The Influence of relational factors on men's adjustment to their partners' newly-diagnosed breast cancer

Steadily rising breast cancer rates in America's women are forcing more men to confront challenges of living with a partner afflicted with this disease. This study assesses teh impact of mutual emotional support as perceived by male partners on their adjustment to the diagnosis and the illness and on interactions between their perceived emotional support nd their coping methods. Seventy-one male partners of newly-diagnosed breast cancer patients completed standardized instruments that measured emotional wellbeing, illness intrusiveness, emotional support, dyadic coping styles and demographic factors. Regression analysis revealed significant associations between perceived emotional support and men's coping strategies, and between coping styles and illness intrusiveness. Also, a history of depression predisposes men to poorer adjustment and affects their coping patterns. Findings suggest that as the health care system continues to relocate burden of care to partners and families, social workers must increase their understanding of how to effectively assist patients' partners. This study emphasizes the need to work with patients and partners to develop positive coping strategies as a couple.     

Interdependent anxiety and psychological distress in women with breast cancer and their partners

The purpose of this study was to determine the extent of interdependence on anxiety within dyads where one person was undergoing treatment for breast cancer. Perceptions of relationship quality were expected to mitigate the anxiety experienced by both members of the dyad. 96 dyads participated in a 3-wave longitudinal study that took place over 10 weeks. Dyads were composed of a woman with stage I-III breast cancer who was currently undergoing treatment, and a partner who she nominated to participate in the study along with her. Results indicated that anxiety felt by women with breast cancer was consistently associated with that of her partner. Structural equation analyses suggest that the within-dyad influence runs mostly from partners' anxiety to the anxiety of women with breast cancer. Partners' anxiety was also associated with other indicators of the women's well being including depression, fatigue, and symptom management. Perceptions of relationship quality from women with breast cancer and their partners were negatively associated with partners' anxiety. However, women's anxiety was only correlated with their partners', but not their own, perceptions of relationship quality. These findings underscore the benefit of having partners who are able to cope with or get help for their own personal distress as women cope with the stress of breast cancer and its treatment.     

The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer

Abstract

The central role of spouses/partners in patients’ adaptation to cancer is well-established, but few studies have examined how partners facilitate adaptation. The Common Sense Model posits that a representation of illness as more controllable and less threatening promotes adaptive coping, but this has not been examined in a dyadic context. This cross-sectional study examined the relations of spouse illness representations of personal and treatment control, and emotional representations to recently diagnosed cancer patients’ coping behaviors, through patient illness representations. One hundred forty-nine heterosexual couples (39.60% female patients; 77.18% dealing with early stage cancer) participated in the study. Structural Equation Modeling showed that spouse illness representations were related to patient coping directly and indirectly through patient illness representations. Both partners’ representations of control were related to greater patient adaptive coping, and both partners’ emotional representations were related to greater dysfunctional coping. These findings highlight the importance of partner illness representations in patients’ adaptation to cancer. They also suggest that early intervention programs that address both partners’ illness representations may enhance patients’ adaptation to cancer.     

Evaluation of the needs and concerns of partners of women at high risk of developing breast/ovarian cancer

This exploratory study investigates the experience of partners of women at high risk of developing breast/ovarian cancer and reports on the partners' views concerning their relationship, communication, future planning, children and childbearing, involvement in decision-making regarding screening and prophylactic measures, and information and support needs. In-depth interviews were conducted with 15 partners. Of these, seven were partners of women who were BRCA1/2 mutation carriers, five were partners of women with unknown mutation status, and three were partners of women who were non-carriers. None of the women had a previous diagnosis of breast or ovarian cancer. Partners of carriers and women with unknown mutation status were found to be more distressed than partners of non-carriers, with partners of mutation carriers reporting the most difficulties. Factors associated with better adjustment and coping for partners included dealing with this situation as a team with their wife, greater involvement in decision-making, satisfaction with their supportive roles and being optimistic. Decision-making difficulties in relation to prophylactic measures, concerns about their children possibly being at increased cancer risk, as well as the need to receive information directly from health professionals and the wish to meet other partners were also discussed.     

