Causal attribution among women with breast cancer

What do cancer survivors believe caused their cancer? A secondary analysis of cross-sectional survey data

PURPOSE

Given that risk reduction and healthy lifestyles can prevent 4 in 10 cancers, it is important to understand what survivors believe caused their cancer to inform educational initiatives.

METHODS

In this secondary analysis, we analyzed cancer survivor responses on the Causes Subscale of the Revised Illness Perception Questionnaire, which lists 18 possible causes of illness and a free text question. We used descriptive statistics to determine cancer survivors' agreement with the listed causes and conducted separate partial proportional odds models for the top three causes to examine their associations with sociodemographic and clinical characteristics. Content analysis was used to examine free text responses.

RESULTS

Of the 1,001 participants, most identified as Caucasian (n = 764, 77%), female (n = 845, 85%), and were diagnosed with breast cancer (n = 656, 66%). The most commonly believed causes of cancer were: stress or worry (n = 498, 51%), pollution in the environment (n = 471, 48%), and chance or bad luck (n = 412, 42%). The associations of sociodemographic and clinical variables varied across the models. Free text responses indicated that hereditary and genetic causes (n = 223, 22.3%) followed by trauma and stress (n = 218, 21.8%) and bad luck or chance (n = 79, 7.9%) were the most important causes of cancer.

CONCLUSIONS

Study results illuminate cancer survivors' beliefs about varying causes of their cancer diagnosis and identify characteristics of survivors who are more likely to believe certain factors caused their cancer. Results can be used to plan cancer education and risk-reduction campaigns and highlight for whom such initiatives would be most suitable.

Revisiting Candidacy: What Might It Offer Cancer Prevention?

The notion of candidacy emerged three decades ago through Davison and colleagues’ exploration of people’s understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one’s own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy’s predictive ability, however, was fallible, and it was from this perspective that the public’s reticence to adhere to prevention messages could be explained, as ultimately anybody could be ‘at-risk’. This work continues to resonate in health research, with over 700 citations of Davison’s Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.

Variables predictivas de calidad de vida en mujeres con cáncer de mama

 Objetivos: Estudiamos el valor predictivo que tiene sobre la calidad de vida relacionada con la salud (CVRS) de las mujeres con cáncer de mama en tratamiento, las variables sociodemográficas, clínicas (tipo de tratamiento) y psicológicas tales como los esquemas desadaptativos tempranos (EDT), las creencias y percepciones sobre la enfermedad y las estrategias de afrontamiento utilizadas. Métodos: Realizamos un estudio descriptivo, correlacional, de subtipo predictivo. Incorporamos una muestra de 228 pacientes adultas con cáncer de mama en tratamiento ambulatorio del sistema público asistencial. Se realizaron entrevistas en las que se aplicó un formulario de datos socio demográficos y clínicos, el Cuestionario FACT-B, el Test de Esquemas Tempranos (YSQ-CEY-VR), el Cuestionario de percepción de enfermedad (IPQ-R) y la escala Brief COPE. Se realizaron análisis descriptivos, de estadística inferencial, regresión lineal múltiple y regresión jerárquica. Resultados: Los diferentes tipos de tratamientos onco-específicos no registraron diferencias significativas en la CVRS, sin embargo las mujeres con mastectomía sin reconstrucción valoraron sensiblemente descendida la CVRS con respecto a los otros tipos de cirugía. Las variables que mostraron relación estadística en explicar el FACT-B global fueron los esquemas de Deprivación emocional, Abandono, Imperfección/vergüenza, Vulnerabilidad, Apego, Dominio 3 y Dominio 4. Así también todos los valores del IPQ-R guardaron relación significativa con la CVRS global. Las creencias y percepción global de la enfermedad (IPQ-R) y los dominios de los EDT, tienen valor predictivo sobre CVRS. Conclusiones: las mujeres con una percepción amenazante de la enfermedad tienden a activar pautas de funcionamiento caracterizadas por la desconexión emocional, el aislamiento, la vergüenza; u otras caracterizadas por la dependencia, la pérdida de autonomía y confianza en sí mismas. Las creencias y percepciones sobre la enfermedad activan necesidades y pautas de respuestas cognitivas, emocionales y relacionales (esquemas desadaptativos) siendo ambas variables predictivas del mayor o menor ajuste y percepción global de bienestar.

