Distress In Breast Cancer Survivors Research Articles

Abstract PO3-28-02: BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY

Abstract A review of the literature reveals a high incidence of body-image distress among breast cancer survivors who have undergone surgery, which is a natural response to the significant changes in their appearance. Reconstructive surgery, utilizing implants or flaps, may be employed to restore breast size and shape. Medical tattooing can recreate the nipple-areola complex and decorative appliques can conceal scars and skin color variations. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on body-image distress. To investigate this, a survey was distributed among national breast cancer support groups and advocacy organizations, yielding 207 responses from individuals meeting the study's criteria. The participants were categorized into two groups: those who received post-surgical medical tattoos (n = 61) and those who did not (n = 146). The study also examined how participants evaluated the cosmetic and decision satisfaction of patients who made various surgical and cosmetic intervention choices. This was accomplished by having participants rate images of patients who had received three types of intervention: mastectomy and reconstruction only, mastectomy and medical tattooing only, and mastectomy, reconstruction, and medical tattooing. Using linear regression and multilevel modeling that controlled for demographic and clinical factors associated with body-image distress, the findings demonstrated that participants with medical tattoos reported significantly lower levels of body-image distress, depressive symptoms, and perceived stress compared to those without medical tattoos. Furthermore, participants rated images of patients who underwent both reconstruction and medical tattooing post-mastectomy as having significantly higher cosmetic and decision satisfaction ratings than images of patients who received reconstruction or medical tattooing alone. This research expands on our understanding of body-image distress in survivors as a multidimensional construct and may serve to indicate potential means for intervention. Enhancing our understanding of how breast cancer treatment and surgery affects survivors' body-image distress may aid healthcare professionals in offering additional psychoeducation and recommendations. Furthermore, presenting information about medical tattooing as a complementary cosmetic option early in the treatment process allows patients the opportunity to consider it within the context of their overall treatment plan. Table. Linear regression results using BIBCQ as the outcome variable and medical tattoo group as the predictor variable with covariates included. Note. PHQ9 = Patient Health Questionnaire-9. PSS = Perceived Stress Scale. Citation Format: Miranda Proctor, Jeffrey Cassisi. BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-28-02.

Psychometric validation of the 15-item Patient Health Questionnaire – Anxiety and Depression Scale (PHQ-ADS) to assess psychological distress in breast cancer survivors

ObjectivePsychological distress persists amongst breast cancer survivors, so reliable assessment of symptoms is essential. The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) is a composite measure of depression and anxiety and has been used to measure distress. This study aimed to evaluate the psychometric properties of the PHQ-ADS within breast cancer survivors. MethodBreast cancer survivors (N = 280) were recruited online and followed up at 12-months. Depression (PHQ-8) and anxiety (GAD-7) items formed the composite PHQ-ADS score. Additional measures included: distress thermometer (convergent validity), fear of cancer recurrence and COVID distress (discriminant validity), and self-compassion (predictive validity). Confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted estimation was undertaken. ResultsOne, two, and bifactor models underlying the PHQ-ADS were evaluated. The bifactor model had the most appropriate model fit overall. Omega hierarchical for the general distress factor was 0.914, accounting for 82% of explained variance. This suggests the PHQ-ADS is sufficiently unidimensional to warrant use of a total composite score. The PHQ-ADS demonstrated strong convergent and moderate discriminant validity. Self-compassion was an independent predictor of distress at 12-months. ConclusionsThe PHQ-ADS is a valid measure for psychological distress in breast cancer survivors prescribed hormone therapy.

Abstract P6-05-33: Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study

Abstract Purpose Improving physical activity (PA) and reducing mental distress are important issues in the treatment of cancer survivors. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. Methods We conducted a single-center, prospective, non-blinded, randomized controlled study. Subjects who got breast cancer surgery were allocated to a control group or a app-based community group (intervention) where members were able to share their daily physical activities. Daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for 24 weeks. To examine the differences in levels of distress and weekly step counts for 6 months, we used a t-test method and multivariable regression modeling. Results From Jan 2019 to Apr 2020, a total of 202 participants were enrolled in this study. The intervention group showed a significant increase in weekly steps by 4,496 for 6 months (p < 0.001). The participants in the intervention group showed a significantly lower rate of above mild distress (DT≥3, beta[B] = -0.731, p < 0.001) and above moderate distress (DT≥5, B = -0.558, p < 0.001) compared to those in the control group for 6 months. Conclusions The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Citation Format: Il-Yong Chung, Miyeon Jung, Sae Byul Lee, Jong Won Lee, Sei Hyun Ahn, Haekwon Chung. Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-33.

