Exploring the relationship between posttraumatic growth,cognitive processing,psychological distress,and social constraints in a sample of breast cancer patients

ABSTRACT

Posttraumatic growth (the perception of positive life changes after an encounter with a trauma) often occurs among breast cancer patients and can be influenced by certain demographic, medical, and psychosocial parameters. Social constraints on disclosure (the deprivation of the opportunity to express feelings and thoughts regarding the trauma) and the cognitive processing of the disease seem to be involved in the development of posttraumatic growth. Through the present study the authors aim to: investigate the levels of posttraumatic growth in a sample of 202 women with breast cancer in Greece, explore the relationships between posttraumatic growth and particular demographic, medical, and psychosocial variables according to a proposed model, and test the role of social constraints in the relationship between automatic and deliberate cognitive processing of the trauma. The results showed that posttraumatic growth was evident in the majority of the sample and was associated inversely with age at diagnosis (β = ?0.174, p < .05) and psychological distress (β = ?0.394, p = .001), directly with time since diagnosis (β = 0.181, p < .05), and indirectly with intrusions and psychological distress, through reflective rumination (β = 0.323, p = .001). Social constraints were found to moderate the relationship between intrusions and reflective rumination. Implications of the results and suggestions for future research and practice are outlined.     

Previving: How Unaffected Women with a BRCA1/2 Mutation Navigate Previvor Identity

ABSTRACT

Receiving a positive result for a BRCA1/2 (BRCA) mutation – indicating a high lifetime risk to develop hereditary breast and ovarian cancer – can significantly alter a woman’s identity. BRCA-positive women who have not been diagnosed with cancer may be labeled “previvors,” which distinguishes those at-risk for developing cancer, but have not had cancer. Using semi-structured interviews (N = 25), this study explored how unaffected BRCA-positive women navigate the previvor identity. Women in this sample differed on their definitions of previvor, views of acceptance, rejection, or ambivalence toward the label, and identification as a previvor. Understanding how women interpret and embrace the previvor identity may help inform communication for those with BRCA genetic mutations, but whom have not been diagnosed with cancer.     

Social constraints and quality of life among chinese-speaking breast cancer survivors: a mediation model

Purpose

Literature has revealed detrimental effects of unsupportive interpersonal interactions on adjustment to cancer. However, no studies have examined this effect and the underlying psychological pathways among Chinese-speaking breast cancer survivors. The study investigated the relationship between social constraints and adjustment to cancer and the underlying psychological pathways among Chinese-speaking breast cancer survivors.

Methods

Chinese-speaking breast cancer survivors (N = 120) completed a questionnaire package assessing social constraints, intrusive thoughts, affect, and quality of life.

Results

Results revealed a negative relationship between social constraints and quality of life. Such a relationship between social constraints and quality of life was mediated by negative affect and intrusive thoughts, while the association of intrusive thoughts and quality of life were completely mediated by positive and negative affect.

Conclusion

Findings highlight the negative association between unsupportive interpersonal interactions and adjustment through cognitive and affective pathways among Chinese-speaking breast cancer survivors.     

The WHOQOL-100 has good psychometric properties in breast cancer patients

ObjectiveThis prospective follow-up study examines the psychometric properties of the World Health Organization Quality of Life assessment instrument (WHOQOL-100) for assessing quality of life in women suspected of having breast cancer and disease-free breast cancer survivors.Study Design and SettingThe WHOQOL-100 was tested at five points in time in women with a palpable lump in the breast or an abnormality on a screening mammography (N = 356) and breast cancer survivors (N = 140). Furthermore, all participants completed measures of anxiety (State Trait Anxiety Inventory) and depression (Center for Epidemiologic Studies Depression scale). Moreover, women who were diagnosed with breast cancer also completed the EORTC-QLQ-BR-23 at time points 2–5. Reliability (internal consistency; test–retest reliability) and construct validity were tested.ResultsConfirmatory factor analyses on the WHOQOL-100 items showed a good fit with models reflecting six factors (physical health, psychological health, level of independence, social relationships, environment, spirituality/religion/personal beliefs) or four factors (physical health, psychological health, social relationships, environment). Internal consistency was adequate. Test–retest correlations were high. The WHOQOL-100 correlated highly with related constructs and showed low correlations with unrelated constructs.ConclusionThe WHOQOL-100 is a reliable and valid instrument for measuring QOL in women suspected of having breast cancer and disease-free breast cancer survivors.     

