Influence of age on psychological adjustment to cancer

A total of 520 patients were assessed within 8 weeks of diagnosis to explore the effect of age on psychological adjustment to cancer. Patients with cancers of the breast, colon, testicle, female reproductive tract and with lymphoma were included. Three measures of adjustment were used: DSM-III diagnoses of depression and/or anxiety, frequency of specific concerns and the total number of patient concerns. For depression and anxiety diagnoses combined, the cases were significantly younger than the non-cases (mean = 49.4 versus 53.7 years, p < 0.01). Younger patients also had significantly higher concern scores (p < 0.001). Younger patients were more likely to report concerns relating to the illness itself, treatment, feeling different, feeling upset, the future, finances, relationship with partner and others and sexuality. No age effect was seen for more practical concerns relating to physical symptoms, restriction of activities, job or amount of support received. Younger patients appear to experience greater difficulties adjusting to a cancer diagnosis but particular attention should be paid to the practical issues faced by older cancer patients.     

Illness-related and treatment-related factors in psychological adjustment to breast cancer

Seventy-eight breast cancer outpatients were interviewed and their medical records were reviewed to document illness-related and treatment-related factors associated with psychosocial adjustment. Poor prognosis and more radical surgery both independently predicted poor psychological adjustment. The effect of type of surgery appeared to be mediated by the patient's sense of disfigurement and by changes in the sexual and affectional patterns in the marriage, rather than by prognosis or disability. Degree of dysfunction and whether or not the patient had radiation therapy or chemotherapy had no independent effects on psychological adjustment. Results point to the problematic psychosocial outcomes associated with mastectomy and, more generally, to the illness- and treatment-related factors that may place a breast cancer patient at risk for psychosocial adjustment problems.     

A review of age differences in psychological adjustment to breast cancer

This article reviews recent literature on age differences in psychological adjustment to breast cancer. Overall, studies have shown that older women experience less psychological distress in terms of anxiety, depression, and posttraumatic stress symptoms. Age differences in health status, treatment provision, social support, and other life circumstances may contribute to differential patient adjustment. Coping also may mediate the relationship between age and affective responses, but the confounding of coping and distress in widely used inventories precludes definitive conclusions. Future research should explore the contextual mechanisms underlying age differences in adjustment.     

Social skills and psychological adjustment of child and adolescent cancer survivors

Social skills and psychological adjustment for survivors of childhood cancer were investigated. Cancer survivors included 42 children and adolescents ranging in age at evaluation from 6 to 18 years with a mean age of 13.1 years. Measures included teacher and parent ratings of social skills and adjustment and parent ratings of family functioning. The findings showed that social skills and psychological adjustment as rated by both parents and teachers were primarily associated with academic functioning. In addition, family cohesiveness was found to account for nearly one third of the variance in survivors' adjustment when rated by teachers, and length of time off treatment accounted for a significant percentage of the variance in children's adjustment when rated by parents. The findings underscore the importance of a multi-informant approach to the assessment of psychological adjustment of pediatric cancer survivors and demonstrate the role of learning difficulties and family functioning in influencing social skills and adjustment for these children and adolescents.     

Does talking about their relationship affect couples’ marital and psychological adjustment to lung cancer?

Introduction Relationship talk refers to talking with a partner about the relationship, what one needs from one’s partner, and/or the relationship implications of a shared stressor. This prospective study examined the effects of relationship talk on couples’ psychosocial adaptation to lung cancer. Methods A total of 169 patients (63% male) and 167 of their partners completed a series of questionnaires within 4-weeks of treatment initiation for newly diagnosed lung cancer (baseline). Follow-up questionnaires were administered 3 and 6 months later. Results Multilevel models using the couple as the unit of analysis showed that patients and partners who reported more frequent relationship talk had less distress (effect size r = 0.16) and greater marital adjustment over time (effect size r = 0.21), regardless of gender. Satisfaction with the frequency of relationship talk was associated with lower baseline distress for patients and partners (effect size r = 0.25). However, over time, greater communication regarding the relationship was related to less distress in the partner (effect size r = 0.15) than in the cancer patient. Discussion Expanding the study of spousal communication in cancer beyond patient cancer-related disclosures to include the effects of talking about the spousal relationship may help clarify the role of relationship processes in couples’ psychosocial adaptation. Patients and partners who begin talking about the relationship implications of lung cancer early on in their cancer experience may be better able to prepare together for the challenges they may face as cancer progresses and the patient moves toward the end-of-life. Implications for Cancer Survivors Results of this study underscore the need for couple-focused interventions in lung cancer that address the communication and relationship needs of both partners. Working with couples during the initial diagnosis and treatment period and emphasizing the benefits of discussing relationship issues during this time of major upheaval may facilitate couples’ successful adaptation to lung cancer.     

