Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer.

OBJECTIVE: After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention. METHOD: A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment. RESULTS: The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy. CONCLUSIONS: Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer.

A qualitative exploration of the cancer experience among long-term survivors: comparisons by cancer type, ethnicity, gender, and age.

BACKGROUND: To elucidate meanings ascribed to the cancer experience by long-term survivors. METHODS: Semi-structured interviews were conducted with 58 cancer survivors (>15 years post-diagnosis). Respondents described how cancer affected their quality of life (QOL) generally and in 17 domains. Systematic content analyses were conducted to extract themes relating to meanings assigned to the cancer experience. Themes were analyzed by cancer type, gender, and age and confirmed using quantitative assessments of self-rated health and QOL. RESULTS: Four themes were identified: Personal Growth, That's Life. Relinquishing Control, and Resentment. Women more frequently acknowledged Personal Growth, and men more often indicated minimal impact on their lives (That's Life). Older survivors were disproportionately classified as That's Life and younger survivors as Personal Growth. No differences were observed by cancer type or ethnicity. Those who saw cancer as personal growth had the highest QOL, while those who resented cancer had the lowest QOL. CONCLUSIONS: Most long-term survivors retrospectively report that cancer either positively influenced their lives or had little long-term impact. Those who express Resentment report that pain, physical deformities, and social isolation significantly reduced their QOL. This qualitative study highlights how cancer survivors incorporate the cancer experience within their overall lives.

Quality of life among long-term survivors of breast cancer: Different types of antecedents predict different classes of outcomes.

Quality of life (QOL) has many aspects, both in the short-term and in the long-term. Different aspects of QOL may have different types of precursors: demographic, medical, and psychosocial. We examined this possibility in a group of long-term breast cancer survivors. Early-stage breast cancer patients (N = 163) who had provided information about medical, demographic, and psychosocial variables during the year after surgery completed a multidimensional measure of QOL 5-13 years later. Initial chemotherapy and higher stage predicted greater financial problems and greater worry about appearance at follow-up. Being partnered at diagnosis predicted many psychosocial benefits at follow-up. Hispanic women reported greater distress and social avoidance at follow-up. Initial trait optimism predicted diverse aspects of better psychosocial QOL at follow-up, but not other aspects of QOL. Thus, different aspects of QOL at long-term follow-up had different antecedents. Overall, psychological outcomes were predicted by psychosocial variables, presence of a partner at diagnosis, and ethnicity. Financial outcomes, in contrast, were predicted by medical variables, which otherwise predicted little about long-term QOL. This divergence among aspects of QOL should receive closer attention in future work.

Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer.

In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection.

Assessing quality of life in adult cancer survivors (QLACS).

This article describes development of a quality of life measure designed to assess issues relevant to long-term cancer survivors. In-depth semi-structured interviews were conducted with 58 long-term cancer survivors to identify domains most relevant to long-term survivors (> or = 5 years post-diagnosis). Self-report items were developed from these interviews and administered to a second sample of 242 long-term survivors. Domains and items were selected from the item pool by a combination of factor analysis and criterion-based item selection. Five cancer-specific domains were identified (appearance concerns, financial problems, distress over recurrence, family-related distress, and benefits of cancer) along with seven generic QOL domains (negative feelings, positive feelings, cognitive problems, sexual problems, physical pain, fatigue, and social avoidance). Cronbach's alpha was 0.72 or greater for each domain. Correlations between domain scores and criterion measures were 0.72 or higher in all but one generic domain (social avoidance), but somewhat lower on cancer-specific domains. The new multidimensional measure has good internal consistency and validity and is appropriate for comparisons between cancer and non-cancer populations, as well as long-term follow-up of cancer patients.