Psychometric properties of the QuickPIPER: a shortened version of the PIPER Fatigue scale

This paper proposes ‘QuickPIPER’, a 15‐item, validated one‐dimensional model representing cancer‐related fatigue, based on factor analysis testing of the Piper Fatigue Scale‐revised (R‐PFS). One hundred and eleven breast cancer survivors participated in this prospective, observational study of the QuickPIPER validation. Participants completed the R‐PFS and the Profile of Mood States (POMS) Fatigue and Vigor subscales. The questionnaires were tested concurrently before and after a multimodal exercise programme trial. Psychometric characteristics assessed from the sample included internal consistency and factor analysis, concurrent criterion validity and predictive ability. The results shows that the correlation matrix for the QuickPIPER questionnaire was determined as suitable with the Kaiser–Meyer–Oklin values (0.89) and Bartlett's Test of Sphericity (P < 0.001). The total cumulative variance explained was 65.32%. The goodness‐of‐fit indices of confirmatory factor analysis were satisfactory (normed fit index = 0.91 and comparative fit index = 0.92). Test–retest reliability was very good (r = 0.947, P < 0.001). The QuickPIPER scores correlated with POMS Fatigue (r = 0.800) and POMS Vigor (r = ?0.352) subscales. Predictive ability showed that the area under the curves for the screening questionnaires was 0.743 (95% confidence interval 0.579–0.906). The 15‐item QuickPIPER possesses similar properties to the 22‐item R‐PFS and offers the important advantage of brevity.     

Evaluation of the psychometric properties of the BCPT Symptom Checklist with a sample of breast cancer patients before and after adjuvant therapy

Objective: The purpose of this analysis was to provide psychometric information related to the Breast Cancer Prevention Trial (BCPT) Symptom Checklist in women with breast cancer prior to the initiation of adjuvant therapy and 6 months post‐initiation of therapy. Methods: This investigation was a secondary analysis of baseline data from the Anastrozole Use in Menopausal Women (AIM) Study (R01 CA 107408). The data used in this study were obtained from women diagnosed with Stage I, II, and IIIa breast cancer and who received adjuvant therapy that included chemotherapy alone, anastrozole alone, and chemotherapy plus anastrozole. Data were examined before adjuvant therapy (n=278), and at 6 months post‐adjuvant therapy (n=195). Construct validity was examined through exploratory and confirmatory factor analysis (CFA), and the internal consistency of each resulting subscale was computed. Discriminant validity evidence was obtained by correlating BCPT subscales with subscales from the MOS SF‐36. Results: A seven‐factor structure was extracted from the 42 items at baseline; an eight‐factor structure was found using 6‐month data. CFA was performed to compare the baseline and 6‐month models as well as an eight‐factor model recommended by Cella et al. Findings revealed that the two eight‐factor models best represented the data. Low negative correlations with the subscales of the MOS SF‐36 provided discriminant validity evidence. Conclusion: This analysis provides evidence for the reliability, discriminant validity, and factor structure of the BCPT Symptom Checklist. Further testing of this instrument is needed to confirm the factor structure of this measure. Copyright © 2010 John Wiley & Sons, Ltd.     

Illness perceptions in Greek patients with cancer: a validation of the Revised‐Illness Perception Questionnaire

