Abstract
Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women’s physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women’s lives.
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References
American Cancer Society. (2015). Breast cancer facts & figures 2015–2016. Atlanta, GA: American Cancer Society Inc.
Andersen, B. L., Kiecolt-Glaser, J. K., & Glaser, R. (1994). A biobehavioral model of cancer stress and disease course. American Psychologist, 49, 389–404.
Bauer, M. R., Harris, L. N., Wiley, J. F., Crespi, C. M., Krull, J. L., Weihs, K. L., et al. (2016). Dispositional and situational avoidance and approach as predictors of physical symptom bother following breast cancer diagnosis. Annals of Behavioral Medicine, 50, 370–384.
Bower, J. E. (2008). Behavioral symptoms in patients with breast cancer and survivors. Journal of Clinical Oncology, 26, 768–777.
Bower, J. E. (2014). Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology, 11, 597–609.
Brown, G. W., & Harris, T. O. (1978). Social origins of depression. London: Free Press.
Burgess, C., Cornelius, V., Love, S., Graham, J., Richards, M., & Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ, 330, 702.
Cella, D., Land, S. R., Chang, C. H., Day, R., Costantino, J. P., Wolmark, N., et al. (2008). Symptom measurement in the Breast Cancer Prevention Trial (BCPT)(P-1): Psychometric properties of a new measure of symptoms for midlife women. Breast Cancer Research and Treatment, 109, 515–526.
Daley, S. E., Hammen, C., & Rao, U. (2000). Predictors of first onset and recurrence of major depression in young women during the 5 years following high school graduation. Journal of Abnormal Psychology, 109, 525–533.
Davies, P. S. (2013). Chronic pain management in the cancer survivor: Tips for primary care providers. The Nurse Practitioner, 38, 28–38.
DeSimone, M., Spriggs, E., Gass, J. S., Carson, S. A., Krychman, M. L., & Dizon, D. S. (2014). Sexual dysfunction in female cancer survivors. American Journal of Clinical Oncology, 37, 101–106.
Diener, E., Lucas, R. E., & Scollon, C. N. (2006). Beyond the hedonic treadmill: Revising the adaptation theory of well-being. American Psychologist, 61, 305–314.
du Toit, S. H., & du Toit, M. (2008). Multilevel structural equation modeling. Handbook of Multilevel Analysis. New York: Springer.
Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430–457.
Ganz, P. A., Kwan, L., Stanton, A. L., Bower, J. E., & Belin, T. R. (2011). Physical and psychosocial recovery in the year after primary treatment of breast cancer. Journal of Clinical Oncology, 29, 1101–1109.
Golden-Kreutz, D. M., & Andersen, B. L. (2004). Depressive symptoms after breast cancer surgery: Relationships with global, cancer-related, and life event stress. Psycho-Oncology, 13, 211–220.
Golden-Kreutz, D. M., Thornton, L. M., Wells-Di Gregorio, S., Frierson, G. M., Jim, H. S., Carpenter, K. M., et al. (2005). Traumatic stress, perceived global stress, and life events: Prospectively predicting quality of life in breast cancer patients. Health Psychology, 24, 288–296.
Grassi, L., Malacarne, P., Maestri, A., & Ramelli, E. (1997). Depression, psychosocial variables and occurrence of life events among patients with cancer. Journal of Affective Disorders, 44, 21–30.
Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology, 58, 595–602.
Hammen, C. (1991a). Depression runs in families: The social context of risk and resilience in children of depressed mothers. New York, NY: Springer-Verlag.
Hammen, C. (1991b). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555–561.
Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319.
Hammen, C., Kim, E. Y., Eberhart, N. K., & Brennan, P. A. (2009). Chronic and acute stress and the prediction of major depression in women. Depression and Anxiety, 26, 718–723.
Hayes, A. F. (2006). A primer on multilevel modeling. Human Communication Research, 32, 385–410.
Helgeson, V. S., Snyder, P., & Seltman, H. (2004). Psychological and physical adjustment to breast cancer over 4 years: Identifying distinct trajectories of change. Health Psychology, 23, 3–15.
Herbert, T. B., & Cohen, S. (1993). Stress and immunity in humans: A meta-analytic review. Psychosomatic Medicine, 55, 364–379.
