ABSTRACT
The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.
Subject(s)
Breast Neoplasms , Resilience, Psychological , Humans , Female , Breast Neoplasms/psychology , Self Efficacy , Quality of Life/psychology , Adaptation, PsychologicalABSTRACT
OBJECTIVE: The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa. DESIGN AND MAIN OUTCOMES MEASURES: Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6. RESULTS: Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high. CONCLUSION: The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.
ABSTRACT
PURPOSE: The development of the adjuvant therapy requires that clinicians and patients should discuss the magnitude of benefit of treatment for individual patient, estimating the pros and cons and the personal preferences. The aim of the present study was to determine the preferences of women treated with adjuvant hormonal therapy (HT) for breast cancer. METHODS: The analyses were conducted into three different groups of early breast cancer patients to evaluate the survival benefit needed to make treatment worthwhile before starting HT (A), after a few months from the beginning (B) and after several years of HT (C). The questionnaires, showing hypothetical scenarios based on potential survival times and rates without HT, were used to determine the lowest gains women judged necessary to make the treatment worthwhile. RESULTS: A total of 452 patients were included in the study: 149 in group A, 150 in group B and 153 in group C. In group C, 65% of patients were receiving HT with aromatase inhibitors (with or without a LHRH analogue). In the groups A, B, C 8%, 20% and 26%, respectively, received adjuvant chemotherapy. Overall, 355 women (79%) had children. The responses were quite similar between the three groups. A median gain of 10 years was judged necessary to make adjuvant HT worthwhile based on the hypothetical scenario of untreated mean survival time of 5 and 15 years. Median gain of 20% more women surviving was judged necessary to make adjuvant HT worthwhile based on an untreated 5-year survival rate expectation of 60%. Cognitive dysfunction was considered the side effect least compatible with the continuation of treatment in all three groups. CONCLUSIONS: This is a large study of patient preferences on HT. Compared with other studies with similar design, the patients included in the present study required larger benefits to make adjuvant therapy worthwhile.
Subject(s)
Breast Neoplasms , Patient Preference , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols , Breast Neoplasms/drug therapy , Chemotherapy, Adjuvant , Child , Female , Humans , Survival RateABSTRACT
It is shown that the nonlinear wave equation partial differential(2)(t)straight phi- partial differential2xstraight phi-&mgr;(0) partial differential(x)( partial differential(x)straight phi)(3)=0, which is the continuum limit of the Fermi-Pasta-Ulam beta model, has a positive Lyapunov exponent lambda(1), whose analytic energy dependence is given. The result (a first example for field equations) is achieved by evaluating the lattice-spacing dependence of lambda(1) for the FPU model within the framework of a Riemannian description of Hamiltonian chaos. We also discuss a difficulty of the statistical mechanical treatment of this classical field system, which is absent in the dynamical description.