The Influence of Relational Factors on Men's Adjustment to Their Partners' Newly-Diagnosed Breast Cancer

Abstract

Steadily rising breast cancer rates in America's women are forcing more men to confront challenges of living with a partner afflicted with this disease. This study assesses teh impact of mutual emotional support as perceived by male partners on their adjustment to the diagnosis and the illness and on interactions between their perceied emotional support nd their coping methods. Seventy-one male partners of newly-diagnosed breast cancer patients completed standardized instruments that measured emotional wellbeing, illness intrusiveness, emotional support, dyadic coping styles and demographic factors. Regression analysis revealed significant associations between perceived emotional support and men's coping strategies, and between coping styles and illness intrusiveness. Also, a history of depression predisposes men to poorer adjustment and affects their coping patterns. Findings suggest that as the health care system continues to relocate burden of care to partners and families, social workers must increase their understanding of how to effectively assist patients' partners. This study emphasizes the need to work with patients and partners to develop positive coping strategies as a couple.     

The role of illness representations in coping and health of patients treated for breast cancer

Objective: The present study examined the relation of cognitive and emotional representations of illness specified by the Common Sense Model of Illness Cognition (Handbook of Psychology and Health: Social Psychological Aspects of Health. Earlbaum, Hillsdale: New York, 1984; 219–252) with the coping strategies and perceived health of patients who were treated for breast cancer. Methods: Participants were 119 women within 2 years after their diagnosis of breast cancer, who completed a questionnaire containing measures of illness representations, coping strategies and perceived physical and mental health. Results: Breast cancer patients differ in the subjective perception of their disease. Patients who view their illness as a condition with serious symptoms and consequences, patients who believe their illness is chronic and patients who consider their illness uncontrollable were found to report worse physical and mental health than those who believed the opposite. Regression analysis showed that, after controlling for external variables, the cognitive illness representations identity and consequences explained 57% of variance in physical health, whereas emotional illness representation and treatment control explained 47% of variance in mental health. Conclusion: Results provide some support for the hypotheses of the Common Sense Model of Illness Cognition. Illness representations seem to play an important role in perceived health in breast cancer. The implications of these findings for the design of health‐care‐related interventions for breast cancer patients are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of individual and partner factors on anxiety and depression in Taiwanese prostate cancer patients: A longitudinal study

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients’ threat appraisals and affective‐oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients’ most recent prostate‐specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients’ harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective‐oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.     

Mental health outcomes in older women with breast cancer: impact of perceived family support and adjustment

OBJECTIVES: (1) To examine the mental health of older women with breast cancer in relation to support provided by, and the adjustment of, significant others including partners, children, and other family members or friends and (2) to document how often physicians address the women's significant others and the helpfulness of doing so. METHODS: A cross-sectional survey of newly diagnosed breast cancer patients aged 55 years or older (n = 222) was conducted. RESULTS: Partners, and in many instances children and other family members or friends, provided support. Support from partners and adjustment of both partners and children independently predicted less depression and anxiety among the study participants. For racial/ethnic minorities, support from, and adjustment of, adult children assumed particular importance. Nonetheless, women reported that their physicians rarely asked their significant others how they were coping (15%) or referred them to a support group (3%), even though both behaviors were rated as extremely helpful. CONCLUSION: For older women with breast cancer, both partners and adult children were important sources of support and their adjustment affected the women's mental health. Support sources and their impact on women's mental health varied among racial/ethnic groups, suggesting the importance of culturally sensitive provision of care by clinicians.     

Depression,anxiety and disease-related distress in couples affected by advanced lung cancer

Objectives

Lung cancer patients and their partners are prone to high levels of depression and anxiety or severe distress related to the poor prognosis of the illness. However, there remain doubts regarding the extent to which this distress exceeds levels in the general population. This study explored levels of depression and generalized anxiety for comparison with matched data of a representative sample from the general population. Additionally, covariance of distress between the two partners, together with disease-specific components and differences were investigated.

Materials and methods

In a cross-sectional survey, 54 pairs of lung cancer patients and their partners (n = 108) were assessed for depression and anxiety, cancer-related distress, unmet needs and disclosure in communication. Comparisons between distress levels of participating couples and matched community-comparisons (n = 162) were conducted. Additionally, multilevel analysis for estimating intra-dyadic associations of anxiety and depression was computed. Components of distress, needs and aspects of communication were explored via item mean values.