Quality of life in patients with multiple sclerosis: A study with patients and caregivers

BackgroundMultiple Sclerosis (MS) is a chronic disease that affects patients' quality of life and requires long term demanding care.ObjectiveThe purpose of this study was to examine the relationships between patients and caregivers' variables regarding patients' quality of life, the moderating role of marital satisfaction between patients' psychological morbidity and quality of life, and the contribution of patient and caregiver variables towards patients’ quality of life.MethodsThe sample included 100 patients with MS and 72 caregivers. Participants’ variables were assessed using self-report measures. The design of this quantitative study was transversal.ResultsMarital satisfaction moderated the relationship between patients' anxiety and mental quality of life. Patients' perception of illness identity and consequences together with caregivers' depressive symptoms were mediators between patients' depression and quality of life. Burden also played a mediator role in the relationship between patients’ depressive symptoms, disability level, and physical quality of life.ConclusionTherefore, intervention in multiple sclerosis should be delivered in a dyadic context.     

Whole Grain Consumption and Breast Cancer: A Case-Control Study in Women

Objective: Whole grain consumption has long been associated with human health. However, its relationship with breast cancer remains not well understood and appreciated. The aim of this work was to evaluate the association between whole grain consumption and breast cancer in women. Methods: A case-control study was designed. Two hundred and fifty consecutive, newly diagnosed breast cancer female patients (56 ± 12 years) and 250 one-to-one age-matched controls were enrolled. A standardized, validated questionnaire assessing various sociodemographic, clinical, lifestyle, and dietary characteristics was applied through face-to-face interviews. Moreover, data on regular consumption of whole grains (i.e., never/rarely, 1–6 times/week, >7 times/week) were recorded. Overall dietary habits were assessed through the level of adherence to the Mediterranean diet using the MedDietScore (theoretical range 0–55). Results: Whole grain consumption of more than 7 times/week was associated with a 0.49-fold (odds ratio = 0.49; 95% confidence interval, 0.29, 0.82) lower likelihood of having breast cancer, after adjustments were made. Conclusions: This study suggested that whole grain consumption more than 7 times/week was consistently associated with reduced risk of breast cancer.     

Health Literacy and Health-Related Quality of Life Among a Population-Based Sample of Cancer Patients

Health-related quality of life is an important outcome in cancer care. A few studies indicate that health literacy influences cancer patients’ health-related quality of life, but additional investigation is needed. The authors examined the relation between health literacy and health-related quality of life among cancer patients. A cross-sectional survey was conducted with cancer patients in Wisconsin during 2006–2007. Data on sociodemographics, clinical characteristics, health-related quality of life, and health literacy were obtained from the state's cancer registry and a mailed questionnaire. Regression analyses were used to characterize the association between health-related quality of life and health literacy. The study sample included 1,841 adults, newly diagnosed with lung, breast, colorectal, or prostate cancer in 2004 (response rate = 68%). Health-related quality of life was measured with the Functional Assessment of Cancer Therapy-General. Adjusting for confounders, higher health literacy was associated with greater health-related quality of life (p < .0001). Controlling for covariates, we found significant differences between those in the highest and lowest health literacy categories (p < .0001) and in the physical (p < .0001), functional (p < .0001), emotional (p < .0001), and social (p = .0007) well-being subscales. These associations exceeded the minimally important difference threshold for overall health-related quality of life and functional well-being. Health literacy is positively and independently associated with health-related quality of life among cancer patients. These findings support adoption of health literacy best practices by cancer care systems.     

What contributes to long-term quality of life in breast cancer patients who are undergoing surgery? Results of a multidimensional study

Purpose

This study aims to examine the key determinants of long-term quality of life in breast cancer patients who are undergoing surgery using a multidimensional approach and taking into account preoperative and post-operative psychological characteristics such as anxiety, depression, posttraumatic growth, body image, and physical activity as well as medical parameters.

