Journal of Behavioral Medicine

, Volume 40, Issue 6, pp 875–885 | Cite as

Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis

  • Lauren N. HarrisEmail author
  • Margaret R. Bauer
  • Joshua F. Wiley
  • Constance Hammen
  • Jennifer L. Krull
  • Catherine M. Crespi
  • Karen L. Weihs
  • Annette L. Stanton


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.


Stress Life events Breast cancer Physical symptoms Survivorship 



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.

Compliance with ethical standards

Conflict of interest

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.

Human and animal rights and Informed consent

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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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Lauren N. Harris
    • 1
    Email author
  • Margaret R. Bauer
    • 1
  • Joshua F. Wiley
    • 2
  • Constance Hammen
    • 1
  • Jennifer L. Krull
    • 1
  • Catherine M. Crespi
    • 3
  • Karen L. Weihs
    • 4
  • Annette L. Stanton
    • 5
  1. 1.Department of PsychologyUCLALos AngelesUSA
  2. 2.School of Psychological SciencesMonash UniversityMelbourneAustralia
  3. 3.Department of Biostatistics, UCLA School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer CenterUCLALos AngelesUSA
  4. 4.Department of Psychiatry, Cancer Prevention and Control Program, University of Arizona Cancer CenterUniversity of ArizonaTucsonUSA
  5. 5.Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer CenterUCLALos AngelesUSA

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