Adherence and psychological adjustment among women at high risk for breast cancer

Summary Increasingly, women with a positive family history of breast cancer are being targeted for cancer prevention and control efforts. Two findings have been demonstrated consistently across studies of this high risk population. First, these women often have high levels of psychological distress, as well as persistent and intrusive worries about developing breast cancer. Second, despite their increased risk for developing breast cancer, a substantial proportion of these women do not adhere to recommended breast cancer screening guidelines. There is growing evidence that psychological distress is an important barrier to adherence among high risk women. Despite this, little is known about how to intervene to improve psychological adjustment and adherence in this population. In the present paper, we review the literature on adherence and psychological adjustment in women who are at increased risk for breast cancer because of a positive family history of disease. This review provides the basis for a discussion of potential intervention strategies designed to increase adherence and reduce psychological distress in this population. Finally, we present some of the psychological implications of recent developments in genetic testing for breast cancer susceptibility.     

Coping responses following breast cancer diagnosis predict psychological adjustment three years later

The relationship between coping responses and psychological adjustment to a breast cancer diagnosis is well documented for time periods close to diagnosis. The purpose of the present study was to assess the long term association between these two variables. Fifty-five women completed measures of coping response, decisional control, frustration expression, and psychological adjustment within six months of receiving their breast cancer diagnosis. These women were contacted three years later and their psychological adjustment-as measured by the profile of mood states (POMS)-was reassessed. Univariate and multivariate analyses were performed. The results showed that women who were depressed at time of treatment planning, and who responded to their cancer diagnosis with cognitive avoidance, i.e. acceptance/resignation, had significantly worse psychological adjustment three years later. Poor adjustment was significantly associated with cognitive avoidance and minimal use of approach-based coping responses. The findings suggest that women who respond to their breast cancer diagnosis with passive acceptance and resignation are at significant risk for poor long term psychological adjustment. Psychological interventions for these women should address cognitive avoidance, with the aim of fostering approach-based coping and positive well-being.     

Predictors and mediators of psychological adjustment in mothers of children newly diagnosed with cancer

Early psychological adjustment (PA) of mothers of children with cancer (MCC) and mothers of children with acute illnesses (MCA) were compared, and predictors and mediators of maternal adjustment were tested. Sixty-nine MCC and 22 MCA completed standardized measures of depression, anxiety, global mental health (GMH), concurrent stress and strains, social support, coping strategies and child behavior. MCC reported greater depressive symptomatology, emotion-focused coping, and social support than did MCA. For MCC, emotion-focused coping and child behavior both predicted depression, anxiety, and GMH; concurrent stress and strain mediated the relationship between child behavior and depression and between emotion-focused coping and each measure of adjustment. For MCA, only emotion-focused coping predicted PA and concurrent stress and strains mediated the relationship between emotion-focused coping and depression. These findings suggest that MCC have more PA difficulties that are uniquely related to their child's behavior than MCA. Concurrent stress and strains seems to be an important mediator of PA for both groups of mothers.     

Communication in the cancer 'bad news' consultation: patient perceptions and psychological adjustment

The purpose of this study was to explore relationships between breast cancer survivors' experiences during the diagnostic consultation and their subsequent long-term psychological adjustment. Sixty women (M age=53 years) who had been diagnosed with local or regional breast cancer (Stage 0-IIIA) an average of 28 months prior were interviewed by telephone. Measures included: Cancer Diagnostic Interview Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist - Civilian Version, Center for Epidemiologic Studies Depression Scale, and ad hoc items regarding memory for, and satisfaction with, the diagnostic consultation. After controlling for demographic and clinical variables, the three CDIS subscales accounted for 12% of the variance in women's PCL-C scores (F change=3.46, p<0.05). The CDIS-Caring subscale was a significant predictor in the 'best-fit' regression model for each of the three indices of long-term distress (all B's>-0.23, p<0.05). In contrast, the CDIS-Competence subscale was not a significant predictor in any of the 'best-fit' models. Additionally, women's satisfaction with physician behavior during the diagnostic consultation was unrelated to all adjustment measures (r's<0.10, p's>0.50). Findings suggest that women's perceptions of physicians' interpersonal skills during the diagnostic consultation are associated with later psychological adjustment.     

