Stress, Breast Cancer Risk, and Breast Self-Examination: Chronic Effects of Risk and Worry1

Checking Behavior, Fear of Recurrence, and Daily Triggers in Breast Cancer Survivors

BACKGROUND

Fear of cancer recurrence (FCR) is a top ongoing concern of breast cancer (BC) survivors and thus the focus of recent intervention development. The Self-Regulation Model of FCR (Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence-a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology. 1997;6:95-105.) states that everyday cancer-related events trigger FCR, which, in turn, leads to specific behavioral responses, including checking the body for signs or symptoms of cancer. Links between triggering events, FCR, and checking behavior have not yet been studied in the context of daily life or at the within-person level.

PURPOSE

The goal of this study was to examine whether FCR has a within-person link with daily checking behavior and whether FCR mediates the link between triggering events and checking behavior.

METHODS

Seventy-two early-stage BC survivors completed daily diaries over a 21-day period approximately 5 months after BC surgery. FCR, checking behavior, and triggering events were assessed each evening.

RESULTS

Multilevel modeling results indicated that FCR predicted greater odds of same-day, but not next-day, checking behavior. We found that daily FCR significantly mediated the same-day effect of triggering events on checking behavior. These average within-person effects varied substantially between patients and were not explained by momentary negative affect.

CONCLUSIONS

Findings support the within-person relationship between triggering events, FCR, and checking behavior posited by guiding theory, and can inform FCR intervention development.

Perceptions of a patient-staff-caregiver group among inpatients in a radiotherapy unit

Objective:

Coping with cancer and its treatments has significant psychological implications for patients, and hospitalization can lead to emotional distress. Based on a community meeting (CM), a common therapeutic intervention in psychiatric wards, a unique patient–staff–caregiver group is held weekly on the radiotherapy unit of our hospital. The goals are to strengthen patient coping abilities and prompt open communications. The present study aimed at quantitatively estimating the effect of the community meeting by gauging the perceptions with respect to several therapeutic aspects.

Method:

A questionnaire was developed for patients who participated in CMs during their hospitalization based on four theoretical factors: illness perception, relations with the main caregiver, relations with other participants, and relations with unit staff.

Results:

Participants' general satisfaction with the meetings was found to be positive. The most significant aspect of the meetings, as perceived by participants, was relationships with the staff. Patients born in Israel perceived relationships with other participants more positively.

Significance of results:

Attentive interaction with medical staff and open communications are highly important for patients and contribute to their general satisfaction with the meetings.

A review of the evidence of harm from self-tests

Although HIV self-testing may overcome some barriers to HIV testing, various stakeholders have expressed concerns that HIV self-testing may lead to unintended harm, including psychological, social and medical harm. Recognizing that similar concerns were raised in the past for some other self-tests, we conduct a review of the literature on a set of self-tests that share some characteristics with HIV self-tests to determine whether there is any evidence of harm. We find that although the potential for harm is discussed in the literature on self-tests, there is very little evidence that such harm occurs.

Perceptions of cancer as a death sentence: prevalence and consequences

Research suggests that perceiving cancer as a death sentence is a critical determinant of health care-seeking behaviors. However, there is limited information regarding the prevalence of this perception in the US population. Cross-sectional analysis of data (n = 7674 adults) from the 2007-2008 administration of the nationally representative Health Information National Trends Survey (HINTS 3) was performed. A majority (61.6%) of respondents perceived cancer as death sentence, and more than one-third (36%) of respondents reported that they avoid seeing their physicians. In the adult US population, perceiving cancer as a death sentence is common and is associated with education level and avoidance of physicians.

Coping with genetic testing for breast cancer susceptibility

OBJECTIVE

To examine how women cope with genetic testing for heightened susceptibility to breast cancer.

METHODS

Participants were 126 White women (age = 44 +/- 9 years) who were participants in a larger study of genetic testing for risk of different chronic diseases. All women were at higher-than-average risk for breast cancer due to a personal and/or family history and were considering genetic testing. Distress (Symptom Checklist-90-Revised, Impact of Event Scale, Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale) was assessed at four assessments; one before and three after the decision to have genetic testing. The majority of women (n = 100) had testing. The follow-up assessments occurred at 1 week after receiving results (or 3-4 months after baseline if testing was not elected), and then at 3 and 6 months after the second assessment. Coping (Brief COPE) was measured at the first and third assessments.

RESULTS

Coping was relatively stable over time and did not vary as a function of genetic test results. Active coping strategies were used more often by women with a personal cancer history than by women without cancer. Use of avoidant coping was reliably and positively associated with distress over time independent of cancer history and test result.

CONCLUSIONS

The identification of specific coping styles that were associated with more or less distress is useful as a means of identifying and targeting coping interventions and predicting which participants may be at risk for distress.