Association of coping style, pain, age and depression with fatigue in women with primary breast cancer

The purpose of this study was to explore the relative contributions of coping, depression, pain and age, in the experience of cancer related fatigue. A total of 353 women treated for primary breast cancer were assessed within one year of diagnosis using the Profile of Mood States, the Hospital Anxiety and Depression Scale and the mini-Mental Adjustment to Cancer Scale. Fatigue was positively associated with depression and pain, but inversely related to age. In contrast to our expectations, fighting spirit was not associated with less fatigue. A relationship between coping style and cancer-related fatigue was found exclusively for 'positive reappraisal', a combination of fighting spirit and fatalism. Detectable only in multivariate analysis together with depression, the results suggest a weak association between coping and fatigue. The relationship between cancer related fatigue, age and coping styles requires further exploration within longitudinal studies.     

乳腺癌患者癌因性疲乏与抑郁、焦虑情绪的调查

目的 探讨乳腺癌患者中癌因性疲乏与抑郁、焦虑情绪的发生情况及两者相关性。方法 分别采用Piper疲乏评估量表和HAD情绪测定量表,评价200例乳腺癌术后患者的癌因性疲乏与抑郁、焦虑情绪的状况,收集数据并分析。结果 在200例乳腺癌术后患者中,109例（54.5％）乳腺癌患者经历了不同程度的癌因性疲乏,整体疲乏评分为4.38±1.27。行为／严重性维度、情感维度、感觉维度、认知／情绪维度评分分别为3.73±1.67、5.06±1.84、 4.39±1.60和4.38±1.35。在各维度中,评分最高的条目分别为“疲乏对性生活的影响”、 “疲乏令自己不愉快的程度”、“感到身体虚弱”和“感到无记性的程度”。109例癌因性疲乏的患者中合并焦虑情绪者34例（31.2%）,合并抑郁情绪者45例（41.3%）,癌因性疲乏同时合并抑郁、焦虑者27例（24.8%）。存在癌因性疲乏的患者中焦虑、抑郁发病比例明显高于无癌因性疲乏患者（P＜0.001）,存在焦虑、抑郁的患者与不存在焦虑或抑郁情绪的患者在癌因性疲乏各维度评分有显著差异（P＜0.05）。结论 乳腺癌术后患者癌因性疲乏的发生率较高,疲乏水平属轻、中度,焦虑、抑郁情绪与其密切相关,癌因性疲乏的病因、治疗方法有待进一步研究。     

Art therapy for anxiety,depression, and fatigue in females with breast cancer: A systematic review

This systematic review employed a meta-analysis to examine the effectiveness of art therapy for treating anxiety, depression, and fatigue in female patients with breast cancer, the most prevalent cancer and the most common cause of cancer-related mortality among women worldwide. The review included nine original studies and analyzed data from a total of 754 patients. Data extraction and quality assessment were conducted by two independent reviewers. In total, 1,466 articles were retrieved. We excluded studies in which the participant, interventions, and study design did not satisfy the inclusion criteria, leaving nine articles for analysis, The Cochrane risk of bias assessment tools were used for quality evaluation. The analysis revealed a significant difference in treatment outcomes between patients who received art therapy and those who did not (SMD?=?–0.48, 95%CI [–0.75, –0.21, p?=?0.0005]). The review provides initial evidence to suggest that art therapy benefits female breast cancer patients with respect to the treatment of anxiety, depression, and fatigue. However, additional and better-quality studies must be conducted, particularly with larger sample sizes, greater specificity of the design of trials and interventions, and a longer follow-up duration.     

Repressive coping style: Relationships with depression, pain, and pain coping strategies in lung cancer out patients

Researchers have shown that coping style is related to pain and adjustment in people with chronic illness. This study was the first to examine how coping style related to pain, pain coping strategies, and depression in lung cancer outpatients. We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4 ± 10.43 years, 88% Caucasian). As in prior studies, we classified patients into four coping style groups based on Marlowe-Crowne Social Desirability Scale and trait anxiety scores. The coping style groups were low-anxious (n = 25); high-anxious (n = 31); defensive high-anxious (n = 21); and repressive (n = 30). Compared to other coping style groups, the repressive group reported statistically significant lower mean scores for pain quality, pain catastrophizing, and depression. Assessing coping style by measuring personal characteristics such as social desirability and trait anxiety may help clinicians to identify vulnerable individuals with lung cancer who may be candidates for early and timely intervention efforts to enhance adjustment to pain.     