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513–524.
Holland, J. C., Breitbart, W. S., Butow, P. N., Jacobsen, P. B., Loscalzo, M. J., & McCorkle, R. (2015). Psycho-Oncology (3rd ed.). New York, NY: Oxford University Press.
Jim, H. S., Andrykowski, M. A., Munster, P. N., & Jacobsen, P. B. (2007). Physical symptoms/side effects during breast cancer treatment predict posttreatment distress. Annals of Behavioral Medicine, 34, 200–208.
Kilpatrick, F. P., & Cantril, H. (1960). Self-anchoring scaling: A measure of individuals’ unique reality worlds. Journal of Individual Psychology, 16, 158–173.
Kornblith, A. B., Herndon, J. E., Zuckerman, E., Viscoli, C. M., Horwitz, R. I., Cooper, M. R., et al. (2001). Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer, 91, 443–454.
Low, C. A., Stanton, A. L., Thompson, N., Kwan, L., & Ganz, P. A. (2006). Contextual life stress and coping strategies as predictors of adjustment to breast cancer survivorship. Annals of Behavioral Medicine, 32, 235–244.
Lutgendorf, S. K., & Andersen, B. L. (2015). Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. American Psychologist, 70, 186–197.
Marroquín, B., Czamanski-Cohen, J., Weihs, K. L., & Stanton, A. L. (2016). Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors. Journal of Behavioral Medicine, 39, 832–834.
Muthén, L. K., & Muthén, B. O. (2012). Mplus User’s guide (7th ed.). Los Angeles: Muthén & Muthén.
Revenson, T. A. (2003). Scenes from a marriage: Examining support, coping, and gender within the context of chronic illness. In J. Suls & K. A. Wallston (Eds.), Social psychological foundations of health and illness (pp. 530–559). Malden, MA: Blackwell Publishing.
Rudolph, K. D., Hammen, C., Burge, D., Lindberg, N., Herzberg, D., & Daley, S. E. (2000). Toward an interpersonal life-stress model of depression: The developmental context of stress generation. Development and Psychopathology, 12, 215–234.
Shapiro, C. L., & Recht, A. (2001). Side effects of adjuvant treatment of breast cancer. New England Journal of Medicine, 344, 1997–2008.
Stanton, A. L., Bernaards, C. A., & Ganz, P. A. (2005). The BCPT symptom scales: A measure of physical symptoms for women diagnosed with or at risk for breast cancer. Journal of the National Cancer Institute, 97, 448–456.
Stanton, A. L., Wiley, J. F., Krull, J. L., Crespi, C. M., Hammen, C., Allen, J. J., et al. (2015). Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer. Breast Cancer Research and Treatment, 154, 105–115.
Suh, E., Diener, E., & Fujita, F. (1996). Events and subjective well-being: Only recent events matter. Journal of Personality and Social Psychology, 70, 1091–1102.
Vickberg, S. M. J. (2003). Locating breast cancer in the context of women’s lives. Journal of Psychosocial Oncology, 21, 68–69.
Funding
This research was supported by 1R01 CA133081 (Stanton and Weihs, co-PIs), NCI P30CA023074—University of Arizona Cancer Center Support Grant, NIH/NCI P30 CA 16042 (Dorshkind, PI), a National Institute of Mental Health Predoctoral Fellowship (Harris, MH 15750), and a National Science Foundation Fellowship (Bauer, DGE-1144087). We are grateful to the women who took part in the My Year After Breast Cancer research, the referring oncologists, and research coordinators Alexandra Jorge and Martha Barrón.
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Lauren N. Harris, Margaret R. Bauer, Joshua F. Wiley, Constance Hammen, Jennifer L. Krull, Catherine M. Crespi, Karen L. Weihs, and Annette L. Stanton declare that they do not have any conflict of interest.
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All procedures performed in this study were in accordance with the ethical standards of the relevant Institutional Review Boards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.
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Harris, L.N., Bauer, M.R., Wiley, J.F. et al. Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis. J Behav Med 40, 875–885 (2017). https://doi.org/10.1007/s10865-017-9855-x
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DOI: https://doi.org/10.1007/s10865-017-9855-x