Psychological well-being and perceived control after a breast cancer diagnosis

Transcription

1 Psychological well-being and perceived control after a breast cancer diagnosis University Medical Center Groningen, University of Groningen Department of Health Sciences, section Health Psychology Graduate School for Health Research SHARE Promotores Adelita V. Ranchor Robbert Sanderman Co-promotor Jaap de Vries (surgery, UMCG) Grant Dutch Cancer Society Thesis, October 2009 Inge Henselmans Number of papers on psychological issues in breast cancer (Psychinfo) < Study sample 1

2 Study design Predictors Demographic Educational level/age 15% 15% 33% 36% Personal Personal control over life Optimism Neuroticism Medical Cancer stage Type of surgery Type of adjuvant treatment Physical complaints due to surgery Physical complaints due to adjuvant treatment 2

3 No versus late distress? Personal control over life Optimism Neuroticism Physical complaints due to adjuvant treatment Recovery versus chronic distress? Personal control over life Optimism Neuroticism Physical complaints due to adjuvant treatment Many women do not report problems after diagnosis or only during active treatment. Some women start to report problems only after treatment or report problems in all stages. > Monitor distress in all illness stages Trajectories can be predicted by personal characteristics and reported physical complaints due to adjuvant treatment. Women who do not report any distress are well off with respect to both. > Easier to predict no distress than to predict distress Inge Henselmans, Vicki S. Helgeson, Howard Seltman, Jakob de Vries, Robbert Sanderman, Adelita V. Ranchor. Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychology, in press. Most frequent reported indicators of emotional well-being Depressive symptoms (CES-D) Low mood and lack of interest in enjoyable activities Triggered by irrevocable loss, associated with hope- and helplessness Anxiety (STAI-6) Sensation of fear, a state of hyper-arousal Triggered by threat or imminent danger Non-specific distress (GHQ-12) Constellation of symptoms not specific for a single disorder Multi-factor unpleasant emotional experience Discontinuity in normal functioning

4 The first emotional response if mostly characterized by anxiety. Non-specific distress is elevated in almost all stages after diagnosis. Depression is relatively uncommon. > Consequences for screening and interventions Inge Henselmans, James C. Coyne, Robbert Sanderman, Jakob de Vries, Adelita V. Ranchor. Distinct trajectories of anxiety, depression and non-specific distress following diagnosis of breast cancer. In preparation. Perceived personal control over life the extent to which one believes that the outcomes of important events and situations in life are under one s own control instead of being ruled by fate. 4

5 primary threat appraisal worries over the impact breast cancer will have on life (Vinokur, 1990) secondary appraisal self-efficacy for coping with cancer (CBI) Cognitions Cognitions Personal control Adjustment to illness Personal control Adjustment to illness Behavior Behavior Skinner, 1995 Folkman, 1984 Taylor & Stanton, 2007 Skinner, 1995 Folkman, 1984 Taylor & Stanton, 2007 primary threat appraisal worries over the impact breast cancer will have on life (Vinokur, 1990) Initial response secondary appraisal self-efficacy for coping with cancer (CBI).00 n.s. (-.21*) Cognitions Threat appraisal T1 Distress T0 Before diagnosis.52 Personal control Adjustment to illness * Personal control T0 Before diagnosis Distress T1 illness-specific active behavior active patient behavior, e.g. asking questions (KHOS) active behavior in social life remain engaged in social life, e.g. contact with friends, visits (SIP, GSBQ) Behavior Skinner, 1995 Folkman, 1984 Taylor & Stanton, * Coping self-efficacy T1 Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediators models. Behavior Research Methods, 40, Adjustment later on -.17 Threat appraisal T n.s. (-.18*).13 Anxiety T1 a sense of control buffers the impact of a cancer diagnosis because women with a strong sense of control appraise the situation less negative and have more confidence in their coping skills. Personal control T1 Coping self-efficacy T3 Anxiety T5 After end of treatment.46 a sense of control promotes the regulation of anxiety because women with a high sense of control appraise the situation less negative do not disengage from their social life during treatment..39 Active patient behavior T > Consequences for psychosocial caregivers working worth cancer patients. A general sense of control might be hard to change; cancer-specific appraisal and behavior might not. Engagement social life T3 Inge Henselmans, Joke Fleer, Jakob de Vries, Peter C. Baas, Robbert Sanderman, Adelita V. Ranchor. The adaptive effect of personal control when facing breast cancer: cognitive and behavioral mediators. Psychology & Health, 2009 Sep 11, e- pub ahead of print. 5

6 Fighting cancer is: not knowing if you will survive, while in the meantime you try to stay on your feet. This takes courage, perseverance and support, but it is totally different from beating cancer. Cancer survivor is an undeserved and inappropriate term. A better term would be lucky bastard. Armstrong beschrijft zijn gevecht, hoe hij knokte, hoe hij voelde dat hij kankercellen uitkotste. Daarmee zeg je bijna dat het je eigen schuld is als je het niet haalt. Dat je niet hard genoeg hebt gevochten. A sense of personal control is adaptive..at all times, regardless the actual controllability of the situation (Taylor,1983 ; Taylor & Armor, 1996; Thompson, 1999)..only when not disconfirmed by reality (setbacks, deteriorations or a recurrence) (Folkman, 1984; Christensen et al., 1991; Affleck et al.,1987) Toen bij mij kanker werd geconstateerd, ben ik in het ziekenhuis gaan liggen en heb me overgegeven aan de artsen. Je hoort altijd die verhalen dat je positief moet denken, dat je moet knokken om het te overleven. Voor patiënten kan die vechtgedachte heel beklemmend zijn. Er is nooit ook maar enigszins aangetoond dat je door positief denken of vechten geneest. Interview met Maarten Van der Weijden NRC 8 mei 2008 Personal control over cure There is a lot I can do to control my breast cancer What I do, can determine whether I will recover from my breast cancer The cure of my breast cancer depends on me Nothing I do will affect the cure of my breast cancer* I have the power to cure my breast cancer My actions will have no effect on the cure of my breast cancer* Disconfirmation Bad news after surgery: chemotherapy is necessary In short: Does the relation between control over cure an psychological outcomes after surgery depend on the news women receive? Is a sense of control over cure less adaptive when news is bad? 6

7 no no + + Is a sense of control over cure less adaptive when news is bad? NO A sense of control over cure did not have a maladaptive effect when women were confronted with bad news after surgery > In the first year after diagnosis illness specific control perceptions might not need to be altered because of potentially maladaptive effects. 1a. We identified four distinct trajectories in psychological distress 1b. We learned that three indicators of emotional well-being are differntially affected by the 2a. We found cognitive and behavioral mediators that explain the relation between control and well-being. 2b. We found that a strong sense of control over cure does not hurt when one is confronted with bad news after surgery. Inge Henselmans, Robbert Sanderman, Vicki S. Helgeson, Jakob de Vries, Ans Smink, Adelita V. Ranchor. Personal control opver the cure of breast cancer: adaptiveness, underlying beliefs and correlates. Psycho-Oncology, 2009 June 25, e- pub ahead of print. Since October 2009 Fellow Dutch Cancer Society Doctor-patient communication in oncology: the role of the patient Academic Medical Center, University of Amsterdam Medical Psychology 7