Going beyond social support: Fear of receiving compassion from others predicts depression symptoms in breast cancer patients

Background: Recent studies have highlighted the importance of being able to receive compassion and affiliative signals from others. The main aim of the present study was to explore whether social support and fear of receiving compassion from others are predictors of depression symptoms in a sample of breast cancer patients. Methods: The sample included 86 female patients with non-metastatic breast cancer. Participants were recruited at a Radiotherapy Service in central Portugal and completed validated self-report instruments. Multiple regression analysis were conducted to examine the predictive effects of clinical (cancer stage, comorbidities) and demographic variables (age, education), social support, and fear of receiving compassion from others on depressive symptoms. Results: Fear of receiving compassion from others was the only significant predictor of the model, with a positive effect on depression symptomatology (β = 0.44; p < 0.001). These results suggest that the amount of supportive social contacts and networks may not be as important as cancer patients' ability to receive compassion from others. Conclusions: This is the first study to focus on fear of receiving compassion from others in cancer patients and seems to be a significant contribution for the study of the social factors that may be associated with depression in breast cancer. Psychological screening interviews in breast cancer, besides assessing patients' level of depression and social support, ought to also evaluate the ability to receive empathy and emotional help and support from other people.     

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 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.     

On the positive relation between received social support and negative affect: a test of the triage and self-esteem threat models in women with breast cancer

Objective: There is a seemingly paradoxical positive relation between received social support and psychological distress in cancer patients. This study evaluates two models that explain this positive relation: (a) the triage model, which argues that more distressed people receive more support and (b) the self‐esteem threat model, which argues that receiving support increases distress by undermining self‐esteem. Methods: Longitudinal survey data were collected from 71 women treated for breast cancer at 3‐ (T1) and 18‐months (T2) post‐diagnosis Results: Analyses did not disconfirm either model. Consistent with the triage model, there was a marginally significant (p=0.052) positive relation between T1 negative affect and T2 received support, controlling for T1‐received support. Consistent with the self‐esteem threat model, a significant positive relation between T1 received support and T2 negative affect, controlling for T1 negative affect, appeared to be mediated by T2 self‐esteem. Conclusions: These findings suggest that people with cancer who are most distressed may receive the most social support, but the conveyance of support can have negative consequences for self‐esteem and affect. Copyright © 2008 John Wiley & Sons, Ltd.     

Physical activity levels and supportive care needs for physical activity among breast cancer survivors with different psychosocial profiles: a cluster‐analytical approach

CHARLIER C., PAUWELS E., LECHNER L., SPITTAELS H., BOURGOIS J., DE BOURDEAUDHUIJ I. & VAN HOOF E. (2012) European Journal of Cancer Care Physical activity levels and supportive care needs for physical activity among breast cancer survivors with different psychosocial profiles: a cluster‐analytical approach The transition from breast cancer patient to survivor is associated with many treatment‐related and psychosocial factors, which can influence health behaviour and associated needs. First, this study aimed to identify clusters of treatment‐related and psychosocial factors among breast cancer survivors. Second, clusters' physical activity levels and care needs for physical activity were evaluated. Breast cancer survivors (n= 440; 52 ± 8 years) (3 weeks to 6 months post treatment) completed self‐reports on physical and psychological symptoms; illness representations; social support and coping; physical activity and care needs for physical activity. Analyses identified four clusters: (1) a low distress‐active approach group; (2) a low distress‐resigned approach group; (3) a high distress‐active approach group; and (4) a high distress‐emotional approach group. Physical activity levels were higher in the low distress groups than in the high distress‐emotional approach group. However, women with low distress and an active approach reported equal care needs for physical activity than women with high distress and an emotional approach. These findings suggest that care needs for physical activity are unrelated to distress and actual physical activity levels. The results emphasise the importance of screening for needs and provide a framework supporting the referral of breast cancer survivors to tailored interventions.     

Type of social support matters for prediction of posttraumatic growth among cancer survivors

Objective: Previous research in people with cancer on social support and psychological well‐being has mainly focused on the short‐term negative outcomes of adjustment. Little is known about the role of social support in the experience of positive outcomes in the long term. This study examined the relation between emotional support in the period following diagnosis and the experience of positive consequences of the illness, so called posttraumatic growth, at 8 years after diagnosis. We focused on three distinct types of emotional support: perceived availability, actual received, and dissatisfaction with received emotional support. Methods: This longitudinal study was conducted in a sample of 206 long‐term cancer survivors. Social support was assessed with the Social Support List (SSL) at 3 months and 8 years after diagnosis. Positive consequences of the illness were assessed with the Silver Lining Questionnaire (SLQ) at 8 years after diagnosis. Correlation‐ and regression analyses were used to examine the associations of initial levels of emotional support with the long‐term report of posttraumatic growth. Results: Regression analyses showed that more received emotional support at 3 months after diagnosis significantly predicted a greater experience of positive consequences of the illness at 8 years after diagnosis. This association remained significant, when controlling for concurrent levels of emotional support at 8 years after diagnosis. Conclusions: The findings suggest that getting support from family and friends, characterized by reassuring, comforting, and problem‐solving, in the period following diagnosis is an important resource that may help cancer survivors to find positive meaning in the cancer experience. Copyright © 2009 John Wiley & Sons, Ltd.     

Willingness of cancer patients to help family members to quit smoking

Objectives: The impact of social support on successful smoking cessation has been well documented. However, little is known about whether personal experience with cancer may motivate cancer survivors to support smoking cessation among their family members and friends. As a first step in this line of research, we sought to explore interest in playing a supportive role for smoking cessation as well as correlates of such interest among cancer survivors. Methods: Cancer survivors undergoing radiation therapy (N=211) completed a 77‐item pencil–paper questionnaire. A section of the survey assessed interest in helping a smoker quit and characteristics of the smoking social network member. Respondents provided information on their smoking status, medical status, and psychosocial and behavioral factors related to cigarette smoking. Results: Over half of the respondents 114 (54%) reported having someone close to them (family member or friend) smoking cigarettes who they thought should quit. Of these respondents (44 females, 70 males) 78% (89/114) reported they were definitely or probably interested in helping a smoker quit. Nearly all respondents wanted to help a family member (typically an adult child). Conclusions: Results suggest the potential feasibility of engaging cancer survivors to help family members quit smoking. Research is needed to determine the optimal methods and timing for engaging the cancer patient to maximize positive effects and minimize potential harms. Copyright © 2010 John Wiley & Sons, Ltd.     

Depression,anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients

MEHNERT A., LEHMANN C., GRAEFEN M., HULAND H. & KOCH U. (2010) European Journal of Cancer Care 19 , 736–745
Depression, anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients The aim of this study is to identify anxiety, depression and post‐traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health‐related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow‐up care for an average of 27 months after surgery using standardised self‐report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist – Civilian Version, Illness‐Specific Social Support Scale, Short‐Form Health Survey). Seventy‐six per cent of patients evaluated their disease as ‘not’ or a ‘little threatening’. The cancer diagnosis and uncertainty were most frequently reported as ‘distressing’, while medical treatment and doctor–patient interaction were most frequently evaluated as ‘most helpful’. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age‐adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co‐morbidity (P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health (P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening.     

Psychosocial factors and survival after diagnosis of inoperable non-small cell lung cancer

Objective: Although several previous studies have investigated the association between psychosocial factors and the survival of lung cancer patients, most previous studies were flawed by severe methodological limitations. The purpose of the present study was to use a rigorous study design to investigate the association between relevant psychosocial factors and survival after a diagnosis of inoperable non‐small cell lung cancer (NSCLC). Methods: The subjects were 122 consecutive newly diagnosed patients with inoperable NSCLC. Patients coping with cancer, psychological distress, clinical depression, and social support were evaluated after diagnosis but before treatment and 2 months later. After a 2‐year follow‐up period, 108 patients had died. The survival data were censored for the remaining 14 patients. The influence of psychosocial factors after diagnosis but before treatment on survival time was analyzed using a Cox regression, with adjustments for well‐established (definite and/or possible) prognostic factors. The stability of the investigated psychosocial factors was also examined. Results: None of the examined psychosocial factors significantly predicted survival time among the patients with inoperable NSCLC. Among the biomedical factors that were examined, advanced clinical stage, a high serum lactate dehydrogenase level, and not receiving chemotherapy were independently associated with shorter survival periods. Most of the psychosocial factors exhibited a moderate to high stability. Conclusions: We found little convincing evidence that psychosocial factors after cancer diagnosis had a clinically relevant effect on the survival of inoperable patients with NSCLC. Copyright © 2008 John Wiley & Sons, Ltd.     