Causal Attributions in Breast Cancer Patients Planning to Undergo Adjuvant Endocrine Therapy

The aim of this study was to explore causal attributions among Korean breast cancer patients who were planning to undergo adjuvant endocrine therapy (AET) as well as the relationships between patient demographic and clinical characteristics and their causal attributions. Causal attributions were assessed with an open-ended response item, which asked patients to list what they thought were the three most important causal factors of their illness. The relationships between patient characteristics and causal attributions were determined through univariate analysis, and the relationships between causal attributions were obtained using social network analysis. A total of 299 participants provided 707 responses. Stress, diet, and exercise were believed to be the three most likely causes of breast cancer. There were no significant differences between causal attributions and the age, education level, marital status, or cancer stage of patients. However, there were differences in the associations between personality, genetics, and reproductive history and patient-identified causal attributions according to the patients' family history of cancer. Patients with a family history of cancer were more likely to believe that personality and genetics/family history were causes of breast cancer compared to patients without such a history. Therefore, it is necessary to educate patients to perceive stress and lifestyle-related factors as modifiable causal factors in order to have a positive effect on their adherence to AET.

Patient-reported causes of heart failure in a large European sample

BACKGROUND

Patients diagnosed with chronic diseases develop perceptions about their disease and its causes, which may influence health behavior and emotional well-being. This is the first study to examine patient-reported causes and their correlates in patients with heart failure.

METHODS

European heart failure patients (N = 595) completed questionnaires, including the Brief Illness Perceptions Questionnaire. Using deductive thematic analysis, patient-reported causes were categorized into physical, natural, behavioral, psychosocial, supernatural and other. Clinical data were collected from medical records.

RESULTS

Patients who did not report any cause (11%) were on average lower educated and participated less often in cardiac rehabilitation. The majority of the remaining patients reported physical causes (46%, mainly comorbidities), followed by behavioral (38%, mainly smoking), psychosocial (35%, mainly (work-related) stress), and natural causes (32%, mainly heredity). There were socio-demographic, clinical and psychological group differences between the various categories, and large discrepancies between prevalence of physical risk factors according to medical records and patient-reported causes; e.g. 58% had hypertension, while only 5% reported this as a cause. Multivariable analyses indicated trends towards associations between physical causes and poor health status (Odds ratio (OR) = 1.41, 95% confidence interval (95% CI) = 0.95-2.09, p = 0.09), psychosocial causes and psychological distress (OR = 1.54, 95% CI = 0.94-2.51, p = 0.09), and behavioral causes and a less threatening view of heart failure (OR = 0.64, 95% CI = 0.40-1.01, p = 0.06).

CONCLUSION

European patients most frequently reported comorbidities, smoking, stress, and heredity as heart failure causes, but their causal understanding may be limited. There were trends towards associations between patient-reported causes and health status, psychological distress, and illness perceptions.

Early detection of breast cancer: the role of risk perception and family history

Background: Breast cancer is the neoplasm with the highest mortality rates among Brazilian women. Family history plays an important role in tracking the illness because its analysis reveals possible genetic risks. Objective: The aim of this study is to compare the risk perception and self-care for breast cancer among healthy women with and without family history. Method: The study included 211 women (mean age = 59.11 years, SD = 8.54) of which 55 (26.4%) had a family history of the illness. The instruments used were a sociodemographic and health behavior questionnaire and a risk perception questionnaire. Results and Conclusions: The results showed no significant differences in risk perception and self-care behavior among women with and without breast cancer history, signaling the need of guidelines for psychologists to act in breast cancer prevention among women with a family history, encompassing understanding of the risk factors and causes of the illness as well as women’s responsibility in tracking.