The contribution of self‐esteem and self‐concept in psychological distress in women at risk of hereditary breast cancer

Objective: Clarification of the role of several aspects of self‐concept regarding psychological distress in women at risk of hereditary breast cancer will help to target counselling and psychosocial interventions more appropriately. In this study, we aimed (1) to examine the role of general self‐esteem and specific aspects of self‐concept (i.e. stigma, vulnerability, and mastery) in psychological distress in women at risk of hereditary breast cancer and (2) to compare the relative importance of these self‐concept aspects in psychological distress in women with low versus high self‐esteem. Methods: General and breast‐cancer‐specific distress, self‐esteem, self‐concept, and demographics were assessed in 246 women being at risk of hereditary breast cancer, who opted either for regular breast surveillance or prophylactic surgery. Results: In the total study group, self‐esteem was negatively associated with general distress. Furthermore, feeling stigmatized was strongly associated with more breast‐cancer‐specific distress, and to a lesser degree with general distress. In women with low‐self esteem, feelings of stigmatization were strongly associated with higher levels of both breast–cancer‐specific and general distress, while a sense of mastery was associated with less general distress. For women with high self‐esteem, feelings of both stigmatization and vulnerability were associated with more breast‐cancer‐specific distress, whereas there were no significant associations with general distress. Discussion: Psychosocial interventions or support groups for women at risk of hereditary breast cancer should focus on self‐esteem and feelings of stigmatization and isolation, and consequently tailor the interventions on specific items for respective women. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological effects of a cosmetic education programme in patients with breast cancer

Treatments for breast cancer often include interventions related to psychosocial issues such as negative body image, loss of femininity, and low self‐esteem. We identified the psychological effects of a cosmetics education programme in patients with breast cancer. Cosmetic programme is a specific care designed to help patients handle appearance‐related side effects. Thirty‐one women with breast cancer at a university hospital in South Korea who received a cosmetics education programme were compared with 29 subjects in a control group who received the treatment as usual. Psychological factors including distress, self‐esteem, and sexual functioning were assessed three times (before and after the programme, and at the 1‐month follow‐up). After the programme, patients in the treatment group were significantly less likely than those in the control group to rely on distress (P = 0.038) and avoidance coping (P < 0.001) but not on self‐esteem. The mean scores in the treatment group for sexual functioning were higher than those in the control group after the treatment. Our results suggest the potential usefulness of a brief cosmetics education programme for reducing distress and reliance on negative coping strategies. Implementing a cosmetics programme for patients with breast cancer may encourage patients to control negative psychological factors.     

Socio-demographic, psychosocial and attitudinal predictors of help seeking after cancer diagnosis

Objective: The objective is to describe cancer patients' patterns of use of psychosocial support services and identify socio‐demographic, psychosocial, and attitudinal predictors of service utilization. Methods: A cross‐sectional survey of 439 cancer patients (61.2% response) at a regional tertiary cancer center assessed patterns of support service utilization, cancer‐specific distress, social support and constraints, and attitudes to help seeking. Results: Patients less frequently received advice about psychosocial support in comparison with treatment‐related information. More than half the respondents were aware of social work support, support groups, and chaplain support; however, most did not utilize these services. For unaware patients, up to 47% would have utilized support services if they had known of their existence. The use of services was significantly related to being female, younger, and having greater cancer‐specific distress, more positive and less negative attitudes to help seeking. Future intention to contact a health professional for psychological support was predicted by more positive subjective norms and outcome expectations, higher cancer‐specific distress, and less negative attitudes to help seeking. Conclusion: Initiatives that encourage distressed patients to use psychosocial care services should highlight positive outcomes. Educational programs for health professionals to support psychosocial care in oncology are needed. Copyright © 2008 John Wiley & Sons, Ltd.     