Gender differences in pain, fatigue, and depression in patients with cancer

A quick review of virtually any research topic documents the pervasiveness of sex and gender bias throughout all of science. A large portion of both animal and human research has been, and continues to be, done primarily with male subjects. This gender bias influences research results and often leads to inappropriate and questionable generalizations of research findings, usually from studies done with male participants to females. Needless to say, this bias exists in symptom management research on pain, fatigue, and depression in patients with cancer. This article reviews the evidence from the studies on gender differences in pain, fatigue, and depression in patients with cancer. It should be noted that research studies on gender differences in cancer-related pain, fatigue, and depression are minimal in number, are restricted to studies of the differences in prevalence rates and severity scores, and for the most part have yielded inconsistent results. Additional investigations are warranted to determine whether the gender differences in prevalence rates and severity of these symptoms represent clinically meaningful differences. If these gender differences are substantiated, these findings will guide the design of studies to elucidate the underlying mechanisms for these differences, as well as the development and testing of gender specific interventions to treat cancer-related pain, fatigue, and depression.     

The influence of relational mutuality on dyadic coping among couples facing breast cancer

Abstract

Objective: The study examined how a couple’s capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer.

Methods: Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM).

Results: Relational mutuality was positively associated with both the patients’ and the caregivers’ scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients’ and caregivers’ reduced scores on avoidance of dyadic coping.

Conclusions: Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors.

Implications: The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.     

Short- and long-term anxiety and depression in women recalled after breast cancer screening

The aim was to investigate the psychological consequences of further investigation after breast cancer screening. Study participants include 509 women (61%) recalled due to suspicious findings on screening mammograms, and a matched control group of 285 women (68%) with normal mammograms. Psychological distress was prospectively assessed with the Hospital Anxiety and Depression Scale (HADS). 46% of the women reported borderline or clinically significant anxiety prior to the recall visit. A few days after the visit, anxiety and depression had decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy. The results demonstrate the adverse short-term effect of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women.     

Impact of body image on depression and quality of life among women with breast cancer

The purpose of this study was to explore body image, physical attractiveness, and femininity among survivors of breast cancer and to examine the effects of the aforementioned variables on depression and quality of life. The participants comprised 70 female survivors of breast cancer, ages between 23 and 79 years. They completed a questionnaire that includes Center for Epidemiological Studies Depression Scale, Functional Assessment of Cancer Therapy, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire--Breast Cancer, measuring depression, quality of life, and body image, respectively. On the depression scale, 56% of the participants had scores higher than 16; a score of 16 and above identifies participants with potential depression. Majority of women felt less attractive and less feminine. Low body image, attractiveness, and femininity positively correlated with depression and negatively with overall quality of life. The authors conclude that multidisciplinary health care services relevant to physical attractiveness and femininity of survivors of breast cancer may foster positive body image perceptions, reduced depression, and increased quality of life.     

心理干预对癌痛患者疗效及焦虑抑郁的影响

目的 观察心理干预联合止痛药物对癌痛患者治疗效果和焦虑抑郁的影响.方法 选取200例伴有疼痛的肿瘤患者,采用随机数字表法分为干预组和对照组,每组各100例.所有患者均进行癌痛规范化治疗,干预组在癌痛规范化治疗的基础上联合心理干预,4周后采用数字评分法(NRS)及医院焦虑抑郁量表(HAD)对患者的疼痛程度进行评定.结果 干预组患者治疗后的癌痛缓解率为92%,高于对照组的81%,差异有统计学意义(P﹤0.05);干预组患者治疗后的焦虑、抑郁评分低于对照组,差异均有统计学意义(P﹤0.05);干预组患者治疗后便秘的发生率为41%,明显低于对照组的62%,差异有统计学意义(P﹤0.01).结论 心理干预联合止痛药物可缓解癌痛程度,减轻患者的焦虑和抑郁,降低便秘的发生率.     