Objective: The Revised‐Illness Perception Questionnaire (IPQ‐R) assesses illness perceptions according to Leventhal's self‐regulatory model. The aim of this paper is to present findings on the reliability and validity of the IPQ‐R in a population of Greek cancer patients. Methods: A total of 206 patients completed a Greek translation of the IPQ‐R and the Greek version of the Beck Depression Inventory (BDI). The scale's reliability was investigated by examining its internal consistency (Cronbach's alpha) and its test–retest reliability. Structural validity was examined through factor analyses. Predictive validity was tested by regressing BDI scores on IPQ subscale scores. Inter‐relationships between IPQ‐R dimensions were also examined by computing Pearson's Correlation Coefficients. Results: Cronbach's alpha showed satisfactory internal consistency for the IPQ‐R subscales. Paired samples' t‐test showed good test–retest reliability. Factor analysis of the IPQ‐R items revealed that the Greek version reflects the structure of the original with the only difference being that the ‘Consequences’ and ‘Emotional Representations’ subscales loaded on one factor. Factor analysis of the causal dimension items revealed a different structure of Causal Representations than that of the original questionnaire yielding three main factors: Psychological Attributions, Behavioral, and External Factors. Multiple regression analyses showed that Consequences, Emotional Representations, Illness Identity, and Psychological Attributions were the best predictors for depression. Conclusions: Translation of the IPQ‐R has good reliability and similar structure to that of the original. Difficulties to confirm the structure of Causal Representations may represent cultural differences in understanding illness causation. Copyright © 2009 John Wiley & Sons, Ltd.     

The Norwegian version of the Mini‐Mental Adjustment to Cancer Scale: factor structure and psychometric properties

Objective: The object of the study was to examine the factor structure and the psychometric properties of the Mini‐Mental Adjustment to Cancer Scale (Mini‐MAC) among a large sample of Norwegian breast cancer patients. Methods: A total of 402 patients with breast cancer completed the Mini‐MAC. Results: Principal component analysis with varimax rotion confirmed four factors. Three had psychometric properties to the original Mini‐MAC Helpless‐Hopeless (HH), Anxious Preoccupation (AP) and Cognitive Avoidance (CA) subscales. The fourth, named Positive Attitude (PA) combined the Fighting Spirit (FS) and the Fatalism subscales of the original Mini‐MAC. Construct validities were assessed by examining the interscale correlations as well as the correlations between the Mini‐MAC subscales and the HADS subscales scores. Internal consistency of the five subscales was satisfactory for the original (HH, AP, CA, FA, coefficients=0.60‐0.83), except for the FS subscale (coefficient=21). Conclusion: In view of the low internal reliability for the Norwegian Mini‐MAC FS subscale coefficient; it appears to be more appropriate to use the Norwegian Mini‐MAC as a four‐factor model. If researcher or clinicians in Norway use the five‐factor model, they should take great care when interpreting the fighting spirit subscale. Copyright © 2009 John Wiley & Sons, Ltd.     

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients

Objectives: The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients. Methods: Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time. Results: In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test–retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test–retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses. Conclusion: The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross‐national usefulness of the MAC scale. Copyright © 2009 John Wiley & Sons, Ltd.     

Development,confirmation, and validation of a measure of coping with colorectal cancer: a longitudinal investigation

Objective: This longitudinal study developed and confirmed the factor structure of the 32‐item Coping with Colorectal Cancer (CCRC) measure. Reliability and validity of the measure were also assessed. Methods: Participants were 1800 individuals diagnosed with colorectal cancer (CRC). A written questionnaire and a telephone interview were completed at 5 (Time 1) and 12 months post‐diagnosis (Time 2). Results: Exploratory and confirmatory factor analyses revealed eight mostly empirically distinct subscales: Positive Perceptual Change, Religion/Spirituality, Rumination, Acceptance, Humour, Palliative, Seeking Social Support, and Lifestyle Reorganisation. Internal reliabilities were adequate and comparable to other coping measures, and test–retest analyses showed moderate temporal stability of the subscales. Cross‐sectional and longitudinal regression analyses were conducted to establish criterion‐related validity. As hypothesised, after controlling for demographics, disease/treatment, and stress/coping variables, regression analyses showed that CCRC subscales uniquely predicted Time 1 quality of life (QOL) outcomes (positive affect, cancer‐related QOL, psychological distress). After controlling for Time 1 QOL, Seeking Social Support coping continued to predict Time 2 positive affect. Conclusions: Results demonstrated the preliminary validity and reliability of the CCRC subscales, and have extended the cancer coping research by revealing new relations between coping subscales and QOL in a mixed‐gender, older population with CRC. Copyright © 2008 John Wiley & Sons, Ltd.     