Methods

The study involved 63 breast cancer patients from the Department of Surgery at the University of Szeged. Assessments occurred 1 day before surgery as well as 3 days and 18 months after surgery using the Spielberger State and Trait Anxiety Inventory (STAI), Beck’s Depression Inventory (BDI), Functional Assessment of Cancer Therapy–Breast Cancer Scale (FACT-B), Posttraumatic Growth Inventory (PTGI) and Breast Impact of Treatment Scale (BITS). Data relating to physical activity, medical parameters and sociodemographic characteristics were also collected.

Results

The level of depression did not change over time. State anxiety decreased 18 months after the surgery compared to before the surgery; however, there was a greater decrease immediately after the surgery and then anxiety increased again 18 months later. Trait anxiety was associated with quality of life, posttraumatic growth and body image. Posttraumatic growth and the level of depression were found to be possible contributing factors to the increase in long-term quality of life.

Conclusions

The results show that the timely detection and proper management of psychological distress and the enhancement of posttraumatic growth are of great value, as they might be important contributing factors to long-term quality of life in breast cancer patients.

     

Breast Cancer Diagnosis from Screening in Trinidad and Tobago: Opportunities for Cancer Prevention

Trinidad and Tobago (TT) experiences the highest breast cancer mortality in the Caribbean; the distribution of traditional breast cancer risk factors in this population has not been analyzed. Data on women who underwent breast cancer screening at the TT Cancer Society between January 2009–December 2011(N = 2,689) were retrospectively collected. The screening detected 131 incident breast cancers; variables significantly associated with breast cancer diagnosis were, a positive family history of breast cancer (adjusted odds ratio [OR_adj]: 1.55; 95 % CI 1.00–2.41), presence of symptoms (OR_adj: 1.91; 95 % CI 1.25–2.92), and previous breast surgery (OR_adj: 1.67; 95 % CI 0.97–2.88). Breast cancer was significantly associated with increased breast density. Among healthy women, breast density was positively associated with nulliparity (OR_adj: 1.46, 1.37, 2.52 respectively for density level 2, 3 and 4 vs. 1) and previous breast surgeries (OR_adj: 2.27, 3.09 and 4.13 respectively for density level 2, 3 and 4 vs. 1). This analysis confirms that breast density is an important predictor of newly diagnosed breast cancer in this Caribbean population. Screening is still a diagnostic tool rather than a preventive measure in TT.     

Exploring the association between quality of homecare services and older adults’ well-being

ABSTRACT

Homecare services play an important role in enabling older adults with chronic illness or functional impairment to continue living in their homes and communities. Previous research on homecare services has not fully explored the potential psychological benefits of homecare services. This study investigates the association between quality of homecare services and psychological well-being by analyzing two surveys. The results showed that the association between well-being and the quality of homecare services was mediated by satisfaction with health (z = 4.36, p = .000), satisfaction with family life (z = 4.96, p = .000) and satisfaction with friendship (z = 3.56, p = .000). The top three most important life domains, health, family life, and friendships, combined fully mediated the association between well-being and the quality of homecare services. These findings suggest that quality homecare services could enhance clients’ well-being in the areas of family life and friendships beyond health.     

Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors

Purpose

Ambivalence over emotional expression (AEE) is the inner conflict of desiring emotion expression and fearing consequence of emotion expression. Few studies to date have examined the effects of AEE within an ethnic group that prioritizes emotional self-control. The present study examined the associations between AEE and well-being (viz., quality of life and depressive symptoms) as a function of acculturation among a sample of Chinese American breast cancer survivors.

Methods

Ninety-six Chinese breast cancer survivors (M _age = 54.64 years old, SD = 7.98) were recruited from Southern California. Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-Breast (FACT-B), and the Center for Epidemiologic Studies Depression Scale—Short Form (CESD-10).