Managing social difficulties: roles and responsibilities of patients and staff

Background: Implementation of guidance on assessment and management of psychosocial and supportive‐care problems or needs will be successful only if consideration is given to existing skills, experience and expectations of staff and patients. This study examines the roles and responsibilities of staff, patients and families in relation to management of social difficulties and proposes a pathway for response. Methods: A qualitative study was performed using staff and patient interviews. Seventeen doctors and 16 nurses were interviewed using patient scenarios and a support service questionnaire. Patients (n = 41) completed a screening questionnaire (the Social Difficulties Inventory) and were interviewed. Interviews were audio‐recorded, transcribed and subjected to a Framework analysis. Analysis examined (1) actions taken by staff and patients in response to social difficulties, (2) reasons given for action taken and (3) perceptions of staff and patients of who was responsible for taking action. Results: Staff were confident concerning clinically related issues (i.e. mobility) but more hesitant concerning difficulties related to money, work and family concerns. Patients liked to cope with problems on their own where possible, would have liked information or support from staff but were uncertain how to access this. Results led to development of a hierarchy of interventions in response to detected social difficulties. Discussion: For routine assessment of social difficulties, patients, nurses and doctors will have to work collaboratively, with nurses taking a lead in discussion. For specific clinically related problems doctors would play a more primary role. Copyright © 2010 John Wiley & Sons, Ltd.     

Social support and quality of life of prostate cancer patients after radiotherapy treatment

QUEENAN J.A., FELDMAN‐STEWART D., BRUNDAGE M. & GROOME P.A. (2010) European Journal of Cancer Care 19 , 251–259
Social support and quality of life of prostate cancer patients after radiotherapy treatment Research suggests that social support can have an impact on health‐related quality of life (HRQOL). Social support can be structural support (SSS) or functional support (FSS). Our study was designed to clarify the relationships between HRQOL, FSS and SSS. We conducted a cross‐sectional survey and a detailed chart review. The study population was men attending a follow‐up clinic after receiving radiotherapy for prostate cancer. Functional social support was measured by using the MOS Social Support Survey. Structural social support was measured by using questions adapted from the 1994–1995 National Population Health Survey conducted by Statistics Canada. Health‐related quality of life was measured by using the European Organization for Research and Treatment of Cancer's QLQ‐C30. We found a statistically significant positive correlation between FSS and HRQOL but no association between overall SSS and HRQOL. Worsening urinary symptoms were significantly associated with lower levels of FSS and with lower HRQOL. This study underscores that the perception of support (functional) is more important than the amount or size of support (structural). We also identified a subgroup of men who have lower FSS and lower HRQOL that suffer from urinary side effects of their treatment. Further research to clarify the relationship between FSS and urinary symptoms will also clarify how an intervention could improve the HRQOL of these men.     