Association of sexual attitudes with sexual dysfunction and sexual distress among Chinese breast cancer survivors: a cross-sectional study.

Little is known about sexual dysfunction and sexual distress in Chinese female breast cancer survivors (BCSs), and their associations with physical variables, psychological factors, body image, and sexual attitudes. A cross-sectional study of 341 BCSs was performed with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Associations between physical variables, psychological factors, body image, sexual attitudes, sexual dysfunction, and sexual distress were evaluated using logistic regression, adjusted for confounding factors. We found that 75.37% and 18.48% of BCSs reported sexual dysfunction and sexual distress during the past month, respectively. Attitudes toward sexual behavior such as "sexual activity may impede disease recovery," "sexual activity may cause cancer recurrence or metastasis," and "sexual activity may weaken treatment effects" were significantly associated with an increased likelihood of reporting sexual dysfunction and sexual distress. Body image disruption such as "felt physically less attractive as a result of your disease or treatment" was significantly associated with the experience of sexual distress. Sexual dysfunction and sexual distress are common issues in Chinese BCSs. Sexual misconception likely contributes to sexual dysfunction and sexual distress, and body image has a significantly negative association with sexual distress in BCSs. Interventions targeting sexual attitudes and body image might be important to address BCSs' sexual issues and improve their overall sexual health.

MHealth system (ATOPE+) to support exercise prescription in breast cancer survivors: a reliability and validity, cross-sectional observational study (ATOPE study)

Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https://clinicaltrials.gov/ct2/show/NCT03787966.

ICOnnecta't: Development and Initial Results of a Stepped Psychosocial eHealth Ecosystem to Facilitate Risk Assessment and Prevention of Early Emotional Distress in Breast Cancer Survivors' Journey.

Simple SummaryIn current clinical practice, between one third and a half of patients diagnosed with cancer experience distress. Moreover, many of these psychosocial needs often remain unaddressed, although effective interventions exist. Nowadays, eHealth solutions like ICOnnecta’t offer new tools to overcome these limitations and improve access to treatment. This digital ecosystem has been proved to be feasible to implement, reaching good acceptability, use, and satisfaction between users. In addition, it allowed symptom monitoring in real time, facilitating preventive early interventions. Overall, fostering social support appears as a key to facilitate a resilient response after diagnosis.Psychosocial interventions prevent emotional distress and facilitate adaptation in breast cancer (BC). However, conventional care presents accessibility barriers that eHealth has the potential to overcome. ICOnnecta’t is a stepped digital ecosystem designed to build wellbeing and reduce psychosocial risks during the cancer journey through a European-funded project. Women recently diagnosed with BC in a comprehensive cancer center were offered the ecosystem. ICOnnecta’t consists of four care levels, provided according to users’ distress: screening and monitoring, psychoeducation campus, peer-support community, and online-group psychotherapy. Descriptive analyses were conducted to assess the platform’s implementation, while multilevel linear models were used to study users’ psychosocial course after diagnosis. ICOnnecta’t showed acceptance, use and attrition rates of 57.62, 74.60, and 29.66%, respectively. Up to 76.19% of users reported being satisfied with the platform and 75.95% informed that it was easy to use. A total of 443 patients’ needs were detected and responsively managed, leading 94.33% of users to remain in the preventive steps. In general, strong social support led to a better psychosocial course. ICOnnecta’t has been successfully implemented. The results showed that it supported the development of a digital relation with healthcare services and opened new early support pathways.

Comparing online support groups with psychoeducation versus psychoeducation alone for distressed breast cancer survivors: a randomized controlled trial

Abstract Background: Online support groups are one forum that can help breast cancer survivors cope with negative mood states, but little is known about their effects compared to self-administered psycho-educational interventions. This randomized controlled trial compared the effects of synchronous, text-based professionally led online support groups (OSGs) plus a psychoeducational coping skills training program, called Nucare, versus Nucare alone in distressed survivors of breast cancer. Methods: Consented participants were randomized to an OSG (90-minute once-weekly session for 12 weeks) plus home-based Nucare or a self-directed home-based Nucare intervention alone. The primary outcome was the Profile of Mood States-Short Form – Total Mood Disturbance score (POMS-TMD). Secondary outcomes included measures of anxiety, depression, coping, illness intrusiveness, and loneliness. Outcomes were measured before and after the intervention, and 3 months post-intervention (follow-up). Results: One hundred twenty-five stage I–III breast cancer survivors enrolled with a mean age of 53 years (OSG plus Nucare [n = 68]; Nucare alone [n = 57]). There was a significant improvement in POMS-TMD scores among the entire study sample during the intervention period (Cohen's d = 0.25, P = .002), which was maintained over follow-up. The group × time interactions on POMS-TMD over the intervention and follow-up periods were not significant (all Ps > .05), indicating neither group outperformed the other. Group x time interactions on three coping domains (positive reframing, use of instrumental support, self-blame) favored Nucare alone over OSG plus Nucare during the intervention period (Cohen's d ranged from 0.40 to 0.48), while group x time interactions over the follow-up period favored OSG plus Nucare over Nucare alone on loneliness (Cohen's d = 0.34) and one coping domain (self-blame) (Cohen's d = 0.58). Anxiety, depression, and illness intrusiveness were not significantly different between groups at any time point (all Ps > .05). Conclusion: OSGs plus Nucare were not found superior to Nucare alone in improving mood disturbance. Mood improvement among the entire sample indicates that regular use of either Nucare alone or in combination with OSGs may have the potential to ameliorate negative mood states in breast cancer survivors.

The mediating role of avoidant coping in the relationships between physical, psychological, and social wellbeing and distress in breast cancer survivors.

Many breast cancer survivors (BCSs) recover from the negative sequelae of cancer treatment. However, some report persistent and disruptive distress well into disease-free survivorship. More information is needed on the predictors of distress in this growing population of BCS, including the role of avoidant coping, or attempts to avoid thoughts, feelings, and reminders of cancer, in mediating the relationship between distress and psychological, physical, and social domains of well-being. In a large cross-sectional study, BCS (n=1,127), who were 3 to 8 years post-diagnosis, completed a survey assessing demographic characteristics, medical history, distress (anxiety and depressive symptoms), avoidant coping, and physical (fatigue), psychological (fear of recurrence, attention, body image), and social (social support from a partner, social constraints from a partner) well-being. Multiple mediation analyses were conducted to determine if avoidant coping mediated the relationship between each distress variable (anxiety and depressive symptoms) and each well-being (fear of recurrence, attention, body image, fatigue, social support, and social constraints) variable. In all six mediation models, avoidant coping significantly (p<0.001) mediated the relationship between each well-being variable (fear of recurrence, attention, body image, fatigue, social support, and social constraints) and each distress indicator (depression and anxiety). Avoidant coping mediated 19%-54% of the effects of the contributing factors on the distress variables. Avoidant coping may indicate risk for, or presence of, distress among BCS. Interventions to reduce distress may benefit from addressing avoidant coping styles.

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors

ABSTRACT Background The majority of breast cancer survivors (BCSs) experience body image concerns following treatment. Body Image distress (BID) is associated with psychological distress and diminished quality of life. A web-based self-compassion focused writing activity (My Changed Body – MyCB) reduces BID in BCSs, yet limited research exists on participant characteristics associated with such intervention adherence. Self-compassion-based meditations are also efficacious in reducing BID in non-BCS populations. This parallel, double-blind pilot randomised controlled trial aimed to assess the feasibility and acceptability of MyCB, with and without an additional meditation component, on BID and related psychological outcomes in BCSs. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#ACTRN12619001693112). Methods BCSs were randomly allocated to MyCB (n = 39), MyCB + Meditation (MyCB + M) (n = 17) or an expressive writing (EW) active control arm (n = 23). The primary outcome was BID. Secondary outcomes were body appreciation, affect (positive and negative), psychological distress (depression, anxiety and stress) and self-compassion (state and trait). Assessments were completed online at baseline, post-intervention and 1-month. Results Adherence to the MyCB writing (45%) and meditation (50%) was modest, and acceptability was high for both MyCB and MyCB + M. Intent to treat linear mixed model analyses indicated: Post-intervention – state self-compassion and positive affect increased for MyCB compared to EW; 1-month: BID scores decreased across all conditions; trait self-compassion increased and anxiety decreased for MyCB + M compared to MyCB and EW. Conclusion These findings provide preliminary evidence for the efficacy and potential clinical use of the MyCB brief web-based self-compassion intervention alone and with the addition of meditation, to increase self-compassion and psychological wellbeing in BCSs.

Fruit and vegetable consumptions in relation to frequent mental distress in breast cancer survivors.

Evidence suggests that fruit and vegetable consumptions may improve mental health among general population. However, their associations among breast cancer survivors are unclear. We planned to investigate this association via a nationwide survey in the USA. We identified 7988 breast cancer survivors from 2009 Behavioral Risk Factor Surveillance System (BRFSS). Fruit juice, fruit, and vegetable consumptions were categorized as ordinal variables to approximate tertiles. Survivors who were mentally unhealthy for at least 14days in the past 30days were defined as having frequent mental distress (FMD). Multivariable logistic regression treating FMD as the outcome was used to calculate adjusted odd ratios (aORs) and 95% confidence intervals (CIs) for exposures. Quadratic model was used to depict the dose-response pattern in primary analysis. Subgroup analyses by adverse lifestyle behaviors were conducted; Wald tests were used to examine if there were interactions between these factors and exposures in relation to FMD. Overall, 825 (10.3%) survivors had FMD. Mean age was 67.2years, and 89.7% of survivors were white. Juice showed non-significant associations with FMD. Moderate (aOR = 0.81, 95% CI = 0.68-0.98) and high (aOR = 0.79, 95% CI = 0.63-0.98) fruit consumptions, as well as moderate vegetable consumption (aOR = 0.78, 95% CI = 0.64-0.94), were significantly and inversely associated with FMD. The dose-response curves were consistent with results in primary analysis. No interaction was identified for adverse lifestyle behaviors. Fruit and vegetable, but not fruit juice, show potential preventive effects against FMD among breast cancer survivors. The conclusion should be verified by studies with clear temporality in future.

Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics

PurposeBreast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC.MethodsData were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC.ResultsOf the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3–4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1–3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6–5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2–7.8, p < 0.001) were all associated with the SC.ConclusionThirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors’ ability to work.

Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study.

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients’ satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson’s correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = −0.60). Qualitative feedback confirmed patients’ benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients’ satisfaction and qualitative feedback they help refine treatment.

Could worry and rumination mediate relationships between self-compassion and psychological distress in breast cancer survivors?

Many breast cancer (BCa) patients experience clinically significant anxiety and depression in survivorship. Self-compassion offers a bulwark to anxiety and depression in nonclinical, mental health, and some chronic physical health populations. We examined whether self-compassion predicted lower anxiety and depression symptoms in survivors and whether this might be mediated by lower worry and rumination. The design was a cross-sectional survey using self-report measures. Female adult BCa survivors of mixed stages who had finished primary surgical, radiotherapy, or chemotherapy treatments completed self-compassion subscales and worry, rumination, and anxiety and depression scales. Higher self-compassion subscale scores were negatively associated with anxiety and depression. Depressive brooding and worry mediated any effects of self-kindness and mindfulness on depression and anxiety, whereas common humanity directly predicted lower depression scores. Findings are consistent with the view that self-compassion reduces threat-related rumination and worry in BCa survivors, consequently reducing anxiety and depression. This may form a basis for prevention and treatment.

Predictors of psychological distress in breast cancer survivors: A biopsychosocial approach.

A cross-sectional study was conducted to examine the extent to which perceived social support, cortisol-awaking response (CAR) and tumour necrosis factor alpha (TNF-α) interact to statistically predict psychological distress in breast cancer survivors. Moderation analyses were performed to study the influence of some psychobiological variables on psychological distress. The sample was comprised by 80 survivor women. TNF-α moderate the relation between social support and psychological distress, with both high and moderate levels being significant. In relation to age, a negative association between social support and psychological distress was found only in younger- and middle-age women, while lower levels of CAR were associated with psychological distress in older breast cancer survivors. This study provides a biopsychosocial approach about the predictors of psychological distress among breast cancer survivors. Social support interventions during and after treatment may help to improve women's longer-term health and quality of live during survivorship.

Long-term psychological distress in breast cancer survivors and their matched controls: A cross-sectional study

IntroductionBreast cancer survivors often experience psychological distress shortly after diagnosis. Long-term psychological effects, however, have not been clearly demonstrated. MethodsThis cross-sectional cohort study included 350 breast cancer survivors and 350 age-matched and general-practitioner-matched women. The median follow-up was 10 years. Using logistic regression we compared breast cancer survivors with controls on having (severe) symptoms of depression and/or anxiety, as measured with the Hospital Anxiety and Depression Scale. In multivariable logistic regression, we adjusted the results for a history of depression or prescription of antidepressants. ResultsLarger proportions of breast cancer survivors experienced symptoms of depression (10.6%) compared with controls (4.9%) and symptoms of anxiety (18.6%) compared with controls (16.3%). The odds of symptoms of depression (OR 2.3, 95%CI 1.3–4.2), severe symptoms of depression (OR 3.3, 95%CI 1.1–10.3) and severe symptoms of anxiety (OR 2.1, 95%CI, 1.1–4.0) were significantly higher for breast cancer survivors than for controls, even after adjusting for history of depression or prescription of antidepressants. No significant difference was seen for mild symptoms of anxiety. ConclusionsBreast cancer survivors have an increased risk of symptoms of depression, including severe symptoms, and severe symptoms of anxiety compared with controls, for up to at least 10 years after diagnosis.

Self-compassion and hope in the context of body image disturbance and distress in breast cancer survivors.

Greater hope and self-compassion have individually been associated with lower psychological distress in women with breast cancer. Self-compassion is also associated with lower body image distress in this population, yet it is unknown whether hope also has this association. This study aimed to investigate the extent to which hope accounts for body image distress and psychological distress in breast cancer survivors alone, and in direct comparison to self-compassion. A total of 195 women were recruited from the Breast Cancer Network Australia and completed a cross-sectional online anonymous questionnaire containing self-report measures of body image (Body Image Scale), self-compassion (Self Compassion Scale-SF), hope (State Hope Scale), psychological distress (depression, anxiety, stress; DASS), and demographic/medical questions. Self-compassion and hope were inversely correlated with all outcomes. Hierarchical linear regression analyses indicated that self-compassion and hope uniquely explained variance in all outcomes with different magnitudes of strength. Comparison of standardised betas indicated (a) Body image distress-self-compassion (Bstd = -.355) vs hope (Bstd = -.161); (b) Stress-self-compassion (Bstd = -.562) vs hope (Bstd = -.287); (c) Depression-hope (Bstd = -.447) vs self-compassion (Bstd = -.374); (d) Anxiety-hope (Bstd = -.406) vs self-compassion (Bstd = -.249). The unique contribution of self-compassion and hope in explaining body image distress and psychological distress suggests that combined, hope-focused components of therapy may be suitable additions to the growing array of self-compassion-based psychosocial interventions to address body image and psychological distress concerns of women with breast cancer.

Screening of physical distress in breast cancer survivors: Concurrent validity of the Distress Thermometer and Problem List.

Several studies support the validity and psychometric properties of the DT&PL for measuring psychosocial distress in breast cancer survivors (BCSs). However, next to psychosocial problems, it is equally important to identify distress caused by limitations in physical functioning. Validity of the DT&PL for the identification of physical problems in BCSs has not yet been investigated. Therefore, the purpose of the present study is to investigate the concurrent validity and psychometric properties of the Dutch DT&PL in BCSs for the identification of physical problems. Ninenty BCSs completed the DT&PL, ShortForm-36 (SF-36) and the Dutch Disability of the Arm, Shoulder and Hand questionnaire (DASH). Forty-seven % of BCSs reported a high level of distress on the DT&PL (score ≥5). Distressed BCS showed increased physical and emotional problems and problems at the upper limb region. The scores obtained with the DT&PL correlated weakly to strongly with subscales for physical functioning of the SF-36 (r=-0.224 to r=-0.676; p<0.05) and with limitations in physical functioning at the upper limb region (DASH; r=0.380 to r=0.619; p<0.01). In conclusion, the Dutch DT&PL is a multidimensional instrument showing good concurrent validity for the screening of physical problems.

A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers.

Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context. Participants were 230 dyads composed of Latinas recently diagnosed with breast cancer and their primary family caregiver, who completed measures of socioeconomic status, stress, family conflict, depression, and anxiety. Data were analyzed following the Actor-Partner Interdependence Mediation Model in structural equation modeling. For both survivors and caregivers, there were significant direct and indirect actor effects (through family conflict) of perceived stress on depression and anxiety. Several indirect partner effects were also evident in this sample. Specifically, caregivers' stress was predictive of survivors' depression and anxiety through survivors' increased perceptions of family conflict. As predicted by the stress process model, stress and family conflict were predictive of psychological distress in breast cancer survivors and their family caregivers. Significant partner effects in the Actor-Partner Interdependence Mediation Model suggest that there are some dyadic influences, particularly from caregivers' stress to survivors' perceptions of exacerbated family conflict. These findings show how strained family relationships can aggravate the well-being of cancer survivors and their family caregivers through this challenging experience.

Comparison of distress in breast cancer survivors treated with different adjuvant endocrine therapies: a single-centre cross-sectional study

AIM: To compare the depression and anxiety scores among breast cancer (BC) survivors who received different adjuvant endocrine therapies.PATIENTS AND METHOD: A total of 154 patients (with 6 months ...

Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators

Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.