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Journal of Behavioral Medicine

, Volume 27, Issue 6, pp 557–580 | Cite as

Early Stage Breast Cancer: Explaining Level of Psychosocial Adjustment Using Structural Equation Modeling

  • Petra J. Vos
  • Bert Garssen
  • Adriaan P. Visser
  • Hugo J. Duivenvoorden
  • Hanneke C. J. M. de Haes
Article

Abstract

In many women, the diagnosis of breast cancer leads to psychosocial adjustment problems. Biodemographic variables, coping, and social support are factors that influence psychosocial adjustment. The main objective of the present study was to identify and estimate the associations between psychosocial adjustment and biodemographic variables, coping, and social support by using Structural Equation Modeling (SEM). Eighty-seven women with newly diagnosed early stage breast cancer completed several questionnaires covering these areas. It appeared that in the period shortly after surgery, coping style, especially illness-specific coping, is of high relevance for psychosocial adjustment. In our study, we could not confirm the positive role of social support found in other studies on psychosocial adjustment. Biodemographic variables had both direct and indirect associations with psychosocial adjustment: older women and women who had had breast-conserving treatment used a more optimistic coping style; the latter group also reported higher body image; and finally, women with a more advanced stage of disease reported a reduction in recreational activities.

breast cancer psychosocial adjustment coping social support 

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REFERENCES

  1. Andersen, B. L., Anderson, B., and deProsse, C. (1989). Controlled prospective longitudinal study of women with breast cancer: II Psychological outcomes. J. Consult. Clin. Psychol. 57: 692-697.PubMedGoogle Scholar
  2. Anllo, L. M. (2000). Sexual life after breast cancer. J. Sex Marital Ther. 26: 241-248.PubMedGoogle Scholar
  3. Auchincloss, S. (1991). Sexual dysfunction after cancer treatment. J. Psychosoc. Oncol. 16: 23-41.Google Scholar
  4. Bentler, P. M. (1990). Comparitive fit indexes in structural models. Psychol. Bull. 107: 238-246.PubMedGoogle Scholar
  5. Bergner, M., Bobbit, R. A., Carter, W. B., and Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure. Med. Care 19: 787-805.PubMedGoogle Scholar
  6. Bleiker, E. M. A., Pouwer, F., van der Ploeg, H. M., Leer, J. W. H., and Ader, H. J. (2000). Psychological distress two years after diagnosis of breast cancer: Frequency and prediction. Patient Educ. Couns. 40: 209-217.PubMedGoogle Scholar
  7. Bloom, J. R., and Spiegel, D. (1984). The relationship of two dimensions of social support to the psychological well-being and social functioning with advanced breast cancer. Soc. Sci. Med. 19: 831-837.PubMedGoogle Scholar
  8. Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketchman, A. S., Moffat, F. L., and Clark, K. C. (1993). How coping mediates the effect of optimism on distress: Astudy of women with early stage breast cancer. J. Pers. Soc. Psychol. 65: 375-390.PubMedGoogle Scholar
  9. Carver, C. S., Scheier, M. F., and Weintraub, J. R. (1989). Assessing coping strategies: A theoretical based approach. J. Pers. Soc. Psychol. 56: 267-283.PubMedGoogle Scholar
  10. Classen, C., Koopman, C., Angell, K., and Spiegel, D. (1996). Coping styles associated with psychological adjustment to advanced breast cancer. Health Psychol. 15: 434-437.PubMedGoogle Scholar
  11. Cunningham, A. J., Edmonds, C. V. I., Jenkins, G. P., Pollack, G. P., Lockwood, G. A., and Warr, D. (1998). A randomised controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psycho-Oncology 7: 508-517.PubMedGoogle Scholar
  12. Day, R., Ganz, A. A., Costantino, J. P., Cronin, W. M., Wickerham, L., and Fisher, B. (1999). Health related quality of life and tamoxifen in breast cancer prevention. A report from the National Surgery Adjustment Breast and Bowel project P-1 Study. J. Clin. Oncol. 17: 2659-2669.PubMedGoogle Scholar