Rural and urban breast cancer patients: health locus of control and psychological adjustment

Objective: This study examines the moderating influence of rural residence on the associations between health locus of control (HLC) beliefs and psychological well‐being. Method: Two hundred and twenty‐four breast cancer patients were surveyed. Results: The results revealed that rurality interacted with HLC beliefs in predicting psychological adjustment. The pattern indicated that, whereas endorsing external forms of locus of control can be detrimental to the psychological well‐being of urban breast cancer patients, the same is not true for rural breast cancer patients. For rural breast cancer patients, powerful others locus of control was beneficial for and chance locus of control was unrelated to well‐being. Conclusions: Implications for future research and medical care are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

The psychological impact of a cancer diagnosed during pregnancy: determinants of long-term distress

Background: Cancer occurs during one in 1000–5000 of the approximately 6 million yearly US pregnancies identified by the American Pregnancy Association. Although a newly diagnosed cancer is associated with substantial distress, little is known about cancer's emotional impact on women when diagnosed during pregnancy, and no studies have been conducted on the subject. Objective: The Cancer and Pregnancy Registry was developed by Elyce H. Cardonick MD, specialist in Maternal and Fetal Medicine and Associate Professor of Obstetrics and Gynecology at Robert Wood Johnson Medical School, to examine the consequences of maternal cancer diagnosis and treatment during pregnancy on maternal, fetal, and neonatal outcomes, including the impact of in utero exposure to chemotherapy. Methods: Participants were asked to complete questionnaires, including measures of psychological distress, permitting the examination of variables associated with long‐term psychological distress in women following a cancer diagnosis in pregnancy. Results: Seventy‐four women completed the Brief Symptom Inventory‐18 and Impact of Event Scale on average 3.8 years (SD 2.5) following their cancer diagnosis. Potential variables related to distress included information on: sociodemographics, disease, pregnancy, birth, cancer treatment, and health status. Multiple regression analyses revealed that women were at higher risk of long‐term distress if they had not received fertility assistance, had been advised to terminate the pregnancy, had had a preterm baby, had had a cesarean delivery, had not produced sufficient milk to breastfeed, had been experiencing a recurrence, and/or had undergone surgery post‐pregnancy. Conclusion: Results are discussed in light of our current knowledge of the normal developmental phase of pregnancy and motherhood. Copyright © 2011 John Wiley & Sons, Ltd.     

Spirituality,quality of life,psychological adjustment in terminal cancer patients in hospice

The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy – Spiritual Well‐Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale – General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and ‘Instrumental Support’ coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end‐of‐life care.     

Coping and adjustment to breast cancer

This study examined possible predictors of adjustment to breast cancer. Sixty‐one women participated soon after they were diagnosed with Stage I or Stage II breast cancer. Measures were gathered at diagnosis and again 4 months later. Predictor variables included aspects of the disease and treatment process and reported coping behavior. The most consistent predictor of distress and, to a lesser extent, quality of life, was avoidant coping: women who reported more avoidant coping were more distressed. These data fit well with most previous research and suggest one way of identifying women who may be more at risk for special difficulties coping with the diagnosis of breast cancer. Copyright © 1999 John Wiley & Sons, Ltd.     

Social-cognitive correlates of adjustment to prostate cancer

This study examined whether social support might enhance health-related quality of life in men (n=89) treated for localized prostate cancer by improving their ability to cognitively process their cancer experience. Data were collected using two, structured in-person interviews and abstracting medical records. The baseline interview was within several months (T1) after treatment for cancer, and follow-up was 3 months later (T2). Most men (61.8%) were treated by radical prostatectomy. Results showed that T1 social support was positively related to T2 mental functioning, and this relation appeared to be mediated by T1 indicators of cognitively processing, intrusive thoughts and searching for meaning. These findings suggest that supportive social relations may improve mental functioning by helping men cognitively process their prostate cancer experience.     

Attachment orientations and psychological adjustment of parents of children with cancer: A matched-group comparison

Objective: To investigate the impact of childhood cancer on parents' adult attachment, social support, marital adjustment, anxiety, and depression. Methods: 30 parents of children with childhood cancer and 30 matched controls completed the following questionnaires: Experiences in Close Relationships-Revised, Dyadic Adjustment Scale-4, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory – form Y, and Beck Depression Inventory. Results: Parents of children with childhood cancer had a significantly lower dyadic adjustment than controls, and higher levels of insecure-avoidant attachment, state anxiety, and depression. Conclusion: It is important for health-care personnel to take into account these parents' propensity to show increased levels of avoidant attachment during children's treatment to foster effective communication and supportive relationships between clinicians, pediatric patients, and parents.