Validation of the needs assessment for advanced lung cancer patients (NA-ALCP)

Objective: The Needs Assessment for Advanced Cancer Patients (NA‐ACP) is a 132‐item self‐report questionnaire designed to assess the seven needs domains of patients with advanced, incurable cancer. This study aimed to evaluate the short derivative form of that questionnaire with advanced lung cancer patients. Methods: Item factor loadings, item test–retest data and response distributions were used to retain or reject items from the original NA‐ACP scale. This resulted in 38 items being maintained, preserving the original subscales. The response scale was simplified following feedback from patients. 108 people with advanced lung cancer completed the shortened NA‐ALCP along with measures of psychological distress (HADS, DT) and quality of life (EORTC QLQ‐C30). A‐priori predictions were made for divergent and convergent validity. Results: Internal consistency coefficients were satisfactory for six of seven subscales, range 0.71–0.95. Correlations between NA‐ALCP and HADS, DT and EORTC‐QLQ‐C30 provided support for 11 of the 22 divergent (r = 0.13–0.27) and convergent predictions (r = 0.45–0.71). Conclusions: Subscales of the NA‐ALCP demonstrated internal reliability consistent with the original scale. Results provided supporting evidence for divergent and convergent validity. This study indicates that the NA‐ALCP is psychometrically robust, easily understood and one‐quarter the length of the original version. Copyright © 2011 John Wiley & Sons, Ltd.     

Cancer Treatment Survey (CaTS): development and validation of a new instrument to measure patients' preparation for chemotherapy and radiotherapy

Objective: Cancer patients experience high levels of pre‐treatment anxiety. Chemotherapy and radiotherapy are threatening medical procedures. Preparation for these procedures should include the provision of sensory and procedural information, and addressing fears. The aim of this study was to develop a cancer treatment survey (CaTS) to assess the preparation for chemotherapy and radiotherapy in cancer patients. Methods: Drawing on evidence for how to prepare patients for threatening procedures, items were generated by psychosocial/clinical experts and pilot tested with cancer patients. The 36‐item draft CaTS was administered to 192 cancer patients commencing chemotherapy for lymphoma, breast or colon cancer. Participants also completed the Hospital Anxiety and Depression Scale (HADS) and basic medical and demographic information was recorded. Results: A systematic process of item selection removed 11 items. Factor analysis indicated a two‐factor solution, with 11 items representing sensory/psychological concerns and 14 items representing procedural concerns. The two subscales demonstrated excellent internal reliability with Cronbach's alpha both over 0.90 and the average inter‐item correlation for each scale exceeded 0.30. Divergent validity was established for both CaTS subscales with the HADS‐A and‐T (all r<0.30). Younger participants (under 65 years of age) had significantly greater procedural concerns (p = 0.001; medium effect). Conclusions: The CaTS is a two factor, 25‐item measure that assesses sensory/psychological concerns and procedural concerns relating to cancer treatment. The instrument provides a reliable and valid outcome measure for interventions to prepare cancer patients for chemotherapy and radiotherapy. Copyright © 2010 John Wiley & Sons, Ltd.     

The Posttraumatic Growth Inventory: an examination of the factor structure and invariance among breast cancer survivors

Objective: The present study tested the proposed five‐factor structure and invariance of the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) in a sample of physically active breast cancer survivors. Methods: A sample of breast cancer survivors (N=470, Mage=57.3, SD=7.8 years) completed the PTGI and a demographic questionnaire. The factor structure, factorial invariance, and latent mean invariance were tested using maximum likelihood structural equation modeling. Results: Preliminary analyses showed acceptable reliability for the PTGI subscales (α<0.83). Confirmatory factor analysis (CFA) supported the five related factors corresponding to: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life (χ² (179)=822.53, CFI=0.97, NNFI=0.96, SRMR=0.05, RMSEA=0.09). Multigroup CFA supported the invariance of the PTGI across age groups, treatment type, time since diagnosis, and time since last treatment. Conclusions: These findings provide support for (1) the multidimensional nature and factorial validity of the PTGI, and (2) the use of the PTGI in future research examining posttraumatic growth within samples of physically active breast cancer survivors. Copyright © 2009 John Wiley & Sons, Ltd.     

Distress screening in oncology—evaluation of the Questionnaire on Distress in Cancer Patients—short form (QSC‐R10) in a German sample

Objective: The aim was to examine the psychometric properties of the Questionnaire on Stress in Cancer Patients (QSC‐R10), a 10‐item screening instrument for self‐assessment of psychosocial distress in cancer patients. Methods: A total of 1850 cancer patients were assessed with the QSC‐R10. Patients were recruited from different inpatient and outpatient settings in Germany between 2007 and 2009. Results: Mean age of the sample was 62.9 (SD=12.4) with breast cancer as the most frequent diagnosis (35.2%). The analysis indicated high reliability (Cronbach's α=0.85) and test–retest reliability (ICC=0.89). Validation scales included the Hospital Anxiety and Depression Scale (HADS), Distress–Thermometer (DT), European Organization for Research and Treatment of Cancer QLQ‐C30 (EORTC QLQ‐C30) and Karnofsky Performance Status (KPS). Convergent validity was highest for the HADS total score (r=0.74) and the lowest correlation for KPS (r=?0.36). The QSC‐R10 significantly distinguished subgroups by their clinical characteristics (metastases, illness duration, previous psychiatric treatment and psycho‐oncological support; p<0.001). A cutoff score of >14 demonstrated good sensitivity (81.0%) and specificity (73.2%) and is suitable to determine the need for psychosocial support. Conclusion: The QSC‐R10 is a valid and reliable questionnaire to detect distress in cancer patients with high acceptance among professionals and patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Validation of the Croatian and Lebanese Revised Illness Perception Questionnaires for Healthy People (IPQ‐RH)

The absence of Croatian‐ and Arabic‐language measures to assess illness representations has contributed to lack of research among Croatian and Lebanese populations. Utilising the robust confirmatory factor analysis (CFA) approach, this study aimed to validate Croatian and Arabic versions of the Revised Illness Perception Questionnaire for Healthy People (IPQ‐RH) in the breast and cervical cancer contexts, and compared these illness perceptions among Croatian and Lebanese women living in Australia. Forward and back‐translated versions of the IPQ‐RH were administered in Croatian to Croatian‐born (n = 238), and Arabic to Lebanese‐born (n = 240) women. The IPQ‐RH illness perceptions were assessed for each cancer type, and the Negative Affect (NA) subscale of the Positive and Negative Affect Schedule (PANAS) assessed discriminant validity. The CFA method demonstrated acceptable models across the Croatian and Lebanese IPQ‐RH measures. The internal reliabilities for the IPQ‐RH subscales were adequate and the subscales had low correlations with the NA subscale of the PANAS, indicating that the IPQ‐RH measures are largely distinguishable from negative affective dispositions. These findings demonstrate that the Croatian and Lebanese IPQ‐RH breast and cervical cancer measures have a factor structure similar to the originally developed IPQ‐RH scale and provide further support for the theoretically developed illness representations.     