  13. de Bruin, E. J., and van Dijk, M. (1996). Health and Disease Inventories. Een meetinstrument voor Aanpassingen aan Kanker. Handleiding. [Health and Disease Inventories. A Questionnaire to Measure Adjustment to Cancer. Manual], Swets & Zeitlinger B. V., Lisse; Helen Dowling Instituut, Rotterdam, The Netherlands.Google Scholar
  14. de Groot, M. H. (1991). Psychometrische aspecten van een stemmingsschaal (verkorte POMS) [Psychometric characteristics of a mood state inventory (shortened POMS). Gedrag en Gezondheid [Behav. Health] 20: 46-51.Google Scholar
  15. de Haes, J. C. J. M. (1988). Kwaliteit van leven van kankerpati¨ enten. [Quality of life in cancer pa-tients]. Dissertation, Rijksuniversiteit Leiden, Lisse Swets & Zeitlinger: The Netherlands.Google Scholar
  16. Dobkin, P. L., and Bradley, I. (1991) Assessment of sexual dysfunction in oncology patients: review, critique, and suggestions. J. Psychosoc. Oncol. 9(1): 43-73.Google Scholar
  17. Dunn, J., and Steginga, S. K. (2000). Young women's experience of breast cancer: defining young and identifying concerns. Psycho-Oncology 9: 137-146.PubMedGoogle Scholar
  18. Fallowfield, L. (1991). Counselling patients with breast cancer. In Davis, H., and Fallowfield, L. (Eds), Counselling and Communication in Health Care, Wiley, New York, pp. 253-269.Google Scholar
  19. Fallowfield, L. J. (1995). Assessment of quality of life in breast cancer. Acta Oncol. 34: 689-694.PubMedGoogle Scholar
  20. Fallowfield, L. J., Leaity, S. K., Howell, A., Benson, S., and Cella, D. (1999). Assessment of quality of life in women undergoing hormonal therapy for breast cancer: Validation of an endocrine symptom subscale for the FACT-B. Breast Cancer Res. Treat. 55: 189-199.PubMedGoogle Scholar
  21. Fawzy, I. F., Cousins, N., Fawzy, N. W., Kemeny, M. E., Elashoff, R., and Morton, D. (1990). A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Arch. Gen. Psychiatry 47: 720-725.PubMedGoogle Scholar
  22. Felton, B. J., and Revenson, T. A. (1984). Coping with chronic illness: A study of illness con-trollability and the influence of coping strategies on psychological adjustment. J. Consult. Clin. Psychol. 52: 343-353.PubMedGoogle Scholar
  23. Ganz, P. A., Coscarelli Schag, C., and Heinrich, R. (1985). The psychosocial impact of cancer on the elderly. A comparison with younger patients. J. Am. Geriatr. Soc. 33: 429-435.PubMedGoogle Scholar
  24. Goldberg, J. A., Scott, R. N., Davidson, P. M., Murray, G. D., Stallard, S., and Maguire, G. P. (1992). Psychological morbidity in the first year after breast surgery. Eur. J. Surg. Oncol. 18: 327-331.PubMedGoogle Scholar
  25. Greer, S. (1994). Psycho-oncology: Its aims, achievements and future tasks. Psycho-Oncology3: 87-101.Google Scholar
  26. Hair, J. F., Jr., Anderson, R. E., Tatham, R. L., and Black, W. C. (1998). Multivariate Data Analysis, 5th ed., Prentice-Hall, New Jersey.Google Scholar
  27. Harrison, J., and Maguire, P. (1994). Predictors of psychiatric morbidity in cancer patients. Br. J. Psychiatry 65: 593-598.Google Scholar
  28. Heim, E., Valach, L., and Schaffner, L. (1997). Coping and psychosocial adaptation; longitudinal effects over time and stages in breast cancer. Psychosom. Med. 59: 408-418.PubMedGoogle Scholar
  29. Hopwood, P., Howell, A., and Maguire, P. (1991). Psychiatric morbidity in patients with ad-vanced cancer of the breast: prevalence measured by two self-rating questionnaires. Br. J. Cancer 64: 349-352.PubMedGoogle Scholar
  30. Hoyle, R. H., and Smith, G. T. (1994). Formulating clinical research hypotheses as structural equation models: A conceptual overview. J. Consult. Clin. Psychol. 62: 429-440.PubMedGoogle Scholar
  31. Hughson, A. V. M., Cooper, A. F., McArdle, C. S., and Smith, D. C. (1988). Psychosocial consequences of mastectomy, levels of morbidity and associated factors. J. Psychosom. Res. 32: 383-391.PubMedGoogle Scholar
