Objective and subjective stressors and the psychological adjustment of melanoma survivors

This study of 300 melanoma survivors examines the relative contributions of objective illness-related factors (stage of illness at diagnosis, time since diagnosis, and change in physical condition) and of subjective factors (cognitive appraisal) to their psychological adjustment. The findings show that lower appraisal of their situation as a threat, higher appraisal of it as a challenge, and higher appraisal of their subjective ability to cope with it all increased their well-being, while lower threat appraisal and higher appraisal of subjective ability to cope also reduced their distress. These findings, which are consistent with Lazarus and Folkman's stress coping theory, suggest that subjective factors may be more important than objective medical factors in predicting patients' adjustment. With this, more advanced stage at diagnosis contributed to reducing distress, while being married contributed both to higher well-being and reduced distress.     

Psychological adjustment of survivors of localised prostate cancer: investigating the role of dyadic adjustment, cognitive appraisal and coping style

OBJECTIVES: The aim of this study was to identify the factors that contribute to psychological adjustment in prostate cancer patients two or more years post-treatment. METHOD: One hundred and sixty-seven men who had undergone treatment for localised prostate cancer participated in this study. In the sample 63 participants had undergone external beam radiotherapy (EBRT), 55 radical prostatectomy (RP), 27 EBRT plus hormone therapy (EBRT/HT), and the remainder a combination of treatments. Patients completed the UCLA-PCI, the POMS, CISS, DAS and a threat appraisal questionnaire. RESULTS: The majority of patients reported relatively positive adjustment in most domains except sexual functioning. For those who reported ongoing psychological difficulty mood disturbance was associated with sexual bother, dyadic adjustment, threat appraisal, self-efficacy appraisal and emotion-focussed coping. Lower levels of urinary bother were associated with the use of more task-focussed coping. Emotion-focussed coping and threat appraisal mediated the relationship between sexual bother and mood disturbance. Emotion-focussed coping moderated the influence of dyadic adjustment on mood disturbance. CONCLUSIONS: Dyadic adjustment, threat appraisal and coping style play a significant role in the long-term psychological adjustment of prostate cancer patients. The results of the current study indicate that the use of emotion-focussed coping to manage sexual bother appears to result in poor psychological adjustment, which indicates the need for further education or intervention to manage sexual dysfunction. ETHICS CLEARANCE: Human ethics approval was granted from Southern Health, Peter MacCallum Cancer Centre and the Monash University Ethics Committee before commencement of data collection.     

A Controlled Trial of Group Cognitive Behavior Therapy for Irish Breast Cancer Patients

The aim of this study was to evaluate a manualized cognitive behavioral group intervention for early-stage breast cancer patients. Sixty-nine women were recruited at an Irish specialist oncology hospital and assigned to a 6-week cognitive behavior therapy (CBT) program or an educational control group. Participants were assessed at baseline, 6 weeks, and 6-month follow-up. Groups × Time (2 × 3) ANOVAs showed that the program did not lead to greater improvement on standardized measures of coping, quality of life, or mood compared with the control group. Regression analyses showed that maladaptive coping and distress at baseline were predictive of psychological adjustment at follow-up. Level of distress was also predictive of quality of life at follow-up. Repeated measures ANOVAs of data from cases in the intervention group showed that patients who completed the program showed significant improvement in problem severity, impact of problems, coping ability, and goal attainment from pre- to posttreatment, and these gains were maintained at follow-up for problem severity and impact of problems, but not for coping ability or goal attainment. Participation in the program did not lead to less health service usage during the period from baseline to follow-up, compared with the educational control group. A controlled trial provided limited evidence for the effectiveness of brief cognitive behavior intervention in enhancing psychological adjustment of early-stage breast cancer patients with nonclinically significant levels of psychological distress. Future research should evaluate the effectiveness of the program for patients with elevated levels of psychological distress and limited coping resources.     