The Attentional Function Index—a self‐report cognitive measure

Objective: Cognitive assessment in individuals with cancer requires both measured performance on neuropsychological tests and self‐report of effectiveness in functioning. Few instruments are available to assess the perceived impact of cognitive alterations on daily functioning in individuals treated for cancer. In this study, we investigated the psychometric properties of a theoretically based instrument, and the Attentional Function Index (AFI), designed to measure perceived effectiveness in common activities requiring attention and working memory, particularly the ability to formulate plans, carry out tasks, and function effectively in daily life. Methods: Women (N=172), ages 27–86 years, completed the questionnaire before primary treatment for early stage breast cancer. Construct validity was established using exploratory principal component factor analysis with varimax rotation. Results: A 13‐item instrument emerged with 3 subscales, namely effective action, attentional lapses, and interpersonal effectiveness, which explained 74.69% of total variance. The internal consistency coefficients (Cronbach's α) were 0.92 for the total instrument, and ranged from 0.80 to 0.92 for the 3 subscales. Further examination of validity indicated that the scores on the AFI (1) showed expected correlations with established measures of ability to concentrate, cognitive failures, states of confusion, and mental fatigue, and (2) could distinguish differences in perceived cognitive functioning between younger and older age groups. AFI scores were not significantly associated with years of education or presence of comorbid conditions. Conclusion: The brief AFI has demonstrated usefulness for assessment of perceived cognitive functioning in populations with life‐threatening and chronic illness, such as breast cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Discrimination between worry and anxiety among cancer patients: development of a Brief Cancer-Related Worry Inventory

Objectives: A psychometric scale for assessing cancer‐related worry among cancer patients, called the Brief Cancer‐Related Worry Inventory (BCWI), was developed. Methods: A cross‐sectional questionnaire survey for item development was conducted of 112 Japanese patients diagnosed with breast cancer, and test–retest validation analysis was conducted using the data from another prospective study of 20 lung cancer patients. The questionnaire contained 15 newly developed items for cancer‐related worry, the Hospital Anxiety and Depression Scale, The Impact of Event Scale Revised, and the Medical Outcomes Study Short Form‐8. Results: Exploratory factor analysis of the 15 items yielded a 3‐factor structure including (1) future prospects, (2) physical and symptomatic problems and (3) social and interpersonal problems. A second‐order confirmatory factor analysis identified a second‐order factor called cancer‐related worry and confirmed the factor structure with an acceptable fit (chi‐square (df=87)=160.16, P=0.001; GFI=0.83; CFI=0.92; RMSEA=0.09). The internal consistency and test–retest reliability were confirmed with the lung cancer sample. Multidimensional scaling found that cancer‐related worry is separate from anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms. Conclusion: Our study succeeded in developing and confirming the validity and reliability of a BCWI. The study also confirmed the discriminable aspects of cancer‐related worry from anxiety, depression, and PTSD symptoms. Copyright © 2008 John Wiley & Sons, Ltd.     

Structural and reliability analysis of a patient satisfaction with cancer-related care measure: a multisite patient navigation research program study

BACKGROUND:

Patient satisfaction is an important outcome measure of quality of cancer care and 1 of the 4 core study outcomes of the National Cancer Institute (NCI)‐sponsored Patient Navigation Research Program to reduce race/ethnicity‐based disparities in cancer care. There is no existing patient satisfaction measure that spans the spectrum of cancer‐related care. The objective of this study was to develop a Patient Satisfaction With Cancer Care measure that is relevant to patients receiving diagnostic/therapeutic cancer‐related care.

METHODS:

The authors developed a conceptual framework, an operational definition of Patient Satisfaction With Cancer Care, and an item pool based on literature review, expert feedback, group discussion, and consensus. The 35‐item Patient Satisfaction With Cancer Care measure was administered to 891 participants from the multisite NCI‐sponsored Patient Navigation Research Program. Principal components analysis (PCA) was conducted for latent structure analysis. Internal consistency was assessed using Cronbach coefficient alpha (α). Divergent analysis was performed using correlation analyses between the Patient Satisfaction With Cancer Care, the Communication and Attitudinal Self‐Efficacy–Cancer, and demographic variables.

RESULTS:

The PCA revealed a 1‐dimensional measure with items forming a coherent set explaining 62% of the variance in patient satisfaction. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The Patient Satisfaction With Cancer Care demonstrated good face validity, convergent validity, and divergent validity, as indicated by moderate correlations with subscales of the Communication and Attitudinal Self‐Efficacy–Cancer (all P < .01) and nonsignificant correlations with age, primary language, marital status, and scores on the Rapid Estimate of Adult Literacy in Medicine Long Form (all P > .05).

