Oesophageal cancer: caregiver mental health and strain

Objective: To investigate strain and mental health among family caregivers of oesophageal cancer patients and possible factors associated with caregiver mental health and strain. Methods: Patients with oesophageal adenocarcinoma in Ireland were recruited into the FINBAR study (the main aim of which was to investigate factors influencing the Barrett's adenocarcinoma relationship). Carers completed the 13‐item Caregiver Strain Index and the General Health Questionnaire‐30 (GHQ) in the context of a brief interview with trained research staff that was undertaken separately from the interview with each cancer patient. Results: Two hundred and twenty‐seven patients participated in the FINBAR study. A total of 39 patients did not have a family carer or the carer could not be identified. Fifty percent (94/188) of carers completed the questionnaires. Mean (SD) scores for strain (6.65, SD=3.63) and mental health status (10.21, SD=7.30) were high and 71% of carers scored >5 on the GHQ indicating psychological distress. There was a statistically significant positive relationship between level of strain experienced by caregivers and the severity of their mental health status and whether or not carers scored >5 on the GHQ. Relatives were 1.70 (95% CI 1.34–2.15) times more likely to be defined as high scorers with each unit increase in the CSI score. Conclusions: A significant proportion of caregivers experienced high levels of strain and psychological distress. There is a need to provide appropriate support and services targeted specifically at reducing the considerable strain of caring for patients with oesophageal cancer, particularly for carers of patients from lower socioeconomic groups. Copyright © 2008 John Wiley & Sons, Ltd.     

Intrusive cognitions and their appraisal in anxious cancer patients

Objective: Previous research found that anxious cancer patients experience uncontrollable negative intrusive cognitions that have an impact on coping and are associated with significant psychological distress. This is the first study to examine the appraisal of intrusive cognitions in an anxious group of cancer patients. Methods: A sample of 139 anxious cancer patients was assessed for evidence of intrusive phenomena, including memories, images and thoughts. Patients completed the Response to Intrusions Questionnaire and the Impact of Event Scale in relation to intrusive cognitions. Results: Forty‐eight percent (67/139) reported frequent, uncontrollable intrusive cognitions. Intrusive thoughts and images were equally as common and images were associated with increased distress and uncontrollability. A significant positive linear relationship was found between the number of intrusions and anxiety severity (P<0.05). Negative appraisal of intrusive cognitions was associated with anxiety (P<0.01) and depression severity (P<0.01), intrusion‐specific distress (P<0.01), rumination (P<0.01) and cognitive avoidance (P<0.01), after controlling for intrusion frequency. Conclusion: Negative appraisal of intrusive cognitions plays a significant role in psychological distress and intrusion‐specific distress in anxious cancer patients. Finding similarities in the types of intrusive cognitions reported by cancer patients and other anxious populations highlights the potential applicability of psychological therapies developed to reduce the frequency and impact of intrusive cognitions. Copyright © 2009 John Wiley & Sons, Ltd.     

Illness cognition and health anxiety in parents of children with cancer

Abstract

Purpose: Health anxiety is a clinical entity characterized by a pathological fear of illness. Illness cognition refers to persistent positive or negative thoughts an individual has towards illness. Evidence has shown that patients with chronic conditions who possess negative illness cognitions experience greater social, emotional, and physical difficulties than patients with positive illness cognitions. This study aims to measure the prevalence of health anxiety in a population of parents of children with cancer, and investigate the association between positive and negative illness cognitions and health anxiety.

Methods: We interviewed 105 parents of children with cancer and administered Arabic versions of the Illness Cognition Questionnaire – Parent Version and the Short Health Anxiety Inventory.