The impact of social and personal resources on psychological distress in women at risk for hereditary breast cancer

Objective: The objectives of the present study were to (1) evaluate whether social and personal resources were independently related to psychological distress and (2) examine the interrelationships of social and personal resources in women at risk for hereditary breast cancer. Methods: General and breast cancer specific distress, family communication regarding hereditary breast cancer, perceived social support, self‐esteem, self‐concept, and demographics were assessed in 222 high‐risk women, having opted either for regular surveillance or prophylactic surgery. Results: Structural equation modeling showed that (1) both personal and social resources were independently associated with psychological distress and (2) the associations between social resources and psychological distress were partially mediated by personal resources. Support from family and friends was associated with a higher level of self‐esteem, which in turn was associated with less general distress. Furthermore, communication regarding cancer within the nuclear family was associated with decreased feelings of stigmatization, which in turn was associated with less general and breast cancer specific distress. Moreover, open communication within the family was associated with a reduced sense of vulnerability. Conclusion: Health workers involved in the care of high‐risk women should carefully monitor women's personal and social resources, and if compromised refer them for appropriate support. Copyright © 2010 John Wiley & Sons, Ltd.     

Survivor centrality among breast cancer survivors: implications for well-being

Objective: The goal of this research was to examine the extent to which 10‐year breast cancer survivors integrated cancer into their self‐concept (i.e. survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well‐being. Methods: Breast cancer survivors (n=240) were interviewed 10 years following the initial diagnosis. They completed measures of survivor centrality, illness valence (i.e. positive or negative views of illness), and well‐being (positive and negative affect, mental and physical functioning, psychological distress, benefit finding). Results: There were few predictors of the kinds of women who were more likely to integrate breast cancer into their self‐concepts, but survivor centrality was related to engaging in behaviors that suggested survivorship was relevant to women's daily lives, such as becoming involved in breast cancer activities. Survivor centrality was related to three markers of negative psychological well‐being: more negative affect, poorer mental functioning, and greater psychological distress. However, in the case of negative affect and psychological distress, this relation was moderated by illness valence, such that survivor centrality was only related to negative psychological well‐being when the illness was viewed in less positive terms. Conclusions: Women vary in the extent to which they define themselves in terms of the breast cancer experience. Survivor centrality in and of itself is not always indicative of adjustment to disease. When women have a more negative view of being a breast cancer survivor, survivor centrality is more likely to signify potential problems. Copyright © 2010 John Wiley & Sons, Ltd.     

Distress in couples approached for genetic counseling and BRCA1/2 testing during adjuvant radiotherapy

Objective: Breast cancer patients mostly rely on their partners for support in dealing with their cancer diagnosis and treatment. Genetic counseling and BRCA1/2 testing during primary treatment may add to demands made on their partners. This study aimed to gain insight into the extent of psychological distress in partners of recently diagnosed patients and to find factors to help identify couples vulnerable to high psychological distress after an active approach for genetic counseling. Methods: Breast cancer patients and their partners (n=110) completed psychological distress measures (HADS and IES) prior to the approach for counseling (T0), after the approach (T1), and after leaving the genetic counseling protocol (T2). Couples not approached for counseling (n=85) completed similar questionnaires. Results: Partners reported an equal or lower level of distress than patients, with a positive correlation between the two, although partners and patients differed in the course of their distress. Couples approached for genetic counseling did not differ in the level or course of either distress measure from not approached couples. A high baseline distress best predicts long‐term high distress in patients and their partners. Younger patients were found to be particularly vulnerable. Conclusions: The approach for genetic counseling during adjuvant radiotherapy was not associated with extra psychological distress in partners or patients in the first year following the breast cancer diagnosis. A partner's long‐term level of distress was significantly associated with that of the patient. Highly distressed patients with highly distressed partners were most likely to experience high distress in the long term. Copyright © 2009 John Wiley & Sons, Ltd.     

The mediating effects of social support and self-efficacy on the relationship between social distress and emotional distress in head and neck cancer outpatients with facial disfigurement