CONCLUSIONS:

The Patient Satisfaction With Cancer Care is a valid tool for assessing satisfaction with cancer‐related care for this sample. Cancer 2011. © 2010 American Cancer Society.     

Developing a self-rating measure of patient competence in the context of oncology: a multi-center study

Objective: Concepts of patient competence (PC) are being increasingly used, but seldom clearly defined in the context of shared medical treatment decision making and coping with cancer. The meaning of such concepts should therefore be clarified, and measures developed that permit the assessment of different facets of this patient characteristic. Consequently, this study attempted to contribute to the definition and measurement of PC. Methods: Employing literature reviews and qualitative interviews, we developed a working definition of PC in the context of cancer from which we designed a self‐rating measure of this patient characteristic that was then tested for validity and reliability in a sample of N=536 patients with cancer. Results: Using factor analyses, we developed five problem‐ and three emotion‐focused subscales that measure distinct facets of PC with satisfactory reliability. Additional analyses provide preliminary evidence of the instruments' validity. Conclusions: This study represents an essential first step in developing a reliable self‐rating measure of PC in the context of cancer. Although further refinement of this measure is clearly required, it provides a preliminary methodological basis for empirically investigating the determinants and potential health effects of PC. Copyright © 2008 John Wiley & Sons, Ltd.     

Fear of movement in cancer survivors: validation of the modified Tampa scale of kinesiophobia-fatigue

Objective: To date, there is no validated questionnaire to assess fear of movement in cancer survivors. We aim to validate the Modified Tampa Scale of Kinesiophobia‐Fatigue (TSK‐F) in Dutch cancer survivors participating in a rehabilitation programme. We first select the optimal model for cancer survivors. Subsequently, stability, internal consistency, and construct validity of the optimal model is tested. Methods: A sample of 658 cancer survivors participating in a rehabilitation programme was included. Out of nine models derived in chronic pain and chronic fatigue patients, the optimal model of the TSK‐F was selected in a calibration sample (n₁ = 329) using confirmatory factor analysis. Stability of the derived optimal model was confirmed in a validation sample (n₂ = 329). Internal consistency and construct validity were assessed in the full sample. Results: The 11‐item two‐factor model of the TSK‐F was the best‐fitting model for cancer survivors and it seemed to be invariant for sex and cancer diagnosis. Internal consistency of the model was acceptable (Cronbach's alpha between 0.62 and 0.74). Construct validity was illustrated by significant associations between TSK‐F total and TSK‐F somatic focus with perceived global health status (EORTC‐QOL‐C30) and fatigue (FACT‐F) (p<0.001). Conclusions: The adjusted 11‐item TSK‐F consisting of two subscales ‘somatic focus’ and ‘activity avoidance’ seems to be a robust and valid tool in measuring fear of movement in cancer survivors with an acceptable internal consistency. Further psychometric testing of the TSK‐F in cancer survivors is recommended. In the future, TSK‐F scores may be used to customise rehabilitation programmes in cancer survivors.Copyright © 2011 John Wiley & Sons, Ltd.     

WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non‐modifiable risk factors

Taller height, family history of breast cancer, greater number of years of potential fertility and nulliparity are established non‐modifiable risk factors for postmenopausal breast cancer. Greater adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet, physical activity and body weight recommendations has previously been shown to be associated with lower breast cancer risk. However, no prior studies have evaluated whether women with non‐modifiable risk factors receive similar benefits from recommendation adherence compared to women without these risk factors. In the Iowa Women's Health Study prospective cohort, we investigated whether associations of WCRF/AICR recommendation adherence differed by the presence/absence of non‐modifiable breast cancer risk factors. Baseline (1986) questionnaire data from 36,626 postmenopausal women were used to create adherence scores for the WCRF/AICR recommendations (maximum score = 8.0). Overall and single recommendation adherence in relation to breast cancer risk (n = 3,189 cases) across levels of non‐modifiable risk factors were evaluated using proportional hazards regression. Mean adherence score was 5.0 points (range: 0.5–8.0). Higher adherence scores (score ≥6.0 vs. ≤3.5, HR = 0.76, 95% CI = 0.67–0.87), and adherence to the individual recommendations for body weight and alcohol intake were associated with a lower breast cancer incidence. While not statistically significant among women with more non‐modifiable risk factors (score ≥6.0 vs. ≤3.5, HR = 0.76, 95% CI = 0.36–1.63), hazard ratios were comparable to women with the no non‐modifiable risk factors (score ≥6.0 vs. ≤3.5, HR = 0.74, 95% CI = 0.49–0.93) (p‐interaction = 0.57). WCRF/AICR recommendation adherence is associated with lower breast cancer risk, regardless of non‐modifiable risk factor status.     

