Direct and Buffering Effects of Social Support Among Gynecologic Cancer Survivors
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
There are few studies of QoL among long-term gynecologic cancer survivors; available data suggest significant sequelae of disease and treatment. Research clarifying circumstances that improve difficult survivorship trajectories is lacking.
The present study examines whether social support moderates the relationship between physical functioning and psychological outcomes by testing the stress-buffering hypothesis.
Participants (N = 260) were gynecologic cancer survivors (cervical, n = 47; endometrial, n = 133; ovarian, n = 69; vulvar, n = 11). Compromised physical health was conceptualized as multidimensional. Social support (SNI, PSS-Fa, PSS-Fr, ISEL) was tested as a buffer of adverse psychological outcomes (IES-R, CES-D).
Results for traumatic stress provided evidence for buffering; whereas social support was of general benefit for depressive symptoms. Effects varied by source and type of support.
These results suggest that circumstances for gynecologic cancer survivors burdened with physical symptoms may be worse for those with fewer support resources, providing needed insight into a common target of psychosocial interventions for cancer survivors.
- Aziz NM. Cancer survivorship research: State of knowledge, challenges and opportunities. Acta Oncol. 2007; 46: 417-432. CrossRef
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin. 2009; 59: 225-249. CrossRef
- Ferlay J, Bray F, Pisani P, Parkin D. GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide. IARC CancerBase No 5 version 20 2004. Available at: http://www-dep.iarc.fr/. Accessibility verified January 12, 2009.
- Carpenter KM, Andersen BL. Psychological and sexual aspects of gynecologic cancer. Global Library of Women’s Medicine 2008. Available at: http://www.glowm.com. Accessibility verified February 12, 2009.
- Carlsson M, Strang P, Bjurstrom C. Treatment modality affects long-term quality of life in gynaecological cancer. Anticancer Res. 2000; 20: 563-568.
- Wenzel LB, Donnelly JP, Fowler JM, et al. Resilience, reflection, and residual stress in ovarian cancer survivorship: A gynecologic oncology group study. Psychooncology. 2002; 11: 142-153. CrossRef
- Li C, Samsioe G, Iosif C. Quality of life in endometrial cancer survivors. Maturitas. 1999; 31: 227-236. CrossRef
- Matthews AK, Aikens JE, Helmrich SP, Anderson DD, Herbst AL, Waggoner SE. Sexual functioning and mood among long-term survivors of clear-cell adenocarcinoma of the vagina or cervix. J Psychosoc Oncol. 1999; 17: 27-45. CrossRef
- Stewart DE, Wong F, Duff S, Melancon CH, Cheung AM. “What doesn't kill you makes you stronger:” An ovarian cancer survivor survey. Gynecol Oncol. 2001; 83: 537-542. CrossRef
- Hodgkinson K, Butow P, Fuchs A, et al. Long-term survival from gynecologic cancer: Psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol. 2007; 104: 381-389. CrossRef
- Frumovitz M, Sun CC, Schover LR, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005; 23: 7428-7436. CrossRef
- Carpenter KM, Andersen BL, Fowler JM, Maxwell GL. Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors. Arch Sex Behav. 2009; 38: 828-841. CrossRef
- Bradley S, Rose S, Lutgendorf S, Costanzo E, Anderson B. Quality of life and mental health in cervical and endometrial cancer survivors. Gynecol Oncol. 2006; 100: 479. CrossRef
- Lutgendorf SK, Anderson B, Sorosky JI, Buller RE, Lubaroff DM. Interleukin-6 and use of social support in gynecologic cancer patients. Int J Behav Med. 2000; 7: 127-142. CrossRef
