONS FOR NURSING

Nurses should work closely with AA women with breast cancer undergoing chemotherapy to help them identify and consciously use coping strategies associated with increased coping capacity.

Uncertainty and quality of life of Malaysian women with breast cancer: Mediating role of coping styles and mood states

PURPOSE

This study aimed to investigate the relationship between uncertainty in illness and quality of life, and examine the mediating role of coping strategies and mood states in this relationship among breast cancer patients.

METHODS

A convenience sample of 135 Malaysian women with breast cancer completed questionnaires measuring uncertainty in illness, mood states (i.e. anxiety and depression), quality of life, and copying styles.

RESULTS

The results showed an inverse correlation between uncertainty and quality of life after controlling for the effects of age, cancer stage and time since diagnosis. Moreover, the negative association between illness uncertainty and quality of life was mediated by coping strategies and mood states.

CONCLUSION

The findings revealed that breast cancer patients experiencing a high level of uncertainty more likely use avoidant and less likely use active emotional coping strategies which in turn amplifies anxiety and depression and undermines their quality of life. While some interventions to reduce the adverse consequences of uncertainty are recommended, the findings indicated the need for targeted psychological interventions seeking to gradually shift cancer patients' coping strategies from avoidant to active emotional coping.

Psychological and clinical correlates of posttraumatic growth in cancer: A systematic and critical review

OBJECTIVE

The objective of this study is to describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates.

METHODS

A search in relevant databases (PsycINFO, Pubmed, ProQuest, Scopus, and Web of Science) was performed using descriptors related to the positive reactions in cancer. Articles were screened by title, abstract, and full text.

RESULTS

Seventy-two met the inclusion criteria. Most articles (46%) focused on breast cancer, used the PTG inventory (76%), and had a cross-sectional design (68%). The PTG resulted inversely associated with depressive and anxious symptoms and directly related to hope, optimism, spirituality, and meaning. Illness-related variables have been poorly investigated compared to psychological ones. Articles found no relationship between cancer site, cancer surgery, cancer recurrence, and PTG. Some correlations emerged with the elapsed time since diagnosis, type of oncological treatment received, and cancer stage. Only few studies differentiated illness-related-life-threatening stressors from other forms of trauma, and the potentially different mechanisms connected with PTG outcome in cancer patients.

CONCLUSIONS

The evaluation of PTG in cancer patients is worthy, because it may promote a better adaption to the illness. However, many investigations do not explicitly refer to the medical nature of the trauma, and they may have not completely captured the full spectrum of positive reactions in cancer patients. Future research should better investigate issues such as health attitudes; the risks of future recurrences; and the type, quality, and efficacy of medical treatments received and their influence on PTG in cancer patients.

The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis

PURPOSE

Information on posttraumatic growth (PTG) among colorectal cancer (CRC) survivors with permanent intestinal ostomies is limited. The aim of this cross-sectional study was to investigate the occurrence of PTG among CRC survivors with permanent intestinal ostomies and its association with perceived social support and resilience.

METHODS

This study was conducted with 164 CRC survivors with permanent intestinal ostomies at least one month after surgery. Participants completed questionnaires assessing socio-demographic and clinical characteristics, perceived social support, resilience and PTG.

RESULTS

The mean total score on the Post Traumatic Growth Inventory was 66.74 (SD = 13.99). Perceived social support (r = 0.450) and resilience (r = 0.545) were significantly positively correlated with PTG. Structural equation modeling analysis showed that resilience mediated the relationship between perceived social support and PTG in which the indirect effect of perceived social support on PTG through resilience was 0.203 (P < 0.001).

CONCLUSIONS

Moderate to high PTG was found in CRC survivors with permanent intestinal ostomies. The most important implication of this study was that improving social support and resilience might be scientific intervention strategies for promoting PTG among CRC survivors.

Correlates of the positive psychological byproducts of cancer: Role of family caregivers and informational support

Objective:

Experiencing a life-threatening illness such as cancer can elicit both negative (e.g., distress) and positive (e.g., growth) psychological responses. The present study sought to determine the correlates of four positive psychological byproducts in cancer survivors: becoming a stronger person, coping better with life's challenges, making positive changes in life, and adopting healthier habits.

Method:

Data for this cross-sectional study were taken from the Medical Expenditures Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement (Yabroff et al., 2012). Cancer survivors (N = 785) reported their sociodemographic and cancer-related characteristics. Descriptive statistics were utilized to summarize cancer survivor characteristics, including demographic factors, cancer factors, and stressors and resources related to cancer. Multivariable logistic regressions were employed to assess the independent association of the stressors and resources with each psychological response, controlling for covariates. All analyses were weighted to account for the complex sampling design of the MEPS.