Results

Acculturation was a statistically significant moderator of the relations between AEE and depressive symptoms, and a statistically marginally significant moderator of the relations between AEE and quality of life. Simple slopes revealed that AEE was negatively associated with quality of life (B = ?.45, p < .001) and depressive symptoms (B = .20, p < .001) for women with high acculturation, but not associated for women with low acculturation (Bs = ?.15 and .04, ps > .05, for quality of life and depressive symptoms, respectively).

Conclusions

These results suggest that less acculturated Chinese breast cancer survivors are protected by Chinese cultural values of emotional self-control and restraint, and thus do not experience the detrimental effects of AEE on their depressive symptoms and quality of life. Implications are discussed.

     

Health-related quality of life in multiple sclerosis: role of cognitive appraisals of self,illness and treatment

Purpose

Health-related quality of life (HRQoL) is considered an important measure of treatment and rehabilitation outcomes in multiple sclerosis (MS) patients. In this study, we used multivariate regression analysis to examine the role of cognitive appraisals, adjusted for clinical, socioeconomic and demographic variables, as correlates of HRQoL in MS.

Methods

The cross-sectional study included 257 MS patients, who completed Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Actually Received Support Scale (a part of Berlin Social Support Scale) and Socioeconomic Resources Scale. Demographic and clinical characteristics of the participants were collected with a self-report survey. Correlation and regression analyses were conducted to determine associations between the variables.

Results

Five variables, illness identity (β = 0.29, p ≤ 0.001), self-esteem (β = ?0.22, p ≤ 0.001), general self-efficacy (β = ?0.21, p ≤ 0.001), disability subgroup “EDSS” (β = 0.14, p = 0.006) and age (β = 0.12, p = 0.012), were significant correlates of HRQoL in MS. These variables explained 46 % of variance in the dependent variable. Moreover, we identified correlates of physical and psychological dimensions of HRQoL.

Conclusions

Cognitive appraisals, such as general self-efficacy, self-esteem and illness perception, are more salient correlates of HRQoL than social support, socioeconomic resources and clinical characteristics, such as type and duration of MS. Therefore, interventions aimed at cognitive appraisals may also improve HRQoL of MS patients.

     

Postpartum depression and its psychosocial correlates: A longitudinal study among a group of women in Turkey

ABSTRACT

The postpartum period is a window of risk for psychological disturbances and particularly for depressive symptoms. This study explored the relationships between postpartum depression and prepartum depressive symptoms, marital adjustment, support from family, previous depressive symptomology, and pregnancy planning. A total of 128 women who were receiving prenatal care at a state hospital in Istanbul, Turkey, and who were in the last trimester of their pregnancy participated in the first phase of the study. Of these, eighty-seven women also participated in the second phase, during the 3–6 month postpartum period. The results indicated that depressed mood in the last trimester of pregnancy, family support, care and support from spouse, previous depression history, and unplanned pregnancy were significant risk factors for postpartum depressive symptoms; significant differences were found for study variables as a function of women’s scores on the Edinburgh Postnatal Depression Scale in pregnancy and in the postpartum period. The recommendation is made to use screening tools, like the Edinburgh Postnatal Depression Scale, in the course of routine prenatal care, and to refer women with Edinburgh Postnatal Depression Scale scores above the cutoff score for further clinical examination.     

Quality of life as a predictor of overall survival after breast cancer treatment

Purpose

To describe quality of life (QoL) in a cohort of surviving women 4 years after breast cancer treatment and to analyze its role as a predictor of mortality within 2 years.

Methods

This is a prospective cohort study of 544 women who have undergone surgical treatment, from 2001 to 2002 and who answered a questionnaire about QoL in 2006. After, we conducted a survival study to evaluate the association between QoL and mortality within 2 years with the same population. We conducted factor analysis between the variables of the scales of function and symptoms. Survival analysis was conducted by Kaplan–Meier, and differences in survival curves were assessed with the log-rank test, assuming significant statistical level of 5 %. The Cox proportional hazards regression model was used to explore the relationship between QoL variables (functional scales) and prognostic value for survival.