  32. Irvine, D., Brown, B., Crooks, D., Roberts, J., and Browne, G. (1991). Psychosocial adjustment in women with breast cancer. Cancer 15: 1097-1117.Google Scholar
  33. Kiebert, G. M., de Haes, J. C. J. M., and van de Velde, C. J. H. (1991). The impact of breast conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: A review. J. Clin. Oncol. 9: 1059-1070.PubMedGoogle Scholar
  34. Lansky, S. B., List, M. A., Herrmann, C. A., Ets Hokin, E. G., DasGupta, T. K., Wilbanks, G. D., and Hendrickson, F. R. (1985). Absence of major depression disorder in female cancer patients. J. Clin. Oncol. 3: 1553-1560.PubMedGoogle Scholar
  35. Lavery, J. F., and Clarke, V. A. (1996). Causal attributions, coping strategies, and adjustment to breast cancer. Cancer Nurs. 19: 20-28.PubMedGoogle Scholar
  36. Lee, M. S., Love, S. B., Mitchell, J. B., Parker, E. M., Rubens, R. D., Watson, J. P., Fentiman, I. S., and Haward, J. L. (1992). Mastectomy or conservation for early stage breast cancer: Psychological morbidity. Eur. J. Cancer 8/9: 1340-1344Google Scholar
  37. Lichtman, R. R., Taylor, S. E., and Wood, J. V. (1987). Social support and marital adjustment to breast cancer. J. Psychosoc. Oncol. 5: 47-74.Google Scholar
  38. Margolis, G., Goodman, R. L., and Rubin, A. (1990). Psychological effects of breast conserving treatment and mastectomy. Psychosomatics 31: 33-39.PubMedGoogle Scholar
  39. Maunsell, E., Brisson, C., Dubois, L., Lauzier, S., and Frazer, A. (1999). Work problems after breast cancer: an exploratory qualitive study. Psycho-Oncolology 8: 467-473.Google Scholar
  40. McCaul, K. D., Sandgren, A. K., King, B., O'Donnell, S., Branstetter, A., and Foreman, G. (1999). Coping and adjustment to breast cancer. Psycho-Oncology 8: 230-236.PubMedGoogle Scholar
  41. Meyer, L., and Aspergen, K. (1989). Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer. Acta Oncol. 28: 13-18.PubMedGoogle Scholar
  42. Meyerowitz, B. E. (1980). Psychosocial correlates of breast cancer and its treatment. Psychol. Bull. 87: 108-131.PubMedGoogle Scholar
  43. Miller, D. L., Manne, S. L., Taylor, K., Keates, J., and Dougherty, J. (1996). Psychological distress and well-being in advanced cancer: The effects of optimism and coping. J. Clin. Psychol. Med. Settings 3: 115-130.Google Scholar
  44. Morris, T. (1979) Psychological adjustment to mastectomy. Cancer Treat. Rev. 6: 41-61.PubMedGoogle Scholar
  45. Muth´en, L. K., and Muth´en, B. O. (1998) Mplus. User's Guide, CA Muth´ en & Muth´ en, Los Angeles.Google Scholar
  46. Noll Hoskins, C., Baker, S., Sherman, D., Bolander, C., and Maisin, G. (1996). Social support and patterns of adjustment to breast cancer. Sch. Inq. Nurs. Pract.: Int. J. 10: 99-123.Google Scholar
  47. Osoba, D., Aaronson, N., Zee, B., Sprangers, M., and te Velde, A. (1997). Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. Qual. Life Res. 6: 103-108.PubMedGoogle Scholar
  48. Polinsky, M. L. (1994). Functional status of long-term breast cancer survivors; demonstrating chronicity. Health Soc. Work 19: 165-173.PubMedGoogle Scholar
  49. Pozo, C., Carver, C. S., Noriega, V., Harris, S. D., Robinson, D. S., Ketcham, A. S., Legaspi, A., Moffat, F. L., and Clark, K. C. (1992) Effects of mastectomy versus lumpectomy on emotional adjustment tobreast cancer: A prospective study of the first year postsurgery. J. Clin. Oncol. 10(8); 1292-1298.PubMedGoogle Scholar
  50. Schnoll, R. A., Harlow, L. L., Stolbach, L. L., and Brandt, U. (1998). A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer. Psycho-Oncology 7: 69-77.PubMedGoogle Scholar
  51. Schottenfeld, D., and Robbins, G. F. (1970). Quality of survival among patients who have had radical mastectomy. Cancer 26: 650-654.PubMedGoogle Scholar
  52. Schover, L. R. (1991). The impact of breast cancer on sexuality, body image and intimate relationships. CA Cancer J. Clin. 41: 112-120.PubMedGoogle Scholar
