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.     

Contextual and stress process factors associated with head and neck cancer caregivers’ physical and psychological well‐being

Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers’ physical and psychological well‐being. Patient‐caregiver variables included socio‐demographics, primary stressors (caregiving, patient clinical characteristics, HNC‐related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well‐being, along with depression and anxiety. A total of 33 patient‐caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well‐being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers’ depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well‐being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well‐being.     

Spirituality and well‐being in cancer patients: a review

Objective: Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well‐being. Special attention is given to the strength of the research findings. Methods: A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty‐seven studies that investigated the relationship between spirituality and well‐being, and 13 publications that explored the relationship between meaning in life and well‐being. Results: The majority of the cross‐sectional studies (31 of 36) found a positive association between spirituality and well‐being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well‐being. Conclusions: Despite that the majority of the studies concluded that spirituality was associated with higher well‐being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well‐being measures that do not overlap in content is recommended. Copyright © 2009 John Wiley & Sons, Ltd.     

Savouring and psychological well‐being in family dyads coping with cancer: An actor–partner interdependence model

Previous studies have investigated interdependence of the associations between predictors and negative psychological outcomes in dyads of cancer patients and family caregivers. This study examined the dyadic effects of perceived capability of savouring the moment on psychological well‐being. A total of 152 dyads of cancer patients and caregivers reported their perceived capability of savouring the moment (Savoring Beliefs Inventory), state positive affect (Chinese Affect Scale) and life satisfaction (Satisfaction With Life Scale) within 6 months following diagnosis. Actor–Partner Interdependence Model (APIM) demonstrated that patients’ and caregivers’ savouring the moment was positively associated with their own positive affect and life satisfaction (actor effects: βs = 0.309–0.603, 95% CIs = 0.171–0.502, 0.446–0.703, ps < 0.001). Patients’ savouring the moment was positively associated with caregivers’ positive affect (β = 0.158, 95% CI = 0.018, 0.299, p = 0.028), whereas caregivers’ savouring the moment was positively associated with patients’ life satisfaction (β = 0.158, 95% CI = 0.026, 0.289, p = 0.020). Partner effects between caregivers’ savouring the moment and patients’ positive affect and between patients’ savouring the moment and caregivers’ life satisfaction were not significant. The findings suggest the role of savouring in psychological well‐being within patient–caregiver dyads, highlighting the importance of investigating positive psychological pathways in their joint adaptation.     

Fear of cancer recurrence and psychological well‐being in women with breast cancer: The role of causal cancer attributions and optimism

This study aims to examine the association between cancer causal attributions, fear of cancer recurrence (FCR) and psychological well‐being and the possible moderating effect of optimism among women with a previous diagnosis of breast cancer. Participants (N = 314) completed an online self‐report assessment of causal attributions for their own breast cancer, FCR, psychological well‐being and optimism. Simultaneous multiple regression analyses were conducted to explore the overall contribution of causal attributions to FCR and psychological well‐being separately. Hierarchical multiple regression analyses were also utilised to examine the potential moderating influence of dispositional optimism on the relationship between causal attributions and FCR and psychological well‐being. Causal attributions of environmental exposures, family history and stress were significantly associated with higher FCR. The attribution of stress was also significantly associated with lower psychological well‐being. Optimism did not moderate the relationship between causal attributions and FCR or well‐being. The observed relationships between causal attributions for breast cancer and FCR and psychological well‐being suggest that the inclusion of causal attributions in screening for FCR is potentially important. Health professionals may need to provide greater psychological support to women who attribute their cancer to non‐modifiable causes and consequently continue to experience distress.     

Impact of alopecia and scalp cooling on the well‐being of breast cancer patients

Objective: Chemotherapy‐induced alopecia, a common and distressing side effect of chemotherapy, may be prevented by scalp cooling, which reduces toxicity of cytostatics in hair root cells. This is the first study designed to assess the effect of scalp cooling on well‐being. Methods: A prospective multi‐centre study was performed in 13 hospitals. Breast cancer patients treated with (N=98) and without (N=168) scalp cooling completed questionnaires (EORTC QLQ‐C30 and EORTC‐QLQ‐BR23, BIS, MBA, HADS) before chemotherapy, and three weeks and six months after the last chemotherapy cycle. Results: Scalp cooling was effective in 52% of the cases. Alopecia was considered among the most distressing problems at all three moments of measurement. A trend towards higher well‐being was found in successfully scalp‐cooled patients, as indicated by a general better health‐related quality of life and better body image, whereas unsuccessfully scalp‐cooled patients reported lowest well‐being. Conclusions: Scalp cooling contributes not only to the well‐being of successfully scalp‐cooled patients but also seems to cause additional distress when patients lose their hair despite scalp cooling. This might be related to disappointment due to alopecia despite scalp cooling or possibly to a general higher biological availability of cytostatics. We recommend additional support for patients when scalp cooling is not successful and to spend more effort to maximise the effectiveness of scalp cooling. Copyright © 2009 John Wiley & Sons, Ltd.     

Social support buffers the impact of functional impairments on caregiver psychological well‐being in the context of brain tumor and other cancers

Objective: This study investigated the association between functional impairments of individuals with cancer and caregiver psychological well‐being, and examined the moderating effect of social support. Methods: Sixty‐three caregivers (71% female) of individuals with brain tumor (n=27) and other cancers (n=36) were recruited from community services. Caregivers rated their psychological well‐being on the World Health Organisation Quality of Life measure Brief version, social support on a brief version of the Social Support Questionnaire, and the individuals' functional impairments on the Patient Competency Rating Scale. Results: For caregivers of individuals with brain tumor, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.33–38, p<0.05), except for cognitive difficulties. For caregivers of individuals with other cancers, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.30–0.49, p<0.05), with the exception of activities of daily living. For the total caregiver sample, better psychological well‐being was significantly correlated with overall functional impairment (r=0.34, p<0.005) and satisfaction with support (r=0.40, p<0.005). Caregivers supporting individuals with greater functional impairment had better psychological well‐being if they were highly satisfied with their social support. Conclusions: Effective social support is particularly important for caregivers who support individuals with poorer functional status, and this study highlights the need to evaluate caregiver social support interventions in the context of cancer. Copyright © 2009 John Wiley & Sons, Ltd.