Results: The mean parental age was 37.7?years with the majority of participants being mothers (78.1%) and married (94.3%) and with 35.2% having completed university education. The average age of the child with cancer was 8.4?years, with the largest proportion of children suffering from leukemia. The prevalence of health anxiety among parents of children with cancer was 21%. The following two dimensions of illness cognition were significantly associated with health anxiety: Helplessness (B?=?0.222, p?=?0.021) and lower Acceptance (B = ?0.242, p?=?0.008). Other variables associated with health anxiety were perceived inadequate income (B?=??0.238, p?=?0.021) and personal illness or illness of a family member/close friend (B?=?0.251, p?=?0.013).

Conclusions: Parents of children with cancer may experience health anxiety. Predictors of health anxiety include feelings of helplessness, lower acceptance, inadequate income, and extended family illnesses.     

The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment

Objectives: To compare health‐related quality of life, emotional functioning and illness cognitions between people with and without a stoma after rectal cancer treatment about 8 years ago and to examine the relation between illness cognitions and health‐related quality of life and emotional functioning. Methods: Sixty‐two people who had undergone abdominoperineal resection with a permanent stoma and 60 people who had undergone low anterior resection without a permanent stoma participated. Questionnaires included the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire—C30, the Hospital Anxiety and Depression Scale, and the Illness Cognition Questionnaire. Results: There were no significant differences between people with and without a stoma in health‐related quality of life, emotional functioning and illness cognitions. There were moderate and significant relations between the illness cognitions helplessness (negative) and disease acceptance (positive) on the one hand and health‐related quality of life and emotional functioning on the other. For helplessness this relation barely differed between people with and without a stoma, but for disease acceptance this relation was stronger for people without a stoma than for people with a stoma. Conclusions: The study showed no differences in health‐related quality of life, but a stronger relation between disease acceptance and health‐related quality of life for people without a stoma than for people with a stoma. If this relation is causal, people with negative illness cognitions after rectal cancer treatment might be identified and offered help. Copyright © 2010 John Wiley & Sons, Ltd.     

The report of coping strategies and psychosocial adjustment in Korean mothers of children with cancer

Objective: Parents of children with cancer must cope with multiple challenges over time. As most research on parental coping has been conducted in Western countries, little information is available on the parental experience of coping in non‐Western countries. Using a new cultural sample of Korean mothers, this study describes their coping strategies. In addition, the association of particular coping patterns with mothers' report of psychosocial adjustment is investigated. Methods: A total of 200 Korean mothers of children with cancer participated in the study. Coping strategies were measured by the Coping Health Inventory for Parents in the following three categories: Maintaining Family Integration and an Optimistic Outlook for the Situation, Seeking Social Support, and Seeking Information. Maternal psychosocial adjustment was measured by psychological distress, family relationship, and social relationship subscales from the Psychosocial Adjustment to Illness Scale. Results: Korean mothers reported coping strategies related to Maintaining Family Integration and an Optimistic Outlook for the Situation as being most helpful. More frequent use of coping pattern, Maintaining Family Integration and an Optimistic Outlook for the Situation, and less frequent use of coping pattern, Information‐Seeking were significantly associated with lower psychological distress and better family relationship after children's medical and maternal characteristics were controlled for. Coping pattern, Seeking Social Support was only predictive of social relationships. Conclusions: This study suggests that culture may play a significant role in the report of coping among Korean mothers. Future studies should consider culturally preferred coping methods and available resources as they relate to different adjustment outcomes. Copyright © 2008 John Wiley & Sons, Ltd.     

Predicting general and cancer-related distress in women with newly diagnosed breast cancer

Background

Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer.

Methods

Women recently diagnosed with breast cancer (N?=?94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress.

Results

Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β?=?.22, p?=?.021), more illness identity (β?=?.25, p?=?.004), greater anxious preoccupation (β?=?.23, p?=?.030), and less fighting spirit (β?=??.31, p?=?.001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β?=??.20, p?=?.043). Greater anxious preoccupation also led to greater general anxiety (β?=?.44, p?<?.001) and cancer-related distress (β?=?.37, p?=?.001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps?<?.001) only if women were also more anxiously preoccupied with their diagnosis.