Self-efficacy, coping, and difficulties interacting with health care professionals among women living with breast cancer in rural communities

This study examined self-efficacy, coping, and social support in relation to difficulties interacting with physicians and nurses among women living with breast cancer. One hundred women living in rural, mountainous communities of northeastern California were recruited, with 89 providing complete data for this study. All women completed a battery of questionnaires that included the CARES--Medical Interaction Subscale and measures of self-efficacy, coping, satisfaction with social support, and demographic and medical characteristics. In a multiple regression analysis, difficulties interacting with medical professionals were found to be greater among women who were not married, who used more behavioral disengagement or less self-distraction to cope with breast cancer, and who reported less self-efficacy for affect regulation and for seeking and understanding medical information. Emotional venting and satisfaction with social support for dealing with cancer-related stress were not, however, significantly related to difficulties in interacting with the medical team. This model accounted for an adjusted value of 42% of the variance. Further research is needed to identify possible causal relationships related to these findings and to determine what interventions might be warranted to improve medical interactions for women with breast cancer living in rural areas.     

Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy

The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (≥55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.     

乳腺癌患者焦虑抑郁的研究进展

乳腺癌是女性常见的恶性肿瘤之一,严重影响患者生活质量,且发病率呈逐年上升趋势。在疾病治疗过程中,乳腺癌患者不仅会出现一系列生理症状,还常表现焦虑、抑郁等心理症状,甚至出现临床无法解释的躯体化障碍,常常被患者及临床医生所忽视。近些年来,随着生物-心理-社会医学模式的发展,临床医生逐渐认识到焦虑、抑郁等心理因素对乳腺癌发生、发展、治疗和转归的影响。本文就乳腺癌患者发生焦虑、抑郁的流行病学特点、影响因素、临床表现、诊断方法、可能的发生机制、治疗和转归等方面作简要综述。     

Measurement of coping and stress responses in women with breast cancer

The development of the Responses to Stress Questionnaire-cancer version (RSQ-CV) to assess coping with and responses to the stress of breast cancer is described. The RSQ-CV was completed by 232 women with breast cancer near the time of their diagnosis. Confirmatory factor analyses verified a model that includes three voluntary coping factors (primary control engagement coping, secondary control engagement coping, disengagement coping) and two involuntary stress response factors (involuntary engagement, involuntary disengagement). Internal consistency reliability, and stability over 12 weeks for the five factors were adequate to excellent. Convergent and discriminant validity was examined through correlations with measures of intrusive thoughts, avoidance, and dimensions of perceived control. Significant correlations with symptoms of anxiety and depression are also reported. Applications of the RSQ-CV for research with breast cancer patients are discussed.     

A structural model of the relationships among stage of disease,age, coping,and psychological adjustment in women with breast cancer

The present study used structural equation modeling to examine the relationships among disease stage (i.e. Stage II versus Stage IV), age, coping style, and psychological adjustment in 100 women diagnosed with breast cancer. Five separate models were examined: a full model, a mediational model, a demographic-disease model, a coping style model, and a regression model The analyses revealed that the present data best fit the mediational model in which age and stage of disease were not directly associated with psychological adjustment but, instead, were mediated by coping style (χ²(25)=45.776, AASR=0.05, CFI=0.94). The mediational model accounted for 56% of the variance in psychological adjustment. In particular, the model showed that younger women and women with an earlier disease stage used greater levels of the coping strategy characterized as a fighting spirit and lower levels of the coping strategies characterized as hopelessness/helplessness, anxious preoccupation, and fatalism which, in turn, were related to better psychological adjustment. Overall, these findings may offer an explanation for the conflicting findings regarding the relationship between age, stage of disease, and psychological adjustment to breast cancer by illustrating that coping strategies may be an essential mediating factor; in turn, a mediating model of psychological adaptation may offer useful information for clinicians as they implement interventions designed to improve patients coping efforts. © 1998 John Wiley & Sons, Ltd.