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

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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.

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REFERENCES

  • 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.

    PubMed  Google Scholar 

  • Anllo, L. M. (2000). Sexual life after breast cancer. J. Sex Marital Ther. 26: 241-248.

    PubMed  Google Scholar 

  • Auchincloss, S. (1991). Sexual dysfunction after cancer treatment. J. Psychosoc. Oncol. 16: 23-41.

    Google Scholar 

  • Bentler, P. M. (1990). Comparitive fit indexes in structural models. Psychol. Bull. 107: 238-246.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • Dunn, J., and Steginga, S. K. (2000). Young women's experience of breast cancer: defining young and identifying concerns. Psycho-Oncology 9: 137-146.

    PubMed  Google Scholar 

  • 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 

  • Fallowfield, L. J. (1995). Assessment of quality of life in breast cancer. Acta Oncol. 34: 689-694.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Greer, S. (1994). Psycho-oncology: Its aims, achievements and future tasks. Psycho-Oncology3: 87-101.

    Google Scholar 

  • 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 

  • Harrison, J., and Maguire, P. (1994). Predictors of psychiatric morbidity in cancer patients. Br. J. Psychiatry 65: 593-598.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Lavery, J. F., and Clarke, V. A. (1996). Causal attributions, coping strategies, and adjustment to breast cancer. Cancer Nurs. 19: 20-28.

    PubMed  Google Scholar 

  • 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: 1340-1344

    Google Scholar 

  • 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 

  • Margolis, G., Goodman, R. L., and Rubin, A. (1990). Psychological effects of breast conserving treatment and mastectomy. Psychosomatics 31: 33-39.

    PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • Meyer, L., and Aspergen, K. (1989). Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer. Acta Oncol. 28: 13-18.

    PubMed  Google Scholar 

  • Meyerowitz, B. E. (1980). Psychosocial correlates of breast cancer and its treatment. Psychol. Bull. 87: 108-131.

    PubMed  Google Scholar 

  • 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 

  • Morris, T. (1979) Psychological adjustment to mastectomy. Cancer Treat. Rev. 6: 41-61.

    PubMed  Google Scholar 

  • Muth´en, L. K., and Muth´en, B. O. (1998) Mplus. User's Guide, CA Muth´ en & Muth´ en, Los Angeles.

    Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • Polinsky, M. L. (1994). Functional status of long-term breast cancer survivors; demonstrating chronicity. Health Soc. Work 19: 165-173.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Schottenfeld, D., and Robbins, G. F. (1970). Quality of survival among patients who have had radical mastectomy. Cancer 26: 650-654.

    PubMed  Google Scholar 

  • Schover, L. R. (1991). The impact of breast cancer on sexuality, body image and intimate relationships. CA Cancer J. Clin. 41: 112-120.

    PubMed  Google Scholar 

  • 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 

  • Singer Kaplan, H. (1992). A neglected issue: The sexual side effects of current treatment for breast cancer. J. Sex Marital Ther. 18: 3-19.

    PubMed  Google Scholar 

  • 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 

  • Spiegel, D. (1997). Psychosocial aspects of breast cancer treatment. Sem. Oncol. 24: S1-36-S1-47.

    Google Scholar 

  • Spiegel, D., and Kato, P. M. (1996). Psychological influences on cancer incidence and progression. Harvard Rev Psychiatry 4: 10-26.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Stanton, A. L., and Snider, P. R. (1993). Coping with a breast cancer diagnosis: A prospective study. Health Psychol. 12: 16-23.

    PubMed  Google Scholar 

  • Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivar. Behav. Res. 25: 173-180.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Tucker, L. R., and Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38: 1-10.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Walbroehl, G. S. (1985). Sexuality in cancer patients. APF 31: 153-158.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Wool, M. S. (1988) Understanding denial in cancer patients. Adv. Psyhcosom. Med. 18: 37-53.

    Google Scholar 

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Authors and Affiliations

  1. Helen Dowling Institute, Utrecht, The Netherlands

    Petra J. Vos, Bert Garssen & Adriaan P. Visser

  2. Department of Medical Psychology and Psychotherapy, Rotterdam, The Netherlands

    Hugo J. Duivenvoorden

  3. Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Hanneke C. J. M. de Haes

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  1. Petra J. Vos
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  2. Bert Garssen
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  4. Hugo J. Duivenvoorden
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  5. Hanneke C. J. M. de Haes
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Vos, P.J., Garssen, B., Visser, A.P. et al. Early Stage Breast Cancer: Explaining Level of Psychosocial Adjustment Using Structural Equation Modeling. J Behav Med 27, 557–580 (2004). https://doi.org/10.1007/s10865-004-0003-z

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