Conclusions

Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.

     

The role of illness representations in coping and health of patients treated for breast cancer

Objective: The present study examined the relation of cognitive and emotional representations of illness specified by the Common Sense Model of Illness Cognition (Handbook of Psychology and Health: Social Psychological Aspects of Health. Earlbaum, Hillsdale: New York, 1984; 219–252) with the coping strategies and perceived health of patients who were treated for breast cancer. Methods: Participants were 119 women within 2 years after their diagnosis of breast cancer, who completed a questionnaire containing measures of illness representations, coping strategies and perceived physical and mental health. Results: Breast cancer patients differ in the subjective perception of their disease. Patients who view their illness as a condition with serious symptoms and consequences, patients who believe their illness is chronic and patients who consider their illness uncontrollable were found to report worse physical and mental health than those who believed the opposite. Regression analysis showed that, after controlling for external variables, the cognitive illness representations identity and consequences explained 57% of variance in physical health, whereas emotional illness representation and treatment control explained 47% of variance in mental health. Conclusion: Results provide some support for the hypotheses of the Common Sense Model of Illness Cognition. Illness representations seem to play an important role in perceived health in breast cancer. The implications of these findings for the design of health‐care‐related interventions for breast cancer patients are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Quality of life,self‐esteem,fatigue, and sexual function in young men after cancer

BACKGROUND:

Androgen deficiency is increasingly recognized in young male cancer survivors; however, its impact on quality of life (QOL) is not established. The authors investigated the relationship between androgen levels, QOL, self‐esteem, fatigue, and sexual function in young male cancer survivors compared with control subjects.

METHODS:

A cross‐sectional, observational study of 176 male cancer survivors and 213 male controls aged 25 to 45 years was performed. Subjects completed 3 QOL scales (Medical Outcomes Study 36‐Item Short‐Form Health Survey version 2, the 12‐item General Health Questionnaire [GHQ‐12], and Aging Male Scale), and measures of self‐esteem (Rosenberg Self‐Esteem Scale), fatigue (Functional Assessment of Chronic Illness Therapy‐Fatigue), and sexual function (Derogatis Interview for Sexual Functioning‐II Self‐Report‐Male).

RESULTS:

Cancer survivors had lower scores for all components of the Short‐Form Health Survey, Aging Male Scale, and Functional Assessment of Chronic Illness Therapy‐Fatigue, and for 4 of 5 subsections of the Derogatis Interview for Sexual Functioning than controls. The majority of these differences remained after adjusting by linear regression analysis. Levels of psychiatric disorder or self‐esteem did not differ between the 2 groups. In cancer survivors, those with androgen deficiency (serum testosterone ≤10 nmol/L) had lower scores than those without for all components of the Short‐Form Health Survey, the General Health Questionnaire, Functional Assessment of Chronic Illness Therapy‐Fatigue, and the Derogatis Interview for Sexual Functioning. Serum testosterone only weakly correlated with health measures.

CONCLUSIONS:

Young male cancer survivors self‐report a marked impairment in QOL, energy levels, and quality of sexual functioning, and this was exacerbated in those with androgen deficiency. However, psychological distress was not elevated, self‐esteem was normal, and sexual relationships were not impaired. The relationship with testosterone is complex, and appears dependent on a threshold level rather than direct correlation. Interventional trials are needed to determine whether testosterone replacement would improve QOL in young male cancer survivors. Cancer 2010. © 2010 American Cancer Society.     

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Objective: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at‐risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post‐traumatic stress symptoms (PTSS). Methods: Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self‐report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State‐trait anxiety, depression, and PTSS were assessed to all of the participants. Results: The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict (‘Supportive‐type’, n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict (‘Conflictive‐type’, n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict (‘Intermediate‐type’, n=113). Among the three types, an analysis of variance revealed that ‘Conflictive‐type’ members had the highest levels of PTSS, depression, and state–trait anxiety. Conclusions: These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family‐focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a ‘Conflictive‐type’ family member. Copyright © 2009 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.     

An art therapy intervention for cancer patients in the ambulant aftercare – results from a non‐randomised controlled study

Art therapy in psycho‐oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato‐oncological patients served as the comparison group (CG). Pre–post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty‐four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty‐nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.     

Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies

VOLLMER T.C., WITTMANN M., SCHWEIGER C. & HIDDEMANN W. (2011) European Journal of Cancer Care 20 , 403–411
Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies The purpose of the present study was to identify preoccupation with death in relation to levels of psychological distress in patients with haematologic malignancies. One hundred and two inpatients with haematologic malignancies, treated with curative intent, and thirty‐three control inpatients with benign dysfunction participated in the present study. Psychological distress was measured with the Hospital Anxiety and Depression Scale and the Freiburg Questionnaire of Coping with Illness. Preoccupation with death was assessed with the Subjective Estimation of Sickness and Death Scale. Patients with haematologic malignancies had significantly more preoccupation with death than the control group. In patients with haematologic malignancies preoccupation with death was related to depressive coping style as well as symptoms of depression and anxiety; regression analyses reveal that the diagnosis of haematologic malignancy leads to stronger subjective feelings of being close to death, which in turn leads to more psychological distress. To the best of our knowledge this is the first study that quantitatively shows the existence of preoccupation with death in patients with haematologic malignancies and its association with psychological distress. Our findings indicate that patients who are treated with a curative regime need psychological intervention focusing on death‐related fear in order to prevent severe emotional distress.     

Women with advanced breast cancer and their spouses: diversity of support and psychological distress

Objective: The current study examines the effect of perceived support from different agents (spouse, family, friends, religion—spirituality) on psychological distress experienced by women with advanced breast cancer and their male spouses. Methods: In all, 150 couples consisting of women with advanced breast cancer and their spouses completed the Cancer Perceived Agent of Support Questionnaire and the Brief Symptom Inventory Scale. Results: Spouses reported more psychological distress (global, depression and anxiety) than patients. Both patients and spouses report a similar level of spousal support, and spouses reported a lower level of support provided from family and friends. Perceived support in the current study contributed significantly to the explanations of global psychological distress, depression and anxiety both for patients and their spouses. However, the specific agents of support that were significant in explaining these outcomes varied between patients and their spouses. For patients, family support received by both patient and partner was the most important source of support, protecting from psychological distress, while for the male partners, support from friends was most important. Religious‐based support was found to contribute negatively to the psychological distress of the patient and spouse. Conclusions: This study emphasizes the role of breast cancer spouses as care receivers in parallel to their role as caregivers, which is especially important in light of the high psychological distress reported by the spouses. The findings support the buffering effect, which different agents of support have against psychological distress while facing cancer for both patients and spouses. Patients and spouses differ with regard to the agents of support possessing this buffering effect. Copyright © 2009 John Wiley & Sons, Ltd.     

Adjustment of caregivers of pediatric patients with brain tumors: a cross-sectional analysis

Objective: The purpose of the study was to compare the psychological adjustment of caregivers of children with brain tumors who are on‐treatment with caregivers of children who are off‐treatment. Methods: Data were collected from 90 participants: 47 (52.2%) caregivers of children undergoing active treatment (on‐treatment) and 43 (47.8%) caregivers of children off‐treatment on measures of global psychological distress and illness and caregiving related distress. Results: Results revealed that the two groups differed significantly in their reported symptoms of general psychological distress, with the off‐treatment caregivers reporting significantly lower levels of general distress. However, off‐treatment caregivers continued to experience elevated levels of uncertainty and caregiving burden related to their child's illness. Conclusions: There is significant evidence suggesting that the burden of caring for a child with a brain tumor is ongoing, continuing well into the off‐treatment period. These results also suggest that the psychosocial functioning of these caregivers is best assessed using measures designed specifically to evaluate illness‐related psychosocial functioning (e.g. the Parent Experience of Child Illness, Impact on Family Scale). Copyright © 2008 John Wiley & Sons, Ltd.     