Results:

In multivariable analyses, those with a family caregiver were 50% more likely to report better coping with challenges, and around 70% were more likely to report making positive changes in life or adopting healthier habits because of their cancer. Receiving informational support from healthcare providers was also consistently associated with positive byproducts (odds ratios ranging from 1.6 to 2.0). Few of the stressors were associated with positive byproducts: having insurance problems due to cancer was positively associated with becoming a stronger person, and work limitations were associated with making positive changes in life; those who reported high perceived chances of recurrence were less likely to report becoming a stronger person.

Significance of Results:

Having a family caregiver and receiving detailed informational support from healthcare providers were associated with reporting positive experiences with cancer. The hypotheses and future research stimulated by these findings may improve our understanding of the process by which positive byproducts develop and may ultimately help improve psychological well-being among cancer survivors.

Impact of Cognitive Function and Cancer Coping on Quality of Life among Women with Post-chemotherapy Breast Cancer

PURPOSE

This study was done to identify effects of cognitive function and cancer coping on quality of life among women with breast cancer treated with antineoplastic agents.

METHODS

The study was correlational research and participants were 145 women with breast cancer who had received antineoplastic agents. Data were collected from October to November, 2015 via online replies. Cognitive function was measured with the Functional Assessment of Cancer Therapy-Cognitive Function Version-3 (FACT-Cog), cancer coping, with the Korean Cancer Coping Questionnaire (K-CCQ), and quality of life with the Functional Assessment of Cancer Therapy-Breast Version-4 (FACT-B). Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, ANCOVA, Bonferroni test, partial correlation coefficient, and hierarchical multiple regression with SPSS 21.

RESULTS

Cognitive functions, total individual coping, and interpersonal coping explained 42% of quality of life. Cognitive function (β=.35, p<.001) was the best predictor of quality of life, followed by total individual coping (β=.34, p<.001), and interpersonal coping (β=.26, p<.001).

CONCLUSION

Results indicate that cognitive function and cancer coping are meaningful factors for quality of life among breast cancer survivors. Therefore when developing intervention programs for these women, content on cognitive function and coping skills as well as coping resources should be included.

Psychological adjustment after breast cancer: a systematic review of longitudinal studies

OBJECTIVES

Breast cancer (BC) can be a traumatic and stressful experience for women, but there are wide-ranging differences in the ways in which women respond and adapt to BC. This systematic review examines which sociodemographic, disease-related, and psychosocial factors near diagnosis predict later psychological adjustment to BC.

METHODS

Database searches were conducted in 9 different health-related databases from 2000 to December 2015 using relevant search terms. Full-text, peer-reviewed articles in English that analyzed potential predictors of psychological adjustment in longitudinal studies were considered for inclusion.

RESULTS

Of 1780 abstracts, 41 studies fulfilled inclusion criteria. Consistent sociodemographic and disease-related variable predictors of adjustment were income, fatigue, cancer stage, and physical functioning. Psychosocial factors, particularly optimism and trait anxiety, as well as perceived social support, coping strategies, and initial levels of psychological functioning, were found to be predictive of later depressive and anxiety symptoms, psychological distress, and quality of life for women with BC, in predictable ways. Other psychosocial variables, such as cognitive and body image factors, predicted psychological adjustment but were explored only by a few studies.

CONCLUSIONS

The majority of studies showed a significant relationship between psychosocial factors and psychological adjustment. These results point to specific sociodemographic, disease-related, and psychosocial factors that can help to identify women at the time of diagnosis who are at risk for long-term psychological challenges so they can be referred for psychological support that targets their specific needs and can improve their quality of life and mood and decrease indicators of anxiety, depression, and psychological distress.

Trajectories of Posttraumatic Growth and Associated Characteristics in Women with Breast Cancer

BACKGROUND

Cancer survivors may experience posttraumatic growth (PTG), positive psychological changes resulting from highly stressful events; however, the longitudinal course of PTG is poorly understood.

PURPOSE

The purpose of the present study was to determine trajectories of PTG in breast cancer survivors and associated characteristics.

METHODS

Women (N = 653) participating in a longitudinal observational study completed questionnaires within 8 months of breast cancer diagnosis and 6, 12, and 18 months later. Group-based modeling identified PTG trajectories. Chi-square tests and ANOVA detected group differences in demographic, medical, and psychosocial variables.

RESULTS

Six trajectory groups emerged. Three were stable at different levels of PTG, two increased modestly, and one increased substantially over time. Trajectory groups differed by age, race, receipt of chemotherapy, illness intrusiveness, depressive symptoms, active-adaptive coping, and social support.

CONCLUSIONS

This first examination of PTG trajectories in US cancer survivors elucidates heterogeneity in longitudinal patterns of PTG. Future research should determine whether other samples exhibit similar trajectories and whether various PTG trajectories predict mental and physical health outcomes.