- Lamkin DM, Lutgendorf SK, McGinn S, et al. Positive psychosocial factors and NKT cells in ovarian cancer patients. Brain Behav Immun. 2008; 22: 65-73. CrossRef
- Lutgendorf SK, Lamkin DM, DeGeest K, et al. Depressed and anxious mood and T-cell cytokine expressing populations in ovarian cancer patients. Brain Behav Immun. 2008; 22: 890-900. CrossRef
- Miller BE, Pittman B, Case D, McQuellon RP. Quality of life after treatment for gynecologic malignancies: A pilot study in an outpatient clinic. Gynecol Oncol. 2002; 87: 178-184. CrossRef
- Michael YL, Berkman LF, Colditz GA, Holmes MD, Kawachi I. Social networks and health-related quality of life in breast cancer survivors: A prospective study. J Psychosom Res. 2002; 52: 285-293. CrossRef
- Parker PA, Baile WF, DeMoor C, Cohen L. Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology. 2003; 12: 183-193. CrossRef
- Andrykowski MA, Cordova MJ, McGrath PC, Sloan DA, Kenady DE. Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: A 1-year follow-up. Psychooncology. 2000; 9: 69-78. CrossRef
- Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003; 30: 799-813. CrossRef
- Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol. 2006; 24: 1105-1111. CrossRef
- Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98: 310-357. CrossRef
- Spira JL, Reed GM. Group Psychotherapy for Women with Breast Cancer. Washington, D.C.: American Psychological Association; 2002.
- Scott JL, Halford WK, Ward BG. United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. J Consult Clin Psychol. 2004; 72: 1122-1135. CrossRef
- Manne SL, Ostroff JS, Winkel G, et al. Couple-focused group intervention for women with early stage breast cancer. J Consult Clin Psychol. 2005; 73: 634-646. CrossRef
- Antoni MH. Stress Management Intervention for Women with Breast Cancer. Washington, D.C.: American Psychological Association; 2002.
- Andersen BL. Biobehavioral outcomes following psychological interventions for cancer patients. J Consult Clin Psychol. 2002; 70: 590-610. CrossRef
- Spiegel D, Classen C. Group Therapy for Cancer Patients: A Research-based Handbook of Psychosocial Care. New York: Basic Books; 2000.
- Brothers BM, Andersen BL. Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence. Psychooncology. 2009; 18: 267-275. CrossRef
- Kornblith AB, Herndon JE, Weiss RB, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer. 2003; 98: 679-689. CrossRef
- Classen C, Butler LD, Koopman C, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer. Arch Gen Psychiatry. 2001; 58: 494-501. CrossRef
- Hays RB, Turner H, Coates TJ. Social support, AIDS-related symptoms, and depression among gay men. J Consult Clin Psychol. 1992; 60: 463-469. CrossRef
- Lepore SJ. A social-cognitive processing model of emotional adjustment to cancer. In: Baum A, Andersen BL, eds. Psychosocial Interventions for Cancer. Washington, D.C: American Psychological Association; 2001: 99-116. CrossRef
- Andersen BL, Anderson B, de Prosse C. Controlled prospective longitudinal study of women with cancer: II. Psychological outcomes. J Consult Clin Psychol. 1989; 57: 692-697. CrossRef
- Klee M, Thranov I, Machin D. Life after radiotherapy: The psychological and social effects experienced by women treated for advanced stages of cervical cancer. Gynecol Oncol. 2000; 76: 5-13. CrossRef
- Lethbridge-Cejku M, Schiller JS, Bernadel L (2004). Summary health statistics for U.S. adults: National Health Interview Survey, 2002. Vital Health Stat 10. (222):1-151.
- Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. J Clin Oncol. 1993; 11: 570-579.
- Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34: 220-233. CrossRef
- Moinpour CM, Feigl P, Metch B, Hayden KA, Meyskens FL Jr, Crowley J. Quality of life end points in cancer clinical trials: Review and recommendations. J Natl Cancer Inst. 1989; 81: 485-495. CrossRef
- Bower JE, Ganz PA, Desmond KA, et al. Fatigue in long-term breast carcinoma survivors. Cancer. 2006; 106: 751-758. CrossRef
- Hann DM, Jacobsen PB, Azzarello LM, et al. Measurement of fatigue in cancer patients: Development and validation of the Fatigue Symptom Inventory. Qual Life Res. 1998; 7: 301-310. CrossRef
- Procidano ME, Heller K. Measures of perceived social support from friends and from family: Three validation studies. Am J Community Psychol. 1983; 11: 1-24. CrossRef
- Cohen S, Mermelstein R, Kamarck T, Hoberman H. Measuring the functional components of social support. In: Sarason IG, Sarason BR, eds. Social Support: Theory, Research and Application. The Hague: Martinus Nijhoff; 1985: 73-94.
- Berkman LF, Syme SL. Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979; 109: 186-204.
- Cortina JM. What is coefficient alpha? J Appl Psychol. 1993; 78: 98-104. CrossRef
- Weiss D, Marmar C. The impact of event scale-revised. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD. New York: Guilford; 1996: 399-411.
- Shapinsky AC, Rapport LJ, Henderson MJ, Axelrod BN. Civilian PTSD scales: Relationships with trait characteristics and everyday distress. Assessment. 2005; 12: 220-230. CrossRef
- Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D depression symptoms index. J Aging Health. 1993; 5: 179-193. CrossRef
- Cohen J, Cohen P, West S, Aiken L. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Mahwah: Lawrence Erlbaum Associates; 2003.
- Preacher K. A Primer on Interaction Effects in Multiple Linear Regression. Chapel Hill, NC: copyrighted manuscript; 2003.
- Riddle DL, Lee KT, Stratford PW. Use of SF-36 and SF-12 health status measures: A quantitative comparison for groups versus individual patients. Med Care. 2001; 39: 867-878. CrossRef
- Wenzel LB, Huang HQ, Monk BJ, Rose PG, Cella D. Quality-of-life comparisons in a randomized trial of interval secondary cytoreduction in advanced ovarian carcinoma: A Gynecologic Oncology Group study. J Clin Oncol. 2005; 23: 5605-5612. CrossRef
- Janda M, Obermair A, Cella D, et al. The functional assessment of cancer-vulvar: Reliability and validity. Gynecol Oncol. 2005; 97: 568-575. CrossRef
- Monk BJ, Huang HQ, Cella D, Long HJ. Quality of life outcomes from a randomized phase III trial of cisplatin with or without topotecan in advanced carcinoma of the cervix: A Gynecologic Oncology Group study. J Clin Oncol. 2005; 23: 4617-4625. CrossRef
- Sadler IJ, Jacobsen PB, Booth-Jones M, Belanger H, Weitzner MA, Fields KK. Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue. J Pain Symptom Manage. 2002; 23: 406-416. CrossRef
- Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. J Pain Symptom Manage. 1999; 18: 233-242. CrossRef
- Stein MB, McQuaid JR, Pedrelli P, Lenox R, McCahill ME. Posttraumatic stress disorder in the primary care medical setting. Gen Hosp Psychiatry. 2000; 22: 261-269. CrossRef
- Carpenter JS, Andrykowski MA, Wilson J, et al. Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues Ment Health Nurs. 1998; 19: 481-494. CrossRef
- Bjordal K, Kaasa S. Psychological distress in head and neck cancer patients 7–11 years after curative treatment. Br J Cancer. 1995; 71: 592-597.
- Vickberg SMJ, Duhamel KN, Smith MY, et al. Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology. 2001; 10: 29-39. CrossRef
- Horowitz MJ. Stress Response Syndromes. 2nd ed. New York: Jason Aronson; 1986.