Surviving recurrence: psychological and quality-of-life recovery

BACKGROUND: To the authors' knowledge, data characterizing patients' psychosocial experiences after a recurrence diagnosis are limited. This report provides the physical, psychological, and quality-of-life trajectories of patients with recurrent breast cancer. In addition, patients with a well-documented trajectory -- patients with their initial diagnosis of breast cancer -- were included as a referent group, providing a metric against which to gauge the impact and course of cancer recurrence. METHODS: Patients with a newly diagnosed, recurrent (n = 69) or initial (n = 113) breast cancer were accrued. The groups did not differ with regard to age, race, education, family income, or partner status (all P values > .18). All patients were assessed shortly after diagnosis (baseline) and 4 months, 8 months, and 12 months later. Mixed-effects models were used to determine health status, stress, mood, and quality-of-life trajectories. RESULTS: In the year after a recurrence diagnosis, patients' physical health and functioning showed no improvement, whereas quality of life and mood generally improved, and stress declined. Compared with patients who were coping with their first diagnosis, patients with recurrence had significantly lower anxiety and confusion. In contrast, physical functioning was poorer among recurrence patients, quality-of-life improvement was slower, and cancer-related distress was high as that of the initially diagnosed patient. Slower quality-of-life recovery was most apparent among younger patients (aged <54 years). CONCLUSIONS: Despite the physical burden, patients with recurrent breast cancer exhibit considerable resilience, with steady improvements in psychological adjustment and quality of life during the year after diagnosis. Management of patients' physical symptoms is particularly important, because patients cope with recurrent breast cancer as a chronic illness.     

Prospective analysis of psychological differences between adult and elderly cancer patients during postoperative adjuvant chemotherapy

Purpose

Despite the burgeoning geriatric population with cancer and the importance of understanding how age may be related to mental adjustment and quality of life so far, differences in coping strategies and psychological harm between the elderly and adults are hardly being taken into account to modify the approach to this population. The aim of this prospective study is to describe the differences in psychological characteristics between older and adult cancer patients and examine dissimilarities in their psychological evolution during adjuvant chemotherapy.

Methods

Adults (18–69 years old) and older patients (≥?70) with newly diagnosed non-metastatic resected cancer admitted to receive adjuvant chemotherapy were recruited. Patients completed the following questionnaires: mini-mental adjustment to cancer, brief symptom inventory, shared decision-making questionnaire–patient’s version, multidimensional scale of perceived social support, EORTC quality-of-life instrument, life orientation test-revised, and satisfaction with life scale.

Results

500 cancer patients (394 adults and 106 older) were evaluated. The impact of the diagnosis was less negative among older patients, with no differences in coping strategies, quality of life, or search for support. Regarding psychological changes from the beginning to the end of the adjuvant treatment, both age groups reported more somatic symptoms, increased psychological difficulty, reduced coping strategies, and a significant decrease in quality of life at the end of postoperative chemotherapy.

Conclusion

Although there were clear psychological differences between adults and senior cancer patients, their evolution during adjuvant chemotherapy was similar, with deterioration in quality of life and coping. This negative psychological impact of adjuvant chemotherapy should be taken into account when considering interventions.

     

Coping responses following breast cancer diagnosis predict psychological adjustment three years later

The relationship between coping responses and psychological adjustment to a breast cancer diagnosis is well documented for time periods close to diagnosis. The purpose of the present study was to assess the long term association between these two variables. Fifty-five women completed measures of coping response, decisional control, frustration expression, and psychological adjustment within six months of receiving their breast cancer diagnosis. These women were contacted three years later and their psychological adjustment-as measured by the profile of mood states (POMS)-was reassessed. Univariate and multivariate analyses were performed. The results showed that women who were depressed at time of treatment planning, and who responded to their cancer diagnosis with cognitive avoidance, i.e. acceptance/resignation, had significantly worse psychological adjustment three years later. Poor adjustment was significantly associated with cognitive avoidance and minimal use of approach-based coping responses. The findings suggest that women who respond to their breast cancer diagnosis with passive acceptance and resignation are at significant risk for poor long term psychological adjustment. Psychological interventions for these women should address cognitive avoidance, with the aim of fostering approach-based coping and positive well-being.     

Psychosocial predictors of outcome: time to relapse and survival in patients with early stage melanoma

This study explored psychosocial predictors of relapse and survival in early stage melanoma patients. Patients with locoregional melanoma whose tumour thickness exceeded 0.69 mm, seen at the Sydney Melanoma Unit between 1991 and 1996 participated in the study. Questionnaires were sent to participating patients every 3 months for 2 years. Domains measured included cognitive appraisal of threat, coping, psychological adjustment, quality of life and perceived aim of treatment. Disease and demographic data were obtained from medical records. Multivariate analyses from baseline data used the Cox proportional hazards model. Of the 682 patients invited to participate 426 (62%) agreed. 91 (21%) relapsed and 60 (14%) died within the follow-up period, that ended in October 1997. After controlling for known prognostic indicators, several psychosocial variables predicted time to relapse and/or survival duration. Patients who perceived their aim of treatment to be cured, who did not use avoidance as a coping strategy or who were concerned about their disease experienced longer periods without relapse. Shorter survival duration was associated with a positive mood, the use of avoidance as a coping strategy, not being concerned with their disease and concern about the impact of the disease on family. There is still much to learn about the potential relationships between psychological well being, human behaviours and cancer outcome. Research in this area needs to clarify the psychological processes, as well as understand the biological and/or behavioural mechanisms that may link them to outcome.     