Objective: Although social support has been recognized as an important factor in the quality of life of head and neck cancer patients, there has been little investigation of the buffering effect of social support on these patients' social distress or of the coping skill of self‐efficacy. The aim of this study was to examine how social support and self‐efficacy mediate the relationship between social distress and emotional distress in head and neck cancer patients. Methods: Two hundred twenty‐five head and neck cancer patients completed our questionnaire (effective response rate, 92.2%). Of these, 129 (57.3%) had facial disfigurement. These participants responded to questions about perception of social distress, social support, self‐efficacy, and emotional distress (depression and anxiety). We used structural equation modeling for statistical analysis. Results: The fit indices of this model were excellent ( χ ² (7) = 9.147, p = 0.242, goodness of fit index (GFI) = 0.981, adjusted goodness of fit index (AGFI) = 0.922, comparative fit index (CFI) = 0.993, root mean square error of approximation (RMSEA) = 0.049). Self‐efficacy strongly buffered the negative influence of social distress on emotional distress. Social support from family members did not have a direct or indirect influence on emotional distress. Social support from friends was related to lower social distress and higher emotional distress. Conclusions: Our findings suggest that self‐efficacy might confound the relationship between social support and emotional distress, and that different sources of social support might play different roles in the mediation of social distress on emotional distress. Copyright © 2010 John Wiley & Sons, Ltd.     

Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer

Introduction: Women with breast cancer may have significant problems adjusting to disease and therapy due to their association with significant changes in body image and sexuality. The aim of this study was to evaluate the effect of beauty treatments in combination with routine cancer care. Methods: One hundred women with breast cancer were randomly assigned to a group receiving beauty treatments during hospitalization or a control group. Psychological distress, body image and coping were assessed twice during the hospitalization period: the day before surgery (baseline) and 6 days later (Time 1). A follow‐up assessment was performed three months later (Time 2). Results: Three months after surgery, patients who had received beauty treatments reported higher body‐image scores than the control group, but there was no effect in psychological distress. Helplessness/hopelessness increased over time in the control group but not in the group receiving beauty treatments. Conclusion: Overall, this study provides evidence of the usefulness of beauty treatments for breast‐cancer patients, in combination with routine care. Although these treatments did not seem to alleviate psychological distress directly, they had a beneficial impact on body image and may strengthen patients' social support and self‐esteem. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychological distress and quality of life of partners of individuals with familial adenomatous polyposis

Objective: Familial adenomatous polyposis (FAP) is a genetic condition characterized by the development of multiple adenomas in the colorectum that could lead to colorectal cancer. Our aim was to assess levels and predictors of psychological distress and quality of life (QOL) among partners of FAP‐patients. Methods: A nationwide, cross‐sectional survey using validated self‐report questionnaires assessing psychological distress and QOL. Results: One hundred and twenty‐nine partners completed the questionnaire (84% response rate), 30% of whom reported moderate‐to‐severe levels of distress. The partners' distress was associated significantly with the patients' distress, having children, and feelings of guilt. Fifty‐seven percent of the partners with moderate‐to‐severe distress levels had received professional psychosocial support. Partners did not differ significantly from the general population in QOL. However, 9–21% reported that FAP had affected their work, leisure time activities, and relationships. Conclusions: Clinicians should be particularly alert for heightened distress levels in partners of patients who are themselves distressed, and among those with children. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological distress and use of psychosocial support in familial adenomatous polyposis

Objective: Familial adenomatous polyposis (FAP) is characterized by multiple adenomas in the colorectum with a high risk to develop colorectal cancer. It is unclear whether individuals at risk of FAP experience distress due to this potentially life‐threatening disease. This nationwide study assessed: (1) the prevalence of psychological distress; and (2) the need for and use of specialized professional psychosocial support. Methods: In this cross‐sectional study, all individuals from families at high risk for FAP registered at the Netherlands Foundation for the Detection of Hereditary Tumours were invited to complete a questionnaire assessing, among other issues, generalized, cancer‐specific and FAP‐specific distress. Results: In total, 525 individuals completed the questionnaire. Approximately 20% of the respondents had moderate to severe levels of FAP‐specific distress. Levels of generalized distress were comparable to the general Dutch population. Significantly more individuals with a FAP diagnosis had frequent cancer worries than those at risk of FAP or non‐carriers (p=0.02). Distress levels were more strongly associated with psychosocial variables (e.g. perceived cancer risk), than with sociodemographic or clinical variables. Up to 43% of the variance in distress could be explained by all variables combined. Of those moderately to severely distressed, 26% had received specialized professional psychosocial support, while 30% of those did not receive the support they wanted. Conclusions: A substantial minority of individuals reported moderate to severe distress levels associated with FAP. However, only one‐third of those received specialized professional psychosocial support. We recommend the use of a screening questionnaire to identify individuals in need of such support. Copyright © 2009 John Wiley & Sons, Ltd.     