Patterns,correlates, and prognostic significance of quality of life following breast cancer

Objective: To describe quality of life (QOL) over a 12‐month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines. Methods: A population‐based sample of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+) was observed prospectively for a median of 6.6 years. QOL was assessed at 6, 12, and 18 months post‐diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT‐B+4) questionnaire. Raw scores for the FACT‐B+4 and subscales were computed and individuals were categorized according to whether QOL declined, remained stable or improved between 6 and 18 months. Kaplan–Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline. Results: Within FACT‐B+4 subscales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional well‐being and FACT‐B+4 scores at 6 months post‐diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well‐being between 6 and 18 months post‐diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at 6 months post‐diagnosis were factors associated with declines in QOL in multivariable analyses. Conclusions: Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Positive adjustment to breast cancer: development of a disease‐specific measure and comparison of women diagnosed from 2 weeks to 5 years

Objective: Many women describe ‘positive adjustment’ as a consequence of having breast cancer. It is unclear whether positive experiences reflect the absence of anxiety and depression or are part of a separate process of adjustment. Existing measures are not specific to breast cancer and may lack validity. Our aims were as follows: (1) to develop a valid questionnaire to measure positive adjustment after breast cancer; (2) to clarify whether it measures aspects distinct from anxiety and depression and (3) to suggest when positive adjustment typically emerges. Methods: A new measure, the Positive Adjustment Questionnaire (PAQ), was developed and completed by 156 women with breast cancer, allocated to three groups: 2–4 weeks; 6 months–2 years and 2–5 years post‐diagnosis. Other questionnaires were used to assess anxiety and depression and test the validity of the PAQ. Results: Principal components analysis of the PAQ identified four domains of positive adjustment; Fulfilment, Re‐evaluation, New ways of living and Valuing Life. Women questioned 2–5 years after diagnosis reported more fulfilment, re‐evaluation of life and new ways of living than those asked shortly after diagnosis. Differences in these aspects of positive adjustment remained after controlling for anxiety and depression. Conclusions: This study (1) provides a measure specific to positive adjustment following breast cancer; (2) suggests that positive adjustment is different from anxiety and depression and (3) indicates that positive adjustment is seen in women assessed 2–5 years after diagnosis. Psychological therapies that promote positive adjustment could enhance existing interventions that focus on reducing anxiety and depression. Copyright © 2010 John Wiley & Sons, Ltd.     

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. Methods: 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch‐SAS) at 1‐, 4‐ and 8‐months post‐operatively. Subscale scores were regressed on baseline (days 3–12 post‐operatively) measures of treatment decision‐making difficulty (TDMD), self‐efficacy (GSeS), consultation satisfaction (C‐MISS‐R), psychological (CHQ‐12) and physical distress (PD), and 1‐month follow‐up optimism (C‐LOT‐R), and disappointment (E‐OI), fully adjusted for demographic and clinical factors. Results: All Ch‐SAS subscales except appearance & sexuality changed significantly over 8‐months follow‐up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self‐image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self‐efficacy and optimism, whereas self‐image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self‐efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. Conclusion: High self‐efficacy and optimism predicted women who have better social relationships with friends and family. Higher self‐efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self‐image and body image. Copyright © 2009 John Wiley & Sons, Ltd.