Psychological intervention. The gap between research and practice

Despite a substantial body of literature on psychological interventions for cancer patients, there is a death of psycho-oncology units where such interventions can be conducted in Britain. For the majority of cancer patients, systematic psychological therapy is not available. Is such therapy of benefit to patients? The literature reveals compelling evidence from randomized trials that patients' quality of life can be improved significantly by psychological interventions, in particular cognitive behavioural therapy, psychoeducational therapy and supportive-expressive group therapy. Evidence concerning the effect of psychological interventions on survival is contradictory. But irrespective of that question, since cancers are chronic diseases, quality of life is important to patients; hence every effort should be made to provide facilities for evidence-based psychological interventions. One psychological factor shown to have a significant detrimental effect on both quality of life and survival of cancer patients is the coping response of helplessness/hopelessness. This response can be altered by psychotherapy.     

Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment

The effectiveness of a structured psychosocial intervention for women with breast cancer was studied in relation to a control group. The study was conducted in a hospital setting in Spain, and the aim of the intervention programme was to foster a higher quality of life and a more positive mental adjustment to the cancer. Three measures were used: baseline, post-treatment and 6-month follow-up for both groups. The dependent variables examined were quality of life and mental adjustment. The independent variable was the psychosocial intervention programme. Subjects were 188 women who had been operated for breast cancer and who satisfied a series of medical criteria, had no history of psychological problems and were between 25 and 65 years old. The results have shown that the psychosocial intervention programme was highly effective in improving the patients' quality of life, as compared with baseline measures, as well as compared with the control group. Additionally, the intervention increased the patients' fighting spirit and hopefulness/optimism, and reduced their anxious preoccupation as coping styles. These changes persevered at the 6-month follow-up.     

Does psychological adjustment of melanoma survivors differs between genders?

Objective: Survival rates of cancer have significantly increased. However, cancer survivors face physical, psychological and social difficulties, while adjusting to post‐illness status. We examined between‐gender differences in the psychological adjustment (mental well‐being, distress and subjective level of functioning), the putative origin of those differences, and the roles of cognitive appraisal, hardiness and attachment style in the psychological adjustment of melanoma survivors. Methods: Our sample included 300 malignant melanoma survivors (182 women and 118 men). Most were diagnosed in stages IA and IB of the disease, and had no evidence of disease for 5 years or more. Participants completed self‐report questionnaires regarding personal data, adjustment measured by sense of well‐being, distress and subjective functioning, cognitive appraisal (primary and secondary) and personal resources (hardiness and attachment style). Results: Between‐gender differences were revealed in psychological adjustment and in various components of cognitive appraisal and attachment styles. Women revealed more distress, less secondary cognitive appraisal and were more secure in attachment styles. Men showed higher secondary appraisal and were more dismissing‐avoidant in attachment. No between‐group differences were found in mental well‐being, subjective functioning, and primary cognitive appraisal or in the global measure of hardiness. Conclusions: We present social processes that seem to account for gender differences in behavior and response to stress, and psychological explanations for these findings. This study contributes to the field of psycho‐oncology by identifying factors that promote adjustment among melanoma survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Do different cultural settings affect the psychological distress of women with breast cancer? A randomized study

Breast cancer is the most common malignant disease among women in developed countries. In Austria and Israel, it accounts for 15% and 18%, respectively, of all cancers and 30% of all cancers in women. The purpose of this study, conducted in Graz, Austria, and Jerusalem, Israel, was to determine whether different geographical and cultural settings differentially affect the psychological distress of women who have survived breast cancer and why. The dependence of psychological distress on psychosocial variables such as quality of life, body image, impact of cancer and coping styles was examined at time 1 in a randomized sample of 424 breast cancer women who were disease-free at the time of the study and were surveyed 1–5 years after diagnosis. The most contributing variables to the level of psychological distress in both populations were: the number of stressful life events during last year, financial problems and feeling uncomfortable with the body. Regarding coping styles, mental adjustment to cancer was the principal contributor to psychological distress level [determined by the Grand Severity Index (GSI) scores] in the Graz group, while intrusion was the principal contributor to the GSI level in the Jerusalem group.     

Quality of life and current coping in young adult survivors of childhood cancer: positive expectations about the further course of the disease were correlated with better quality of life

OBJECTIVES: As a result of advances in the treatment of childhood cancer many patients who may previously have had a limited life expectancy, are now surviving into adulthood. More insight is needed into the long-term adjustment of young adult survivors of childhood cancer. The purpose of this study was to (1) assess health-related quality of life (HRQoL), and (2) to explore the role of cognitive coping in relation to HRQoL. METHODS: HRQoL of 353 Dutch young adult survivors of childhood cancer was compared with HRQoL of 507 peers. Linear regression analyses predicted survivors' HRQoL by cognitive coping, independent of the impact of demographics and medical variables. RESULTS: Survivors reported a lower HRQoL than their peers. Health status was the best predictor of the Physical Component Scale of the RAND-36; health status and cognitive coping contributed almost equally well to the Mental Component Scale. The explanatory value of cognitive coping could mainly be attributed to the use of predictive control strategies. CONCLUSIONS: Because current coping seemed to be an important predictor of HRQoL, interventions directed at the coping strategies of survivors should be useful. The strong association between predictive coping and HRQoL stresses the importance of focusing at having positive expectations about the further course of the disease.     

Application of a stress and coping model to positive and negative adjustment outcomes in colorectal cancer caregiving

This study examined relations between stress and coping predictors and negative (distress) and positive (positive affect, life satisfaction, positive states of mind, health) adjustment outcomes in colorectal cancer caregivers. A total of 622 caregivers and their care‐recipients completed questionnaires and interviews. Predictors included caregiving parameters, social support, appraisal (stress, control, challenge), and coping strategies (problem‐solving, avoidance, substance use, religion, humor, seeking social support). Regression analyses indicated that after controlling for the effects of relevant caregiving parameters (caregiver age, gender and paid employment status, care‐recipient quality of life, cancer stage), better caregiver adjustment was related to higher social support, lower stress and higher challenge appraisals, and less reliance on avoidance and substance use coping, as hypothesized. Stress appraisal emerged as the strongest and most consistent predictor of all adjustment outcomes. Findings support the utility of the stress and coping model of adjustment to caregiving in colorectal cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

The correlation between coping strategies, doctor-patient/spouse relationships and psychological distress among women cancer patients and their spouses

OBJECTIVES: The objectives of the study were (1) to assess similarities and differences between women cancer patients and their spouses in terms of coping strategies, psychological distress and doctor-patient/spouse relationships; and (2) to investigate the impact of formal social support, namely the doctor-patient relationship and coping strategies, on patients' and spouses' psychological distress. METHOD: Fifty-seven women with cancer, and their spouses, completed questionnaires that measured distress (BSI), coping strategies (PF, EF) and doctor-patient relationships (Pat, Md). RESULTS: Patient distress was greater than that of spouses. Patients used more strategies involving problem-focused coping than spouses. A positive relationship was found between patients and spouses in terms of psychological distress, paternalism and emotion-focused strategies. Emotion-focused strategies were found to impact patient psychological distress, as indicated in a hierarchical regression model. CONCLUSION: The paternalism relationship model is an important factor in patient psychological distress but not in spousal psychological distress.     

The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment

Given the marked individual variability in psychological adjustment in response to breast cancer, it is important to specify factors contributing to adaptive survivorship. This longitudinal study of 70 women with Stage I or II breast cancer tested the ability of situation-specific coping strategies and a more stable attribute, hope, to predict adjustment prospectively from the point shortly following diagnosis through the first year. Consonant with previous studies, coping through active acceptance at diagnosis predicted more positive adjustment across time, and avoidance-oriented coping predicted greater fear of cancer recurrence, over and above participant age and initial status on dependent variables. The hypothesis that coping through turning to religion would be more effective for less hopeful women was supported, and mixed support emerged for the hypothesis that approach-oriented coping strategies would yield greater adaptational benefits for women high in hope. Findings suggest that risk and protective factors for adjustment across the first year of survivorship can be identified even prior to definitive surgery for breast cancer, particularly when both dispositional characteristics such as hope and situation-specific coping strategies are considered.     