A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study

Objective: The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention. Methods: Using a one‐arm pre‐ and post‐intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects' marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory‐II [BDI‐II]), and hopelessness (Beck Hopelessness Scale) were assessed through self‐report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post‐intervention follow‐up). Results: RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5–5 points) or significant improvement (>5 points) in marital functioning and 68.8% scoring in the non‐distressed range (?48 RDAS). At T3, 60% of the couples (n=15) continued to score in the non‐distressed range on the RDAS. BDI‐II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI‐II score from T0 to T3 in all subjects (n=30). This reduction was more significant for the patients (n=15). Conclusions: Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end‐stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples. Copyright © 2008 John Wiley & Sons, Ltd.     

Religious beliefs,social support,self‐efficacy and adjustment to cancer

Purpose: Religious beliefs have received relatively little attention in research on coping with cancer. In this study, the relationship of religious beliefs and perceived social support with adjustment to cancer was studied in a coping model that included self‐efficacy for coping as a mediator. Of particular interest was the relationship between religious beliefs and social support. Method: Data were collected from 164 in‐treatment cancer patients. They completed measures of religious beliefs, social support, physical functioning, self‐efficacy for coping, and adjustment. A model comparison approach was used to assess the fit of models that included or excluded the contribution of religious beliefs while testing the relationship between religious beliefs and social support. Results: Religious beliefs were more strongly connected to perceived social support than with other constructs. Importantly, a coping model that included religious beliefs fit the data significantly better than a model without paths related to religious beliefs. Self‐efficacy partially mediated the relation of age, physical functioning, and perceived support to adjustment, but not religious beliefs. Discussion: Religious beliefs may not directly affect self‐efficacy and adjustment; however, cancer patients who have religious beliefs may experience an enhanced sense of social support from a community with whom they share those beliefs. Copyright © 2009 John Wiley & Sons, Ltd.     

Referral patterns and psychosocial distress in cancer patients accessing a psycho-oncology counseling service

Objective: One in three cancer patients will experience significant psychosocial distress, yet less than 10% will seek formal counseling. Who are the patients accessing counseling and what are their presenting needs? The purpose of this study was to identify referral patterns and psychosocial distress in cancer patients newly referred to a psycho‐oncology counseling service. Methods: Consecutive new referrals were tracked over 1 year (n=361). On initial visit, 145 patients completed a demographic survey, Brief Symptom Inventory‐18 (BSI‐18), Cancer Coping Questionnaire and Medical Outcomes Study Social Support Survey. Results: Approximately one in five newly referred patients never attended counseling, with a significant representation of men (p=0.016) and lung cancer patients (p=0.010). Of 361 referrals, 295 patients attended initial counseling, 259 were approached, and 145/259 (56%) completed the survey. Most were women (79%), urban‐dwelling (73%), diagnosed with non‐advanced cancer (72%), well‐educated (68%) and married (56%); average age of 52 years (SD=12.3). Two most common diagnoses were breast (36%) and genitourinary (14%) cancers. A total of 59% were significantly distressed (BSI‐18 global severity index T‐score?63) with less available social support than non‐distressed patients (p=0.022). Coping strategy use did not differ significantly between distressed and non‐distressed groups. Two of five patients were not significantly distressed. Conclusions: Most cancer patients attending counseling are well‐educated urban residing women, with significant psychosocial distress. Further research is needed to better understand barriers and appropriate screening methods for accessing counseling, as well as the needs of men, advanced cancer patients, rural residents, and less well‐educated people. Copyright © 2010 John Wiley & Sons, Ltd.     