  53. Schreurs, P. J. G., van de Willige, G., Brosschat, J. F., Tellegen, B., and Graus, G. M. H. (1993). De Utrechtse Coping Lijst. Omgaan met Problemen en Gebeurtenissen. Herziene Handlei-ding. [The Utrecht coping list. Coping with problems and events. Revised manual] Swets & Zeitlinger B. V., Lisse, The Netherlands.Google Scholar
  54. Singer Kaplan, H. (1992). A neglected issue: The sexual side effects of current treatment for breast cancer. J. Sex Marital Ther. 18: 3-19.PubMedGoogle Scholar
  55. Smyth, M.M., McCaughan, E., and Harrison, S. (1995). Women's perception of their experiences with breast cancer: Are their needs being addressed? Eur. J. Cancer Care 4: 86-92.Google Scholar
  56. Spiegel, D. (1997). Psychosocial aspects of breast cancer treatment. Sem. Oncol. 24: S1-36-S1-47.Google Scholar
  57. Spiegel, D., and Kato, P. M. (1996). Psychological influences on cancer incidence and progression. Harvard Rev Psychiatry 4: 10-26.Google Scholar
  58. Sprangers, M. A. G., Groenvold, M., Arraras, J. I., Franklin, J., te Velde, A., Muller, M., Franzini, L., Williams, A., de Haes, H. C. J. M., Hopwood, P., Cull, A., and Aaronson, N. K. (1996). The EORTC Breast Cancer-Specific Quality of Life Module (QLQ-BR32): first results from a three-country field study. J. Clin. Oncol. 14: 2756-2768.PubMedGoogle Scholar
  59. Stanton, A. L., and Snider, P. R. (1993). Coping with a breast cancer diagnosis: A prospective study. Health Psychol. 12: 16-23.PubMedGoogle Scholar
  60. Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivar. Behav. Res. 25: 173-180.Google Scholar
  61. Taylor, S. E., Lichtman, R. R., Wood, J. V., Bluming, A. Z., Dosik, G. M., and Leibowitz, R. L. (1985). Illness-related and treatment related factors in the psychological adjustment to breast cancer. Cancer 55: 2506-2513.PubMedGoogle Scholar
  62. Tucker, L. R., and Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38: 1-10.Google Scholar
  63. van't Spijker, A., Trijsburg, R. W., and Duivenvoorden, H. J. (1997). Psychological sequale of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosom. Med. 59: 280-293.PubMedGoogle Scholar
  64. Vinokur, A. D., Threatt, B. A., Caplan, R. D., and Zimmerman, B. L. (1989). Physical and psychosocial functioning and adjustment to breast cancer. Long-term follow-up of a screening population. Cancer 63: 394-405.PubMedGoogle Scholar
  65. Vinokur, A. D., Threatt, B. A., Vinokur-Kaplan, D., and Satariano, W. A. (1990). The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65: 1242-1254.PubMedGoogle Scholar
  66. Walbroehl, G. S. (1985). Sexuality in cancer patients. APF 31: 153-158.Google Scholar
  67. Watson, M., Greer, S., Rowden, L., Gorman, C., Robertson, B., Bliss, J. M., and Tunmore, R. (1991). Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients. Psychol. Med. 21: 51-57.PubMedGoogle Scholar
  68. Weisman, A. D., and Worden, J. W. (1976-1977). The existential plight in cancer: significance of the first 100 days. Int. J. Psychiatry Med. 7: 1-15.PubMedGoogle Scholar
  69. Wellisch, D. K., DiMatteo, R., Silverstein, M., Landsverk, J., Hoffman, R., Waisman, J., Handel, N., Waisman-Smith, E., and Schain, W. (1989). Psychosocial outcomes of breast cancer therapies. Lumpectomy versus mastectomy. Psychosomatics 30(4): 365-373.PubMedGoogle Scholar
  70. Wool, M. S. (1988) Understanding denial in cancer patients. Adv. Psyhcosom. Med. 18: 37-53.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Petra J. Vos
    • 1
  • Bert Garssen
    • 1
  • Adriaan P. Visser
    • 1
  • Hugo J. Duivenvoorden
    • 2
  • Hanneke C. J. M. de Haes
    • 3
  1. 1.Helen Dowling InstituteUtrechtThe Netherlands
  2. 2.Department of Medical Psychology and PsychotherapyRotterdamThe Netherlands
  3. 3.Department of Medical PsychologyAcademic Medical Centre, University of AmsterdamAmsterdamThe Netherlands

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