Results

Lung cancer patients as well as their partners exhibited significantly higher levels of depression and anxiety when compared to community-based comparison subjects (patients: mean difference of 1.01 for depression with a relative risk (RR) of 4.5 and 0.84 for anxiety with RR = 6.1; partners: 1.17 for depression with RR = 4.6 and 1.59 for anxiety with RR = 7.6). Partial intraclass correlations between patients and partners were weak (PIC = .29 for depression; PIC = .21 for anxiety). Fear of progression emerged as main component of distress for both patients and partners, although differing stressors were described.

Conclusion

Lung cancer-affected couples exhibit levels of depression and anxiety far exceeding those of the general community. In clinical practice, patients and partners should be assessed separately for distress against the background of weak intra-dyadic associations. In cases of significant depression or anxiety, referral for psychosocial treatment is indicated and has been shown to improve quality of life.     

Coping among older-adult, long-term cancer survivors

This research focuses on the coping behavior of older adult, long-term cancer survivors. Specifically, it identifies the personal (including race and gender) and illness/treatment characteristics of survivors that are significantly associated with the use of specific coping styles: planning, acceptance, venting, denial and seeking social support. It also examines the mediating role that these forms of coping play in terms of psychological distress: anxiety, depression and cancer-related worries. Multivariate analysis of data from a random sample of 321 long-term survivors in a major cancer center tumor registry is used to address the above issues. The most prominent forms of coping used by long-term survivors were planning and acceptance; least used were venting and denial. Increased age was associated with lower use of all forms of coping, but cancer type was not. Denial as a form of coping was associated with higher anxiety, depression and cancer-related worries. While race was not found to be a significant predictor of coping style, it was a significant predictor of three dimensions of psychological distress, anxiety, depression and cancer-related worries, with African Americans exhibiting lower levels of distress than Whites. The relevance of these findings for health and social service practitioners is discussed.     

The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.     

Predicting general and cancer-related distress in women with newly diagnosed breast cancer

Background

Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer.

Methods

Women recently diagnosed with breast cancer (N?=?94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress.

Results

Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β?=?.22, p?=?.021), more illness identity (β?=?.25, p?=?.004), greater anxious preoccupation (β?=?.23, p?=?.030), and less fighting spirit (β?=??.31, p?=?.001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β?=??.20, p?=?.043). Greater anxious preoccupation also led to greater general anxiety (β?=?.44, p?<?.001) and cancer-related distress (β?=?.37, p?=?.001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps?<?.001) only if women were also more anxiously preoccupied with their diagnosis.

Conclusions

Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.

     

Experiences and resources of breast cancer patients in short-stay surgery

Aimed at increasing the understanding and improving the quality of nursing care for breast cancer patients in short-stay surgery, this qualitative study set out to describe the experiences and, the intra- and extra-personal coping resources these patients. The data were collected among eight breast cancer patients (n = 8). On the whole the patients described short-stay surgery as a positive experience. They felt they had been discharged at the right time. The patients thought they had coped well and received valuable emotional, informational and instrumental support from health care personnel at each phase of the illness process. The breast cancer coordinator, in particular, served as a safety net for the patients. Informational support from health care personnel was considered adequate at the illness phase, but there was evidence of some lack of information at the care phase and current phase. Lack of knowledge about follow-up treatment was a major source of fear and anxiety for the patients. Later on, family members and friends served as important extra-personal coping resources, providing emotional and instrumental support. In addition, the patients' own intra-personal coping resources were essential during all the phases.     

Everyday experiences of women posttreatment after breast cancer: the role of uncertainty, hassles, uplifts, and coping on depressive symptoms

Considerable research has examined the experiences of women at risk, during diagnosis, and throughout treatment of breast cancer; however, less in known about these women posttreatment. Many women report dealing with extensive long-standing ailments such as lymphedema and fatigue, as well as a fear of illness recurrence. However, women posttreatment also report finding benefit and meaning from their cancer occurrence. These orthogonal outcomes may be related to the uncertainty an individual is able to tolerate. Thus, this online study examined Canadian women who completed treatment for breast cancer (n = 42), and women in a control condition (n = 42), responses to the daily experience of hassles and uplifts, intolerance of uncertainty, coping strategies, and depressive symptoms. Although depressive symptoms and daily hassles did not differ between the two groups of women, women with a previous cancer experience reported a greater amount and frequency of daily uplifts, and hassle intensity predicted fewer depressive symptoms among women posttreatment compared to healthy controls. Furthermore, hassle intensity mediated the relationship between intolerance of uncertainty and depressive symptoms, but only for women in the control condition. Last, for women posttreatment only, the use of emotion-focused coping to deal with a fear of cancer recurrence mediated the relationship between intolerance of uncertainty and depressive symptoms, whereas problem-focused, avoidant, or cognitive-restructuring coping strategies did not. These results point to the need to provide resources to women posttreatment, but also that those women who survive breast cancer can obtain benefits from the experience.     