Intimacy processes and psychological distress among couples coping with head and neck or lung cancers

Objective: Couples coping with head and neck and lung cancers are at increased risk for psychological and relationship distress given patients' poor prognosis and aggressive and sometimes disfiguring treatments. The relationship intimacy model of couples' psychosocial adaptation proposes that relationship intimacy mediates associations between couples' cancer‐related support communication and psychological distress. Because the components of this model have not yet been evaluated in the same study, we examined associations between three types of cancer‐related support communication (self‐disclosure, perceived partner disclosure, and protective buffering), intimacy (global and cancer‐specific), and global distress among patients coping with either head and neck or lung cancer and their partners. Method: One hundred and nine patients undergoing active treatment and their partners whose average time since diagnosis was 15 months completed cross‐sectional surveys. Results: For both patients and their partners, multilevel analyses using the actor‐partner interdependence model showed that global and cancer‐specific intimacy fully mediated associations between self‐ and perceived partner disclosure and distress; global intimacy partially mediated the association between protective buffering and distress. Evidence for moderated mediation was found; specifically, lower levels of distress were reported as a function of global and cancer‐specific intimacy, but these associations were stronger for partners than for patients. Conclusions: Enhancing relationship intimacy by disclosing cancer‐related concerns may facilitate both partners' adjustment to these illnesses. Copyright © 2010 John Wiley & Sons, Ltd.     

Do concordances of social support and relationship quality predict psychological distress and well‐being of cancer patients and caregivers?

This study examined concordances of cancer patients’ received and caregivers’ provided support and dyadic relationship quality, and their predictive utility in prospective psychological distress and well‐being. A total of 83 Chinese cancer patient–caregiver dyads were recruited in two government‐funded hospitals in Hong Kong. Participants reported received (patient)/provided (caregiver) emotional and instrumental support and dyadic relationship quality within 6 months after diagnosis (T1), and anxiety and depressive symptoms, positive affect and life satisfaction at both T1 and 6‐month follow‐up (T2). We hypothesised that concordances at T1 would predict lower psychological distress and higher psychological well‐being among both patients and caregivers at T2. Concordances were indicated by Gwet's AC₂ scores (possible range = ?1.00 to 1.00) and as follows: emotional support: M = 0.92, SD = 0.12, range = 0.25–1.00; instrumental support: M = 0.92, SD = 0.16, range = 0.08–1.00; and relationship quality: M = 0.63, SD = 0.27, range = ?0.31 to 1.00. Hierarchical multiple regressions revealed that T1 concordances of perceived emotional and instrumental support and dyadic relationship quality positively predicted T2 anxiety symptoms [F(9, 74) = 6.725, ?R² = .031, p < .001)] and state positive affect [F(9, 74) = 3.436, ?R² = .042, p = .001)], whereas inversely predicted T2 depressive symptoms [F(9, 74) = 4.189, ?R² = .042, p < .01)]. Significant associations were found only among caregivers, but not patients.     

Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review

Background: Alopecia is a common side effect of chemotherapies used in the treatment of breast cancer. The aim of this review is to describe the effects of alopecia on quality of life (QOL) in this population. Methods: We conducted a literature review using Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycInfo databases. We searched for studies on the effects of alopecia on various aspects of QOL in breast cancer patients including anxiety and distress, body image, sexuality, self‐esteem, social functioning, global QOL and return to work outcomes. Results: A total of 38 articles were included in the review. Hair loss consistently ranked amongst the most troublesome side effects, was described as distressing, and may affect the body image. Conclusions: We found very little quantitative data on other aspects of QOL. More research is needed to determine the presence and extent of negative effects on chemotherapy‐induced alopecia on various aspects of QOL. Copyright © 2007 John Wiley & Sons, Ltd.     

Accuracy of the Danish version of the 'distress thermometer'

Objective: Short screening instruments have been suggested to improve the detection of psychological symptoms. We examined the accuracy of the Danish version of the ‘Distress Thermometer’. Methods: Between October 2008 and October 2009, 426 women with newly diagnosed primary breast cancer who were operated at the Breast Surgery Clinic of the Rigshospitalet, Copenhagen, were eligible for this study. Of these, 357 participated (84%) and 333 completed a questionnaire. The distress thermometer was evaluated against the ‘hospital anxiety and depression scale’ (HADS). We also examined the women's wish for referral for psychological support. Results: A cut‐off score of 6 vs 7 (low:?6, high:?7) on the distress thermometer was optimal for confirming distress, with a sensitivity of 42%, a specificity of 93%, a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 73%. A cut‐off score of 2 vs 3 was optimal for screening, with a sensitivity of 99%, a specificity of 36%, a PPV of 47% and a NPV of 99%. Of those who were distressed using the cut‐off score of 2 vs 3 on the distress thermometer, 17% (n = 41) wished to be referred for psychological support and 57% (n = 140) potentially wanted a later referral. Conclusion: The distress thermometer performed satisfactorily relative to the HADS in detecting distress in our study. A screening procedure in which application of the distress thermometer is a first step could be useful for identifying persons in need of support. Copyright © 2011 John Wiley & Sons, Ltd.     

Improving social network support for partners facing spousal cancer while caring for minors: Four‐month outcomes of a single‐centre randomised controlled trial

Social support is an important predictor of the well‐being of partners of cancer patients. Those who are caring for minors (well parents) may be in special need of such support. The aim of this study was to evaluate the 4‐month impact of a psychoeducational social support intervention, named the Cancer‐PEPSONE programme (CPP), on well parents’ received and perceived social support, as well as on their psychological distress, quality of life (QOL) and parental capacity. The study was an open randomised controlled trial with a parallel‐group design (N = 35; Intervention = 17, Controls = 18). The participants in the intervention group received CPP in their homes. Controls received support as usual. Data were collected in Norway using validated self‐report questionnaires. Questionnaires were sent by post, before randomisation (T1), and at three‐ (T2) and six‐month (T3) follow‐up. Linear mixed models analyses revealed intervention effects on received (p = 0.04, d = 0.6) and perceived (p = 0.01, d = 1.0) social support, as well as on parental capacity (p = 0.02, d = 1.0), but not on psychological distress and QOL. Social support mediated the relationship between receiving CPP and later psychological distress. CPP may help well parents in maintaining social support and enhancing parental capacity. An improvement in social support may alleviate well parents’ psychological distress.     

Relationships among optimism,well‐being,self‐transcendence,coping, and social support in women during treatment for breast cancer

Objective: The impact of diagnosis and treatment for breast cancer, stressors that affect emotional well‐being, is influenced by several psychosocial factors and the relationships among them. The purpose of this study was to investigate the relationship between optimism and emotional well‐being (EWB) and the individual and combined mediation of this relationship by perceived social support (SS), problem focused coping (PFC), and self‐transcendence in women with breast cancer during radiation therapy. Methods: Ninety‐three women receiving radiation treatment for breast cancer completed questionnaires that measured EWB, optimism, SS, PFC, and self‐transcendence. Results: Correlational and multiple regression analysis revealed that optimism was positively related to EWB. Of the three mediators, self‐transcendence alone was found to partially mediate the relationship between optimism and EWB. The relationship between optimism and PFC was not significant. Optimism was related to SS, but its indirect effect on EWB through SS did not reach significance. Conclusions and implications: During breast cancer treatment, the positive effects of optimism on EWB are partially mediated by a woman's level of self‐transcendence. Brief screening of women's optimism may help identify women at risk for psychological distress. Early detection and interventions to promote psychological adjustment throughout the cancer trajectory (e.g. enhancing self‐transcendence) should receive attention in future research. Copyright © 2008 John Wiley & Sons, Ltd.     

Prospective predictors of psychosocial support service use after cancer

Objective: To identify prospective predictors of psychosocial support service utilisation by people with cancer. Consistent with the theory of planned behaviour (TPB), attitudes towards help seeking and behavioural intentions were predicted to lead to greater support service utilisation. Methods: A heterogeneous sample of cancer patients from a regional cancer treatment centre in Australia completed a prospective survey (n=439 at recruitment, 61.2% response rate; n=396 at follow‐up) examining the utilisation of psychosocial support services. Demographic variables (age and gender), social support, social constraints, cancer specific distress, and positive and negative attitudes towards help seeking were examined as prospective predictors of support service use. Further, a series of regression analyses explored mediation of the relationship between attitudes to seeking help and support service use by behavioural intentions. Results: Approximately 14% of cancer patients reported using a psychosocial support service in the 6 months following the time of the first study. Females and patients with more positive attitudes towards help seeking were more likely to have utilised a support service in the 6 months following recruitment. The relationship between positive attitudes to seeking help and psychosocial support service use was mediated by behavioural intentions. Conclusions: The TPB appears to have utility in explaining in part use of psychosocial help services. Future studies should include contextual factors in the model. Copyright © 2010 John Wiley & Sons, Ltd.