Social support and survival in young women with breast carcinoma

Purpose: Although previous evidence has shown increased likelihood for survival in cancer patients who have social support, little is known about changes in social support during illness and their impact on survival. This study examines the relationship between social support and survival among women diagnosed with breast carcinoma, specifically assessing the effect of network size and changes in social contact post‐diagnosis. Methods: A population‐based sample of 584 women was followed for up to 12.5 years (median follow‐up = 10.3 years). The mean age at diagnosis was 44 years, 81% were married, and 29% were racial/ethnic minorities. Cox regression analysis was used to estimate survival as a function of social support (changes in social contact and the size of social support), disease severity, treatment, health status, and socio‐demographic factors. Results: Fifty‐four percent of the women had local and 44% had regional stage disease. About 53% underwent mastectomy, 68% received chemotherapy, and 55% had radiation. Regression results showed that disease stage, estrogen receptor status, and mastectomy were associated with greater risk of dying. Although network size was not related to survival, increased contact with friends/family post‐diagnosis was associated with lower risk of death, with a hazard ratio of 0.31 (95% CI, 0.17–0.57). Conclusion: Findings from this study have identified an important aspect of a woman's social network that impacts survival. An increase in the amount of social contact, representing greater social support, may increase the likelihood of the women's survival by enhancing their coping skills, providing emotional support, and expanding opportunities for information‐sharing. Copyright © 2010 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.     

Psychosocial resources and sleep disturbance before chemotherapy for gynecologic cancer

ABSTRACT

Personal psychosocial resources (e.g., positive affect, social support, perceived mastery, meaning in life) are associated with better sleep in noncancer populations, but there have been few studies in cancer patients. The present study examined psychosocial resources and sleep in gynecological cancer patients. Before chemotherapy, 72 participants completed self-report measures of sleep and psychosocial resources; 63 also completed actigraphic monitoring. Subjective sleep was associated with positive affect, social support, perceived mastery, and meaning in life; objective sleep was associated with social support. Future studies should examine whether interventions to enhance psychosocial resources result in improved sleep in this population.     

When peer support may be most beneficial: the relationship between upward comparison and perceived threat

Objective: Currently, the mechanism by which dyadic peer support programs may facilitate positive psychological adjustment for cancer patients is unclear. This study utilized social comparison theory to examine the effects of peer support on the psychological adjustment of women with breast cancer. Methods: A cross‐sectional survey of 251 recently diagnosed breast cancer patients (52% response), who had received a dyadic peer support intervention, was undertaken assessing anxiety, depression, perceived threat, and upward comparison. Results: Perceived cancer threat significantly moderated the relationship between positive upward comparison and depression levels (p = 0.017). Women who engaged in upward comparisons and who perceived their diagnosis to be more threatening had lower depression levels than women who were less threatened. Conclusions: Peer support services that provide support from cancer survivors may be especially beneficial for people who appraise their cancer diagnosis as more threatening. The application of theoretical models to future evaluation designs will further increase understanding of the psychological mechanisms involved in the effects of peer support and inform program development. Copyright © 2010 John Wiley & Sons, Ltd.     

The importance of social relationships for brain tumor patients’ quality of life: A case for the inclusion of the concept of disclosure in psycho-oncological care

Abstract

Purpose: Interpersonal factors are of major importance for cancer patients’ physical and mental health. Brain tumor patients rank amongst those cancer patients with the highest psychosocial burden. Changes in language, cognition, and personality pose specific risk factors for impeding interpersonal functioning in this patient group. Despite this, role and relevance of social support including both supportive (e.g., emotional support) and detrimental interactions causing distress (e.g., critical remarks) are not well understood. Aims of this study were thus (1) to investigate the association of social support and patients’ Health Related Quality of Life (HRQoL) and (2) to assess whether this relationship is mediated by the patients’ disclosure behavior.

Methods: Seventy-four ambulatory brain tumor patients (mean age 54?years; 58% women) completed the following self-report questionnaires: Illness-specific Social Support Scale (SSUK) for assessment of positive support and detrimental interactions, the Disclosure of Trauma Questionnaire (DTQ) for assessment of patients’ disclosure behavior, and the Short-Form Health Survey (SF-8) for assessment of QoL.

Findings: Detrimental social interactions were significantly related to patients’ mental and physical well-being while positive support was not. Our results support a model in which patients perceiving detrimental social interactions show more difficulties in talking about illness-specific contents in a functional manner. This, in turn, was associated with a lower physical and mental HRQoL.

Conclusions: This was the first study in which the close associations of detrimental social interactions, brain tumor patients’ dysfunctional disclosure behavior and patients’ mental as well as physical well-being were empiricially validated. Thus, dysfunctional disclosure behavior might pose a relevant therapeutic target when offering psycho-oncological support for brain tumor patients and their families.     

Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer

Objective: To assess the effects of an expressive writing (EW) intervention on perceptions of emotional support in women completing treatment for early stage breast cancer. Methods: Women were recruited to the study during their final week of treatment. Of 260 eligible patients, 104 (40%) agreed to participate, and 93 were randomised. Women in the writing group wrote for 20 min on four consecutive days. The control group received normal care. Women's perceptions of emotional support, quality of life (QOL), mood, and healthcare utilisation were assessed at baseline, 1 month, 3 months and 6 months. Interviews were conducted to explore women's experience of writing. Results: Eighty participants completed all follow‐ups. There was a significant effect of group on women's perceptions of social support with those in the intervention group being more satisfied with the emotional support they received (p<0.05). Satisfaction with emotional support was negatively correlated with depression/dejection (p<0.05) and anger/hostility (p<0.05) and positively correlated with social and family well‐being (p<0.001) 6 months post intervention. There were no significant effects of the intervention on mood, QOL or healthcare utilisation. Most participants found writing valuable and did not report any long‐term negative effects. Conclusion: EW was associated with a higher level of satisfaction with emotional support compared with controls. Given the existing evidence supporting the importance of social support in adjustment to breast cancer, it seems feasible to suggest that EW may be a cost effective accessible treatment that could be incorporated into the ongoing care of women. Copyright © 2009 John Wiley & Sons, Ltd.     

The transition from breast cancer 'patient' to 'survivor'

Background: While much is now known about breast cancer survivors' long‐term health, quality of life, and psychological state, relatively little is known about the period immediately following completion of treatment, when women transition out of the role of breast cancer ‘patient’ to life as ‘survivor’. Objective: To explore women's fears regarding risk of cancer recurrence, sense of loss of medical monitoring, and social support from health‐care providers and other patients, and the strategies they use to cope with these issues. Method: Focus group interviews were conducted with women who had completed adjuvant chemotherapy or radiation for new stage I or II breast cancer in the prior 12 months. Interviews were audio‐taped, transcribed, and analyzed using a constant comparative analysis approach. Results: Of 216 women identified as eligible, over half (155) were reached by telephone and invited to participate. Of those invited, 47 (30%) agreed. Findings suggest that while women acknowledge positive life changes as a result of the cancer experience, emotional and physical stresses are prevalent following the completion of treatment. Conclusion: The period of time when women who have been treated for breast cancer transition to life without treatment presents numerous emotional and physical challenges. By illuminating patients' experience during this transition period, this study provides insights into the development of interventions to support women after treatment. Copyright © 2008 John Wiley & Sons, Ltd.     

Is perceived social support a predictor of survival for patients undergoing autologous peripheral blood stem cell transplantation?

Purpose: Previous research discussed the predictive value of psychosocial variables along with biomedical predictors for survival; such as affective functioning and quality of life. The present study addresses the following research question: does perceived social support prior to PSBCT have an impact on post‐transplant survival? Subjects and methods: Ninety‐nine patients suffering from Multiple Myeloma (n=55), Non‐Hodgkin Lymphoma (n=33), and other malignancies (n=11) completed the Illness Specific Scales of Social Support (ISSS) before undergoing PBSCT. ISSS is comprised of the subscales ‘positive social support’ and ‘problematic social support’, e.g. criticising, victimising, or avoiding interactions. Results: The mean score in the subscale ‘positive social support’ was 3.2 (S.D. 0.54; range 0 until 4), in the subscale ‘negative social support’ 0.94 (S.D. 0.53). There was no association between positive interactions and survival following PBSCT. Conversely, those patients perceiving problematic social support, showed a correspondence with poor survival following PBSCT (RR=3.649; p=0.015; Cox‐regression analysis). The following variables were controlled: Karnofsky Performance Status, interferon treatment, depression and participation in psychotherapy. Conclusion: Differentiating between positive and problematic interactions prior to PBSCT helps to recognise detrimental forms of social support. Future research should investigate the clinical implications and help tailor psychotherapeutic intervention. Copyright © 2005 John Wiley & Sons, Ltd.