Psychosocial adaptation in female partners of men with prostate cancer

STREET A.F., COUPER J.W., LOVE A.W., BLOCH S., KISSANE D.W. & STREET B.C. (2010) European Journal of Cancer Care 19 , 234–242
Psychosocial adaptation in female partners of men with prostate cancer The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi‐structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non‐distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.     

Informal caregiving to older cancer patients: preliminary research outcomes and implications

BackgroundThe population of the Western world is aging while cancer survival rates are rising. Older patients with cancer will increasingly be taken care of by informal family caregivers. The current study describes levels of psychological distress, social support and coping abilities reported by partners who are caregivers to older patients with cancer (60+ years), comparing them to a control group of spouses of similarly aged people not suffering from life-threatening illness.Patients and MethodsTwo hundred sixteen partners who are primary caregivers of cancer patients aged 60+ were compared with 76 partners of healthy people aged 60+ and never diagnosed with any terminal illness. Participants completed self-reporting measures on psychological distress, coping ability and social support.ResultsCaregivers to cancer patients reported high levels of distress, low levels of social support and low levels of coping abilities which are negatively correlated to distress. Increased patient age was found to accentuate these processes.ConclusionAge and the progression of cancer as a chronic illness present the physician with the reality that focus of care should be on the dyad (patient and caregiver), with high priority given to partners who are informal caregivers.     

Coping with the cancer experience. II. Evaluating an education and support programme for cancer patients and their sitgnificant others

As reported, cancer patients and their significant others need information promoting their understanding of events throughout the illness, and support in mobilizing coping strategies when they consider the situational demands to exceed their personal resources. In the present study the provision of information was merged into the field of education and combined with emotional support to facilitate efforts to cope with the cancer experience. A patient education programme entitled Learning to live with cancer was developed (part I) and evaluated (part II).
Cancer patients and their significant others (n = 127) participated in group sessions. Open interviews organizxed around experiences of increased knowledge and understanding, decreased confusion and anxiety, and enhanced coping capacity related to participation in the programme were conducted with the participants. The interviews were analysed using the Grounded Theory approach. The findings indicate that supportive education, sensitively responsive to expressed learning needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feelings reinforced confidence in evolving appropriate coping strategies for living with cancer.     

Anxiety and depression in cancer patients' spouses

The spouse has been identified as a primary source of support for patients in coping with cancer. Therefore, attention must be given to problems faced by the spouses. In this study, 120 spouses were asked to fill in the Hospital Anxiety and Depression Scale and a questionnaire containing 51 items. A response rate of 83% was obtained. Eighteen percent scored as cases on the anxiety dimension and 6% on the depression dimension. No differences were seen according to sex, age, patient's diagnosis, treatment and performance status. Significantly more spouses identified as cases regarding anxiety and depression had problems which they had never talked about, physical symptoms, or feelings of anger. Generally, the level of contact with family and friends was maintained, but the perception of support from family and friends was low. Only 23% sought professional support and only a fraction of the spouses identified as cases did so. Therefore the professional team must be aware of signals from spouses since help seeking does not seem to be part of their coping strategy.     

Do Coping and Social Support Predict Depression and Anxiety in Patients Undergoing Hematopoietic Stem Cell Transplantation?

This study examined whether different types of coping and social support predict anxiety and depression in 212 hematopoietic stem cell transplant (HSCT) recipients. Data were collected prior to and 6 months after HSCT. Coping, social support, and gender predicted 26% of the variance in pre-HSCT anxiety and 24% of the variance in pre-HSCT depression. Coping and social support did not explain significant post-HSCT anxiety or depression when controlling for pretransplant anxiety or depression. High use of acceptance/ resignation coping, cognitive avoidance coping, lower tangible support, and lower belonging support were related to increased pre-HSCT anxiety and depression. Approach coping was not related to pre-HSCT anxiety. Patients who use acceptance/resignation coping and report low levels of two types of social support prior to HSCT may require additional intervention before HSCT, as they are at higher risk for depression and anxiety.