Traumatic Stress, Perceived Global Stress, and Life Events: Prospectively Predicting Quality of Life in Breast Cancer Patients.

Abstract

The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps < .03). These findings substantiate the relationship between initial stress and later QoL and underscore the need for timely psychological intervention. Keywords stress; quality of life; breast cancerThe impact of a breast cancer diagnosis and its treatment on quality of life (QoL) is well documented (e.g., Ganz et al., 1996;Holzner et al., 2001). Shapiro et al. (2001), in their review of the relationship between QoL and psychosocial variables in breast cancer patients, noted that "the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer … a broader, more integrative framework, which includes psychosocial factors, is needed" (p. 502). The biobehavioral model of cancer stress and disease course offers such a framework (see Andersen, Kiecolt-Glaser, & Glaser, 1994, for a complete discussion). In this conceptual model, cancer diagnosis and cancer treatments are defined as objective, negative events. Although negative events do not always produce stress, data from many studies document severe acute stress at cancer diagnosis and treatment (e.g., Andersen, Anderson, & deProsse, 1989;Epping-Jordan et al., 1999;Maunsell, Brisson, & Deschenes, 1992). Even when stress declines from the peak at diagnosis (Edgar, Rosberger, & Nowlis, 1992), many QoL difficulties remain and new ones may arise during treatment and/or recovery (e.g., psychological distress; relationship, social, and occupational disruption; loss of physical stamina and fatigue; financial problems; Bleiker, Pouwer, van der Ploeg, Leer, & Ader, 2000;Ganz et al., 1996;Holzner et al., 2001). The biobehavioral model postulates that higher initial stress levels (i.e., stress at the time of cancer diagnosis and treatment) can, over time, contribute to lower QoL for cancer patients.To examine the hypothesized longitudinal relationship between stress and QoL, we used stress at initial diagnosis and surgical treatment as a predictor of QoL outcomes as patients received additional difficult treatments (i.e., chemotherapy, radiation) and as they recovered (i.e., when treatments ended and medical follow-up began). As the biobehavioral model does not specify or define stress per se, ...

Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors

“…The main reason for the choice of regression analysis lay in the fact that only a few published studies have so far examined psychological predictors of long-term QoL and adaptation. As these studies used regression analysis [10,12,14,30,[34][35][36], the principal aim of the present study was to compare data with these other publications and attempt to replicate their findings and add other possible predictors. One example is a recent study by Schou et al [14], who used multiple regression analysis to investigate oncological and psychological predictors of QoL scores 1 year after breast cancer surgery.…”

“…The impact of primary surgical treatment (BCT vs mastectomy), especially in relation to long-term body image, would also have been of interest [3,5], but the very small subgroup of patients treated with mastectomy (8%) did not allow statistical analysis. The psychological predictors investigated are based on recent studies that have demonstrated the importance of increased distress, early adaptation, and personality traits [10,[12][13][14]16,30] and on the coping theory proposed by Lazarus and Folkman [31] as a biopsychosocial framework. However, the selection of predictor variables inevitably disregards the fact that there are many other variables that may also influence QoL and well-being-such as radiotherapy or endocrine therapy [32,33] on the oncological side, and self-esteem or self-efficacy [15] on the psychological side.…”

Dissemination of an evidence-based treatment for cancer patients: training is the necessary first step

“…If left untreated, this early stress contributes to a consistently low quality of life, slower recovery, and less meaning in patients' lives [1][2][3][4]. The needs of patients go unaddressed [5] despite the fact that 30 years of randomized clinical trials (RCTs) designed for cancer patients show that we can consistently reduce patients' stress and enhance their moods [6][7][8][9], coping [7,10], and quality of life [6].…”

The quality of life of disease-free Brazilian breast cancer survivors

“…There is evidence that women who are sa sfi ed with their partners report feeling be er psychologically (15) . In our mul variate-adjusted analysis, BC survivors living without partners had a worse QOL (with a mean MCS score of 39.0 versus 43.7 for those living with a partner).…”

“…Several studies linking BC and QOL have shown that the diagnosis and treatments can have social, physical, emo onal and psychological repercussions which aff ect women with breast cancer, which may contribute to a wide variety of side eff ects that are closely related to poor QOL outcomes (14)(15)(16) . Nevertheless, other studies which have assessed QOL in women with BC in diff erent socio-cultural contexts have shown that as the years pass, the QOL of women with BC becomes comparable to that of women without BC (17)(18) .…”