Predicting negative mood state and personal growth in African American and white long-term breast cancer survivors
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background: Relatively little research has examined cognitive processes that may impact psychological adaptation in older longterm breast cancer survivors (BCS).Purpose: This study investigated the strength of a conceptual model based on the literature and Uncertainty in Illness Theories which proposes that negative mood state and personal growth in older long-term White and African American BCS would be predicted by the combined influences of demographic and disease variables, social support, religious participation, and cognitive processes (uncertainty, catastrophizing, troublesome thoughts, and cognitive reframing).Methods: Baseline data were gathered from 524 BCS (369 Whites and 155 African Americans, 5-9 years postdiagnosis) prior to their participating in an uncertainty management intervention program. The conceptual model was tested using structural equation modeling.Results: The multigroup model showed good fit to the data and explained substantial variance in negative mood state and personal growth. Cognitive processes showed both direct and indirect effects on outcomes in the expected directions. Several ethnic differences were found: African Americans were more negatively affected by comorbidities and Whites by symptom distress, whereas cognitive reframing was a stronger predictor of personal growth for African Americans than Whites.Conclusions: This is one of the first studies to explore predictors of both negative mood and personal growth in a multiethnic sample of BCS. These findings suggest that cognitive processes play an important role in psychological adaptation to breast cancer survivorship. These processes are amenable to change, suggesting a logical target for intervention with this population.
Dr. Margaret Clayton is now at the University of Utah School of Nursing. Dr. Michael Belyea is now at Arizona State University School of Nursing.
This research was in part supported by grants from the National Institute of Health, National Cancer Institute 1R01 CA78955-02, M. Mishel, Principal Investigator, and 1RO1 CA107477-01, D. Baucom, Principal Investigator.
We thank Chanetta Washington, Project Manager; Susan Campbell and Betsy Clarke, Data Managers; and Guosheng Yin for assistance with data analyses; and all study participants for their time and effort.
Ries LAG, Eisner MP, Kosary CL, et al. (eds):SEER Cancer Statistics Review, 1975-2002. Retrieved October 22,2004 from http://seer.cancer.gov/csr/1975_2002
Ganz PA, Desmond KA, Leedham B, et al.: Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study.Journal of the National Cancer Institute. 2002,94:39–49.PubMed
Gil KM, Mishel MH, Belyea M, et al.: Triggers of uncertainty about recurrence and treatment side effects in long term older breast cancer survivors.Oncology Nursing Forum. 2004,31:1–7.CrossRef
Nelson JP: Struggling to gain meaning: Living with the uncertainty of breast cancer.Advances in Nursing Science. 1996,18:59–76.PubMed
Mishel MH: Uncertainty in illness.Image: Journal of Nursing Scholarship. 1988,20:225–232.CrossRef
Mishel MH: Reconceptualization of the uncertainty in illness theory.Image: Journal of Nursing Scholarship. 1990,22:256–262.CrossRef
Mast ME: Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress.Oncology Nursing Forum. 1998,25:555–562.PubMed
Thornton A: Perceiving benefits in the cancer experience.Journal of Clinical Psychology in Medical Settings. 2002,9:153–165.CrossRef
Gaston-Johansson F, Ohly KV, Fall-Dickson JM, Nanda JP, Kennedy MJ: Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation.Oncology Nursing Forum. 1999,26:1337–1345.PubMed
Lazarus RS, Folkman S:Stress, Appraisal, and Coping. New York: Springer, 1984.
Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology. 1986,151:1173–1182.CrossRef
Giedzinski AS, Meyerowitz BE, Ganz PA, Rowland JH: Health-related quality of life in a multiethnic sample of breast cancer survivors.Annals of Behavioral Medicine. 2004,28:39–51.CrossRef
Mishel M, Germino B, Gil K, et al.: Benefits from an uncertainty management intervention for older long-term breast cancer.Psycho-oncology (in press, 2005).
Koenig HG: An abbreviated Mini-Mental State Examination for medically ill older adults.Journal of the American Geriatrics Society. 1996,44:215–216.PubMed
Boon H, Stewart M, Kennard MA, et al.: Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions.Journal of Clinical Oncology. 2000,18:2515–2521.PubMed
Morris KT, Johnson N, Homer L, Walts D: A comparison of complementary therapy use between breast cancer patients and other primary tumor sites.The American Journal of Surgery. 2000,179:407–411.CrossRef
Satariano WA, Ragheb NE, Dupuis MH: Comorbidity in older women with breast cancer: An epidemiologic approach. In Yancik R, Yates J (eds),Cancer in the Elderly: Approaches to Early Detection and Treatment. New York: Springer, 1989, 71–107.
Sarason IG, Levine HM, Basham RB, Sarason BR: Assessing social support: The social support questionnaire.Journal of Personality and Social Psychology. 1983,44:127–139.CrossRef
Brown DR, Gary LE: Stressful life events, social support networks, and the physical and mental health of urban black adults.Journal of Human Stress. 1987,Winter:165-173.
Gil KM, Williams DA, Keefe FJ, Beckman JC: The relationship of negative thoughts to pain and psychological distress.Behavior Therapy. 1990,21:349–362.CrossRef
Rosenbaum M: Learned resourcefulness as a behavioral repertoire for the self-regulation of internal events: Issues and speculations. In Rosenbaum M, Franks CM, Jaffe Y (eds),Perspectives on Behavior Therapy in the Eighties. New York: Springer, 1983, 54–73.
Mishel MH, Fleury J: The growth through uncertainty scale. Unpublished manuscript.
Schnoll RA, Fang CY, Manne SL: The application of SEM to behavioral research in oncology: Past accomplishments and future opportunities.Structural Equation Modeling. 2004,11:583–614.CrossRef
Norris AE: Structural Equation Modeling. In Munro BH (ed),Statistical Methods for Health Care Research, 4th Edition. Philadelphia: Lippincott, 2001, 379–404.
Byrne BM:Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2001.
Northouse LL, Caffey M, Deichelbohrer L, et al.: The quality of life of African American women with breast cancer.Research in Nursing & Health. 1999,22:449–460.CrossRef
Bower JE, Low C, Ganz PA, et al.: Predictors and outcomes of growth among women confronting breast cancer.Annals of Behavioral Medicine. 2004,27:103.
- Predicting negative mood state and personal growth in African American and white long-term breast cancer survivors
Annals of Behavioral Medicine
Volume 31, Issue 3 , pp 195-204
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Duke University Medical Center, Box 90399, 27708, Durham, NC
- 2. School of Nursing, University of North Carolina at Chapel Hill, P.O. Box 7460, 27599, Chapel Hill, NC