How relevant is marital status and gender variables in coping with colorectal cancer? A sample of middle‐aged and older cancer survivors

Objective: While the population in the western world is aging and cancer survival rates are increasing, there is a lack of knowledge concerning factors affecting social support and its relation to coping and distress among older patients. The aim of the current study is to assess the impact of marital status and gender upon levels of psychological distress, coping, and social support among middle‐aged and older unmarried (divorced/widowed) and married colorectal cancer patients. Methods: Samples of 339 male and female colorectal patients were recruited from three major cancer centers in Israel. Participants' psychological distress, coping styles and social support were assessed using four self‐report standardized instruments. Results: Two‐way MANOVAs and Pearson's correlation coefficient were used to assess the relationships between the study variables. High levels of distress were found among unmarried and male patients. Married men reported on significantly higher levels of spouse support than married women. Family support was correlated with psychological distress only among married patients. Surprisingly, spiritual‐religious support was found to be correlated among some of the study groups with Helplessness and Fatalism. Conclusions: The results support the assumption that married patients cope better with cancer than unmarried patients and that women cope better than men. These differences may be related to the cultural mores of Israeli society in which men are expected to play the ‘hero’ role or to a generally lower ability of men to use social support and of unmarried patients to get family support. Practical conclusions in terms of intervention are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychological distress in women at risk of hereditary breast/ovarian or HNPCC cancers in the absence of demonstrated mutations

Aim: To examine psychological distress in women at risk of familial breast–ovarian cancer (FBOC) or hereditary non-polyposis colorectal cancer (HNPCC) with absence of demonstrated mutations in the family (unknown mutation).Materials and methods: Two-hundred and fifty three consecutive women at risk of FBOC and 77 at risk of HNPCC and with no present or past history of cancer. They were aware of their risk and had received genetic counseling. Comparisons were made between these two groups, normal controls, and women who were identified to be BRCA1 mutation carriers. The questionnaires Beck Hopelessness Scale (BHS), General Health Questionnaire (GHQ-28), Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) were employed to assess psychological distress.Results: No significant differences concerning psychological distress were observed between women with FBOC and women with HNPCC. Compared to mutation carriers for BRCA1, the level of anxiety and depression was significantly higher in the FBOC group with absence of demonstrated mutation. Compared to normal controls, the level of anxiety was higher, while the level of depression was lower in the groups with unknown mutation.Conclusions: Women in the absence of demonstrated mutations have higher anxiety and depression levels than women with known mutation-carrier status. Access to genetic testing may be of psychologically benefit to women at risk for FBOC or HNPCC.     

Coping among older-adult, long-term cancer survivors

This research focuses on the coping behavior of older adult, long-term cancer survivors. Specifically, it identifies the personal (including race and gender) and illness/treatment characteristics of survivors that are significantly associated with the use of specific coping styles: planning, acceptance, venting, denial and seeking social support. It also examines the mediating role that these forms of coping play in terms of psychological distress: anxiety, depression and cancer-related worries. Multivariate analysis of data from a random sample of 321 long-term survivors in a major cancer center tumor registry is used to address the above issues. The most prominent forms of coping used by long-term survivors were planning and acceptance; least used were venting and denial. Increased age was associated with lower use of all forms of coping, but cancer type was not. Denial as a form of coping was associated with higher anxiety, depression and cancer-related worries. While race was not found to be a significant predictor of coping style, it was a significant predictor of three dimensions of psychological distress, anxiety, depression and cancer-related worries, with African Americans exhibiting lower levels of distress than Whites. The relevance of these findings for health and social service practitioners is discussed.     

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

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