Use of Coping Strategies and Breast Cancer Survival: Results from the Black/White Cancer Survival Study

Abstract

This analysis was designed to evaluate the association between coping strategies and breast cancer survival among Black and White women in a large population-based study. A total of 442 Black and 405 White US women diagnosed with invasive breast cancer during 1985-1986 and actively followed for survival through 1994 were administered a modified Folkman and Lazarus Ways of Coping questionnaire. Coping strategies were characterized via factor analyses of the responses. Hazard ratios associated with coping strategies were estimated using Cox proportional hazards models, with adjustment for age, race, tumor stage, study location, tumor hormone responsiveness, comorbidity, health insurance status, smoking, relative body weight, and alcohol consumption. Emotion-focused coping strategies were significantly associated with survival. Expression of emotion was associated with better survival (hazard ratio = 0.6; 95% confidence interval: 0.4, 0.9). When it was considered jointly with the presence or absence of perceived emotional support, women reporting low levels of both emotional expression and perceived emotional support experienced poorer survival than women reporting high levels of both (hazard ratio = 2.5; 95% confidence interval: 1.7, 3.7). Similar risk relations were evident for Blacks and Whites and for patients with early and late stage disease. These results suggest that the opportunity for emotional expression may help improve survival among patients with invasive breast cancer.

Baseline psychosocial predictors of survival in localised breast cancer

“…In this study, the unfavourable effect of emotional defensiveness was strong and persistent. This agrees with previous findings on the favourable effect of more expression and less suppression of emotions on breast cancer progression (Reynolds et al, 2000) and the unfavourable effect of antiemotionality in cancers (Grossarth-Maticek et al, 1985;van der Ploeg et al, 1989). Our scale evaluated control of anger in particular (Swan et al, 1992), and we found it to be associated with the Anger Control trait of the highly validated AX/Scale, which was, however, not predictive on breast cancer survival (In corresponding data concerning localised melanoma (Lehto et al, 2006), we found Anger-in and Anger Control traits to predicted worse survival.).…”

“…The impact of psychosocial factors on cancer progression has been investigated in a number of studies (Greer et al, 1979(Greer et al, , 1990Pettingale et al, 1985;Gross, 1989;Spiegel et al, 1989;Forsen, 1991;Barraclough et al, 1992;Blanchard et al, 1995;Maunsell et al, 1995;Dolbeaut et al, 1999;Watson et al, 1999;Butow et al, 2000;Reynolds et al, 2000;Spiegel, 2001;Petticrew et al, 2002;Garssen, 2004) and many of these have dealt with breast cancer (Greer et al, 1979(Greer et al, , 1990Pettingale et al, 1985;Spiegel et al, 1989;Forsen, 1991;Barraclough et al, 1992;Maunsell et al, 1995;Watson et al, 1999;Butow et al, 2000;Reynolds et al, 2000;Garssen, 2004). However, the contributing factors are uncertain, and there is also a lack of understanding of the psychological processes and the psychobiological mechanisms involved (Garssen and Goodkin, 1999).…”

“…However, the contributing factors are uncertain, and there is also a lack of understanding of the psychological processes and the psychobiological mechanisms involved (Garssen and Goodkin, 1999). In many studies, the theoretical basis has been insufficient, the psychological constructs investigated have varied study by study, and there has been no agreement on definition, operationalisation, and methodology (Butow et al, 1999;Garssen and Goodkin, 1999;Reynolds et al, 2000;Garssen, 2004;Garssen and Remie, 2004). This has made it difficult to summarise the results and has often led to questionable comparisons of studies evaluating different concepts.…”

“…Current research suggests that the most important psychosocial risk factors in cancer progression may include nonexpression of negative emotions (Garssen and Goodkin, 1999;Reynolds et al, 2000;Garssen, 2004) and helplessness/depression (Watson et al, 1999), and that life stresses (stressful life events) and low levels of social support may also have an effect (Maunsell et al, 1995;Garssen and Goodkin, 1999;Garssen, 2004). Favourable prognoses seem to be predicted by a response pattern of denying and/or minimising the fact of having cancer (Butow et al, 1999Garssen, 2004).…”

“…It is suggested that these affect both quality of life (QOL) and survival. Coping can be seen as the main mediator in the process from cancer and its treatment to the health outcomes (Folkman et al, 1986a, b;Holahan and Moos, 1986;Folkman et al, 1991;Lazarus, 1993;Reynolds et al, 2000;Petticrew et al, 2002), and social support and personality factors are assumed to modify the process (Cobb, 1976;Cohen and Wills, 1985;Holahan and Moos, 1986;Burgess, 1987;Temoshok, 1987;Folkman et al, 1991;Blanchard et al, 1995). Also, the presence of other (noncancer) life events at the time of the illness has an effect on the cancer-related stress processes because patients often need to make efforts in order to cope with them, and this may influence or interfere with coping with cancer or affect the health outcomes (Dolbeaut et al, 1999).…”