The importance of expectations on the recovery period after cancer treatment

The purpose was to study expectations concerning recovery-related changes in life, e.g. beliefs regarding future adjustment back to 'normal' life after curative cancer treatment, whether these expectations were met and their importance for both patients' and their spouses' quality of life and psychological distress. Sixty-two patients and 42 spouses took part in the study. Data on recovery-related expectations, measured using a study-specific questionnaire (RRE), on quality of life using EORTC-QLQ C-30 and on psychological distress using HADS, were collected directly after completion of treatment, four and 16 months later. Optimism was measured using LOT at the last follow-up. The results demonstrate that patients generally had higher recovery-related expectations than did their spouses, and their expectations were also fulfilled to a lesser degree at both follow-ups. However, the expectations, or whether these were met, were generally not associated with their quality of life or psychological distress. The few associations that were made indicated that fulfilled expectations meant higher quality of life and/or less distress. The participants' optimism was associated with both their quality of life and psychological distress. It is concluded that optimism influenced the participants' quality of life and psychological distress to a higher degree than did their recovery-related expectations.     

The association between social support,intrusive thoughts,avoidance, and adjustment following an experimental cancer treatment

A social-cognitive processing model was used to examine the association of social support with intrusive thoughts and avoidance in predicting adjustment in 53 patients receiving an experimental vaccine for the treatment of either metastatic melanoma (n=24) or metastatic renal cell cancer (n=29). Social support, intrusive thoughts/avoidance, psychological distress and quality of life were assessed on the day of the first treatment, on the day of the final treatment, and 1 month after the end of treatment during a routine follow-up visit. Social support at the beginning of treatment was negatively associated with psychological distress and positively associated with mental health quality of life (QOL) 1 month after treatment, and these associations were mediated by intrusive thoughts/avoidance at the end of treatment. There was also an interaction between social support and intrusive thoughts/avoidance at the beginning of treatment in predicting both psychological distress and mental health QOL 1 month after treatment. Specifically, for patients with lower levels of support, greater intrusive thoughts/avoidance was associated with greater psychological distress and poorer mental health QOL 1 month after treatment. However, there was no association between intrusive thoughts/avoidance and adjustment in patients with high levels of social support. These results suggest that social support buffers the negative association between intrusive thoughts/avoidance and psychological adjustment. Overall, the results are consistent with a social-cognitive processing model of post-trauma reactions among cancer patients. Our results highlight the need to assess patients' perceived support and to further develop and assess the benefits of interventions to increase patients' supportive networks and to facilitate cognitive processing of the cancer experience.     

Psychosocial predictors of survival: Metastatic breast cancer

Background:Research interest in psychosocial predictors of theonset and course of cancer has been active since the 1950s. Recently wereported associations between psychological factors and survival in patientswith metastatic melanoma. We now report a replication of this study in asample of women with metastatic breast cancer. Patients and methods:Ninety-nine patients with metastatic breastcancer completed questionnaires measuring cognitive appraisal of threat,coping, psychological adjustment, perceived aim of treatment, social supportand quality of life, approximately four months after diagnosis. Survival wasmeasured from date of study entry to date of death or censored at the date oflast follow-up for surviving patients. Results:In a multivariate analysis, four factors independentlypredicted outcome. Patients with metastases in the liver, lung or pleurasurvived for a shorter duration (P < 0.001); older patients(P < 0.001) and those with a better appetite (P <0.05) also lived for a shorter time. Patients who minimised the impact ofcancer survived longer (a median of 29.1 vs. 23.9 months after study entry,P < 0.01). Conclusions:Minimisation was also significantly associated withoutcome in patients with metastatic melanoma who participated in anidentically designed study, reported elsewhere. This suggests thatminimisation may have a general impact on cancer progression and deservescloser scrutiny in other cancers.     

Do nurses and cancer patients agree on cancer patients' coping resources,emotional distress and quality of life?

The present study examines differences, associations and agreement in cancer patients' and their nurses' ratings of cancer patients' coping resources, emotional distress and quality of life. The study sample includes 90 individual patient–nurse pairs. The patient and nurse in each pair independently completed the Cancer Behaviour Inventory, the Hospital Anxiety and Depression Scale and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being. The results indicate a distinct pattern in which nurses overestimate patients' emotional distress and underestimate patients' coping resources and quality of life. A nurse who overestimated a patient's emotional distress and underestimated his/her resources for handling the situation was also likely to underestimate the patient's quality of life. Patient–nurse pairs who demonstrated consistent agreement differed from remaining pairs in that they had a larger percentage of nurses with advanced education and previous responsibility for their patients' care and in that they had higher frequencies of patients who had previously received care at the ward >5 days. Nurses caring for patients with cancer should be aware of the risk of making systematic misjudgements of patients' status. Increased attention to patients' internal resources may improve nurses' ability to make correct assessments and plan for individualized care.