- Wenger DM. Ironic processes of mental control. Psychol Rev. 1994; 101: 34-52. CrossRef
- Bootzin RR. Examining the theory and clinical utility of writing about emotional experiences. Psychol Sci. 1997; 8: 167-169. CrossRef
- Lepore SJ, Silver RC, Wortman CB, Wayment HA. Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. J Pers Soc Psychol. 1996; 70: 271-282. CrossRef
- Lepore SJ, Ragan JD, Jones S. Talking facilitates cognitive-emotional processes of adaptation to an acute stressor. J Pers Soc Psychol. 2000; 78: 499-508. CrossRef
- Lepore SJ, Greenberg MA. Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment, and mental health following a relationship breakup. Psychol Health. 2002; 17: 547-560. CrossRef
- Mortimer J, Sephton SE, Kimerling R, Butler L, Bernstein AS, Spiegel D. Chronic stress, depression, and immunity in spouses of metastatic breast cancer patients. Clin Psychologist. 2005; 9: 59-63. CrossRef
- Manne S, DuHamel K, Redd WH. Association of psychological vulnerability factors to post-traumatic stress symptomatology in mothers of pediatric cancer survivors. Psychooncology. 2000; 9: 372-384. CrossRef
- Manne S, Glassman M. Perceived control, coping efficacy, and avoidance coping as mediators between spousal unsupportive behaviors and psychological distress. Health Psychol. 2000; 19: 155-164. CrossRef
- Rini C, Manne S, DuHamel K, et al. Social support from family and friends as a buffer of low spousal support among mothers of critically ill children: A multilevel modeling approach. Health Psychol. 2008; 27: 593-603. CrossRef
- Schnoll RA, Knowles JC, Harlow L. Correlates of adjustment among cancer survivors. J Psychosoc Oncol. 2002; 20: 37-60. CrossRef
- Helgeson VS. Social support and quality of life. Qual Life Res. 2003; 12(Suppl 1): 25-31. CrossRef
- Penninx B, Van Tilburg T, Boeke A, Deeg D, Kriegsman D, Van Eijk J. Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases? Health Psychol. 1998; 17: 551-558. CrossRef
- Penninx B, van Tilburg T, Deeg D, Kriegsman D, Boeke A, van Eijk J. Direct and buffer effects of social support and personal coping resources in individuals with arthritis. Soc Sci Med. 1997; 44: 393-402. CrossRef
- Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. Social support, life stress, pain, and emotional adjustment to advanced breast cancer. Psychooncology. 1998; 7: 101-111. CrossRef
- Feldman PJ, Cohen S, Doyle WJ, Skoner DP, Gwaltney JM. The impact of personality on the reporting of unfounded symptoms and illness. J Pers Soc Psychol. 1999; 77: 370-378. CrossRef
- Willoughby SG, Hailey BJ, Mulkana S, Rowe J. The effect of laboratory-induced depressed mood state on responses to pain. Behav Med. 2002; 28: 23-31. CrossRef
- Kaufmann PG. Psychosocial interventions in breast cancer: To light a candle. Cancer. 2009; 115: 5617-5619. CrossRef
- Katapodi MC, Facione NC, Miaskowski C, Dodd MJ, Waters C. The influence of social support on breast cancer screening in a multicultural community sample. Oncol Nurs Forum. 2002; 29: 845-852. CrossRef
- Ell K, Sanchez K, Vourlekis B, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol. 2005; 23: 3052-3060. CrossRef
- Hogan BE, Linden W, Najarian B. Social support interventions: Do they work? Clin Psychol Rev. 2002; 22: 381. CrossRef
- Andersen BL, Shelby RA, Golden-Kreutz DM. RCT of a psychological intervention for patients with cancer: I. mechanisms of change. J Consult Clin Psychol. 2007; 75: 927-938. CrossRef
- Direct and Buffering Effects of Social Support Among Gynecologic Cancer Survivors
Annals of Behavioral Medicine
Volume 39, Issue 1 , pp 79-90
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Gynecologic cancer
- Cancer survivorship
- Social support
- Traumatic stress
- Depressive symptoms
- Industry Sectors
- Author Affiliations
- 1. Department of Psychology, The Ohio State University, 1835 Neil Avenue, 159 Psychology Building, Columbus, OH, 43210, USA
- 2. Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA
- 3. Gynecologic Disease Center and U.S. Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA