Journal of Behavioral Medicine, online edition, March 24, 2009
Quality of Life May Impact Coping Strategies of Young Women With Breast Cancer
Numerous studies have shown a relationship between coping strategies and quality of life (QOL) among women with breast cancer. In a study published in the Journal of Behavioral Medicine, an investigation of coping strategies and quality of life among younger women with breast cancer suggests that QOL determines the use of coping strategies.
"It is generally assumed that coping strategies impact quality of life, with more active coping strategies generally associated with better QOL," said Suzanne C. Danhauer, Ph.D., assistant professor at Wake Forest University Baptist Medical Center and lead investigator of these analyses. This investigation was part of a study focused on younger women with breast cancer conducted by co-author and Principal Investigator Nancy E. Avis, Ph.D. The study was funded by the National Cancer Institute. "This research examined coping strategies over time and the reciprocal relationship between coping strategies and QOL among younger women with breast cancer to see if the opposite might be true – that QOL determines the use of coping strategies," said Danhauer.
Studies have consistently shown that younger women report greater psychological distress following breast cancer diagnosis than older women. Several investigations have also found that younger women with breast cancer report significantly worse QOL than older women, particularly in emotional and social domains.
From a developmental perspective, younger women face unique issues such as premature onset of menopause that may lead to infertility, sudden onset of vasomotor symptoms (hot flashes and/or night sweats) and long-term consequences of ovarian decline; changes in relationships with one's partner and/or children; multiple role demands of parenthood and career, and greater concerns about body image and sexuality.
Participants in the study, "A Longitudinal Investigation of Coping Strategies and Quality of Life among Younger Women with Breast Cancer," consisted of 267 women with breast cancer, with a mean age of 43 years, who completed baseline surveys within six months of diagnosis and follow-up surveys six weeks and six months later. The surveys included questions on coping strategies, QOL and medical factors.
Eligible women were sent a baseline packet of self-report questionnaires to complete. Following completion of the baseline survey, women were randomly assigned to receive a booklet or videotape describing how women often respond to a breast cancer diagnosis. Follow-up surveys were completed within six to eight weeks and six to eight months after the mailing of the educational material. These time frames were selected to assess short- and longer-term impact of the interventions.
Results of the study revealed that coping strategies in younger women changed over time. Seeking social support, spirituality, wishful thinking, and making changes decreased over time and detachment increased. Positive cognitive restructuring (reinterpreting something stressful as positive or helpful) was the most frequently used coping strategy and its use remained high over time. Keeping feelings to oneself was the least used coping strategy and its use remained consistently low over time.
Despite the unique issues and difficulties experienced by younger women with breast cancer, their coping strategies do not appear different from those of women with breast cancer in general regardless of age.
The reciprocal relationship between QOL and coping strategies during the year following diagnosis showed an interesting pattern. Coping at one time point showed little predictive value of subsequent QOL. However, poorer QOL was a significant predictor of greater use of several coping strategies (seeking social support, keeping feelings to self and wishful thinking) at subsequent time points. This finding suggests that people adapt their coping strategies in response to problems with which they are dealing.
While the study had several limitations (e.g. sample comprised predominantly of higher educated Caucasian women and only younger women), it adds a valuable contribution to the literature on coping with cancer.
"We emphasize, however, that this finding is suggestive and not definitive," Danhauer said. "The relationship between coping strategies and QOL is complicated and future studies should examine this reciprocal relationship."
SOURCES:
Wake Forest University Baptist Medical Center (http://www.wfubmc.edu)
Study Finds Pregnancy Has No Impact on Breast Cancer Survival But Can Delay Treatment, Diagnosis
Young women who develop breast cancer during their pregnancy, or who are diagnosed within one year of their pregnancy, have no difference in rates of local recurrence, distant metastases and overall survival compared to other young women with the disease, according to researchers at The University of Texas M. D. Anderson Cancer Center.
However, the largest single-institution study to look at pregnant breast cancer patients finds that women with Pregnancy Associated Breast Cancer (PABC), are more likely to be diagnosed later with advanced stages of the disease and, thus, have necessary treatment delayed.
The findings are published in the journal Cancer.
"Breast cancer in young women is a highly aggressive disease, and it's important that we study it in hopes of making a difference in terms of treatment," said Beth Beadle, M.D., a radiation oncology resident at M. D. Anderson and the study's first author. "When we looked at our young breast cancer population, a relatively large percentage had disease affiliated with pregnancy. We thought it would be really instructive to review our data to determine how we can best serve these women."
It's estimated that up to 3.8 percent of pregnancies are complicated by breast cancer, and approximately 10 percent of breast cancer patients under age 40 develop the disease during pregnancy, said the researchers. As the age for first and subsequent pregnancies increases and intersects with advances in imaging and screening, this statistic will only continue to climb, explained George Perkins, M.D., associate professor in M. D. Anderson's Department of Radiation Oncology.
"Because we see care for a large volume of patients who are young, as well as those who are young and pregnant, we wanted to see if there was something additive going on that is attributed to pregnancy, or if the response to treatment and behavior of the disease is a phenomenon of young age itself," said Perkins, the study's senior author.
For the retrospective study, Beadle, Perkins and their colleagues reviewed the records of 652 M. D. Anderson breast cancer patients, all were 35-years-old or younger at the time of diagnosis and treated at M. D. Anderson between 1973 and 2006. Of those women, 104 (15.6 percent) had PABC - 51 developed their cancer during their pregnancy and 53 developed the disease within one year post-pregnancy. Median follow-up for PABC patients compared to non-PABC patients was 95.5 months versus 91 months respectively.
When comparing the PABC and the non-PABC cohorts, the researchers found no statistical difference between the 10-year rates of: locoregional recurrence (23.4 percent, PABC; 19.2 percent, non-PABC), metastasis (45.1, percent PABC; 38.9 percent, non-PABC), or overall survival (64.6 percent, PABC; 64.8 percent, non-PABC).
"What we did find, however, is that women with PABC presented with more advanced disease, both in the breast and lymph nodes," said Beadle. "These women seem to have a significant delay in diagnosis, and their symptoms were not identified as breast cancer for an extended period of time - putting them at a disadvantage by withholding necessary treatment."
In an analysis of the 51 PABC patients who developed breast cancer during their pregnancy, 26 received some form of treatment; 25 received no therapy. Of those 25, 22 patients (88 percent) had disease symptoms that were not evaluated; three had a breast cancer diagnosis but were advised not to begin treatment until after delivery.
In PABC patients, the overall survival in those who received therapy was 78.7 percent, compared to 44.7 percent in those who receive none, though researchers caution that these statistics reflect a small sample size. Regardless, the researchers say it's important to note that there was no difference in the statistic by decade, reiterating there's still progress to be made in terms of diagnosing and treating the disease during pregnancy.
"Women really need to be aware of changes to their breasts that persist, even during pregnancy and to discuss these changes immediately with their doctor," said Perkins. "The study also proves that there's a vital opportunity for physicians to focus on complete breast care during a patient's pregnancy, and should include cancer as a possible diagnosis. Persistent complaints should be monitored aggressively, with breast exams, imaging and biopsy, all being conducted as necessary."
SOURCES:
University of Texas M.D. Anderson Cancer Center (http://www.mdanderson.org)