Results

The mean age of the women was 59.1 years (SD 11.66). The mean of overall QoL score was 75.16 (SD 20.93). Using factor analysis, we identified three conditions that made up the construct of QoL in this group of patients: social, psycho-emotional, and physical. Social condition was the most important factor. After assessment of QoL, the mean survival was 23 months (SD 3.90). Women who reported worse future perspective had higher chance of death compared with women better prospect of future (HR = 3.46; 95 % CI 1.36–8.79; p value = 0.009).

Conclusion

Future perspectives were predictors of mortality, which reinforce the relevance of social support and psychological aspects for these women.     

Sickness absence and return to work rates in women with breast cancer

Purpose

Most women are diagnosed with breast cancer when they are of working age. How long are breast cancer patients absent? How many of them return to work?

Methods

ArboNed Occupational Health Services documents sickness absence data of 1 million workers of whom 40% were women. Between 2001 and 2005, 2,259 women had 2,361 episodes of sickness absence due to breast cancer. These absence episodes were followed for 2 years using Kaplan–Meier analysis.

Results

The mean ± standard error of mean duration of absence due to breast cancer was 349 ± 5 days. Thirty-seven percent of absences lasted longer than one year and 12% of absences lasted longer than 2 years particularly in women aged 25–34 years.

Conclusions

The mean duration of sickness absence due to breast cancer was nearly a year, but most women returned to work. The results of the study can be used as a reference for return to work of women following breast cancer.

     

Women’s knowledge about risk factors of breast cancer in a Brazilian community

Knowledge about risk factors for breast cancer was identified as an important variable that affects women’s avoidance behavior and their screening performance. The present study assessed women’s knowledge about risk factors and associated socio-economic variables. Data from 417 women aged 20–86 years were obtained in Caicó, Rio Grande do Norte, Brazil. In agreement with the recognition of 26 potential risk factors and prevention behaviors, two groups with good (N = 203) and poor (N = 214) knowledge were formed, respectively. Having a close relative with cancer remained the unique significant variable in the adjusted model. Women without any close relative with cancer, were 1.54 (95% confidence interval [CI] 1.036–2.288) times as likely to have poor knowledge, compared to women who had a close relative with cancer (p = 0.033). Other socio-economic variables, including income, employment status and educational level had no significant association with knowledge (p = 0.450, p = 0.914, p = 0.639, respectively). Of 417 women, 302 (72.42%), 339 (81.29%), and 309 (74.10%), respectively, did not identify “physical inactivity,” “overweight after menopause,” and “no breastfeeding of children” as risk factors. Knowledge could help to avoid risk factors and motivate prevention behavior. Information about risk factors should be disseminated in health campaigns.     

Positive and negative aspects of well-being as correlates of breast reconstruction decision

Purpose

The aim of the study was to explore the role of positive and negative aspects of well-being in a breast reconstruction decision, described in terms of the transtheoretical model of change (TTM).

Methods

The study comprised 216 women after total mastectomy in the cross-sectional design. The positive aspects of well-being were measured using the Rosenberg Self-Esteem Scale and Generalised Self-Efficacy Scale; the negative aspects were assessed using the Beck Depression Inventory and State-Trait Anxiety Inventory (T-Anxiety scale).

Results

The multinomial logistic regression analyses were implemented, and the action stage was chosen as a relevant category. McFadden’s pseudo R-squared for positive, negative and combined aspects of well-being models equalled 0.28, 0.13 and 0.27, respectively. For the first model, the differential effects were observed for well-being, age and relationship status (54 % correctly classified cases), whereas for the model with negative aspects—only age and well-being (44 % correctly classified cases). For a model combining two aspects of well-being, the pattern was similar to the one observed for positive well-being (53 % correctly classified cases). The likelihood of classifying women in the action stage rather than in the precontemplation stage was determined by three variables: being in a relationship, better well-being and younger age. For the contemplation stage, the same relations were obtained for well-being and age. Finally, for the preparation stage, the well-being effect disappeared.

Conclusion

The results suggest that positive rather than negative aspects of well-being, after control for sociodemographic variables, may be significant correlates of breast reconstruction decision.