Cancer Causes & Control

, Volume 28, Issue 1, pp 23–39 | Cite as

Intimate partner violence and women’s cancer quality of life

  • Ann L. CokerEmail author
  • Diane R. Follingstad
  • Lisandra S. Garcia
  • Heather M. Bush
Original paper



Because intimate partner violence (IPV) may disproportionately impact women’s quality of life (QOL) when undergoing cancer treatment, women experiencing IPV were hypothesized to have (a) more symptoms of depression or stress and (b) lower QOL as measured with the Functional Assessment of Cancer Therapy (FACT-B) and Functional Assessment of Chronic Illness Therapy—Spiritual Well-being (FACIT-SP) Scales relative to those never experiencing IPV.


Women, aged 18–79, who were included in one of two state cancer registries from 2009 to 2015 with a recent incident, primary, invasive biopsy-confirmed cancer diagnosis were recruited and asked to complete a phone interview, within 12 months of diagnosis. This interview measured IPV by timing (current and past) and type (physical, sexual, psychological), socio-demographics, and health status. Cancer registries provided consenting women’s cancer stage, site, date of diagnosis, and age.


In this large cohort of 3,278 women who completed a phone interview, 1,221 (37.3%) disclosed lifetime IPV (10.6% sexual, 24.5% physical, and 33.6% psychological IPV). Experiencing IPV (particularly current IPV) was associated with poorer cancer-related QOL defined as having more symptoms of depression and stress after cancer diagnosis and lower FACIT-SP and FACT scores than women not experiencing IPV and controlling for confounders including demographic factors, cancer stage, site, and number of comorbid conditions. Current IPV was more strongly associated with poorer QOL. When compared with those experiencing past IPV (and no IPV), women with cancer who experienced current IPV had significantly higher depression and stress symptoms scores and lower FACIT-SP and FACT-G scores indicating poorer QOL for all domains. While IPV was not associated with being diagnosed at a later cancer stage, current IPV was significantly associated with having more than one comorbid physical conditions at interview (adjusted rate ratio = 1.35; 95% confidence interval 1.19–1.54) and particularly for women diagnosed with cancer when <55 years of age.


Current and past IPV were associated with poorer mental and physical health functioning among women recently diagnosed with cancer. Including clinical IPV screening may improve women’s cancer-related QOL.


Spouse abuse Partner violence Cancer registries Quality of life (QOL) Survivorship Epidemiology 



This paper reflects results obtained from a study funded by NIH 5R01MD004598.

Compliance with ethical standards

Conflict of interest

No competing financial interests exist.


  1. 1.
    Logan TK, Walker R, Jordan CE et al (2006) Women and victimization: contributing factors, interventions, and implications. American Psychological Association, WashingtonCrossRefGoogle Scholar
  2. 2.
    Coker AL, Williams C, Follingstad D et al (2011) Psychological, reproductive and maternal health, behavioral and economic impact. In: White JW, Koss MP, Kazdin AE (eds) Violence against women and children: consensus, critical analyses, and emergent priorities. Volume I: mapping the terrain. American Psychological Association, Washington, pp 265–284CrossRefGoogle Scholar
  3. 3.
    Modesitt SC, Gambrell AC, Cottrill HM et al (2006) Adverse impact of a history of violence for women with breast, cervical, endometrial, or ovarian cancer. Obstet Gynecol 107:1330–1336CrossRefPubMedGoogle Scholar
  4. 4.
    Coker AL, Follingstad D, Garcia LS et al (2012) Association of intimate partner violence and childhood sexual abuse with cancer-related well-being in women. J Women’s Health 21:1180–1188CrossRefGoogle Scholar
  5. 5.
    Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra RR (2015) Intimate partner violence surveillance: uniform definitions and recommended data elements, version 2.0. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta.
  6. 6.
    Black MC, Basile KC, Breiding MJ et al (2011) The National Intimate Partner and Sexual Violence Survey (NIDVS): 2010 summary report. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  7. 7.
    Coker AL, Hopenhayn C, DeSimone CP, Bush HM, Crofford L (2009) Violence against women raises risk of cervical cancer. J Women’s Health 18(8):1179–1185CrossRefGoogle Scholar
  8. 8.
    Golding JM (1999) Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Viol 14:99–132CrossRefGoogle Scholar
  9. 9.
    Baum A, Trevino LA, Dougall AJL (eds) (2011) Stress and cancers. Springer, New YorkGoogle Scholar
  10. 10.
    Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115:5349–5361CrossRefPubMedGoogle Scholar
  11. 11.
    Denaro N, Tomasello L, Russi EG (2014) Cancer and stress: what’s matters? From epidemiology: the psychologist and oncologist point of view. J Cancer Ther Res 3:1–11CrossRefGoogle Scholar
  12. 12.
    Afifi TO, MacMillan HL, Boyle M, Cheung K, Taillieu T, Turner S, Sareen J (2016) Child abuse and physical health in adulthood. Health Rep 27(3):10–18PubMedGoogle Scholar
  13. 13.
    Hathaway JE, Mucci LA, Silverman JG et al (2000) Health status and health care use of Massachusetts women reporting partner abuse. Am J Prev Med 19:302–307CrossRefPubMedGoogle Scholar
  14. 14.
    Thananowan N, Vongsirimas N (2016) Factors mediating the relationship between intimate partner violence and cervical cancer among Thai women. J Interpers Violence 31(4):715–731. doi: 10.1177/0886260514556108 CrossRefPubMedGoogle Scholar
  15. 15.
    Farley MS, Golding JA, Minkoff JR (2002) Is a history of trauma associated with a reduced likelihood of cervical cancer screening? J Fam Pract 51:827–831PubMedGoogle Scholar
  16. 16.
    Loxton D, Powers J, Schofield M et al (2009) Inadequate cervical cancer screening among mid-aged Australian women who have experienced partner violence. Prev Med 48:184–188CrossRefPubMedGoogle Scholar
  17. 17.
    Gandhi S, Rovi S, Vega M, Johnson MS, Ferrante J, Chen P-H (2010) Intimate partner violence and cancer screening among urban minority women. J Am Board Fam Med 23(3):343–353. doi: 10.3122/jabfm.2010.03.090124 CrossRefPubMedGoogle Scholar
  18. 18.
    Brown MJ, Weitzen S, Lapane KL (2013) Association between intimate partner violence and preventive screening among women. J Women’s Health 22(11):947–952. doi: 10.1089/jwh.2012.4222 CrossRefGoogle Scholar
  19. 19.
    Lemon SC, Verhoek-Oftedahl W, Donnelly EF (2002) Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner violence. J Women’s Heath 11(6):555–562Google Scholar
  20. 20.
    Coker AL, Bond SM, Pirisi LA (2006) Life stressors are an important reason for women discontinuing follow-up care for cervical neoplasia. Cancer Epidemiol Biomarkers 15:321–325CrossRefGoogle Scholar
  21. 21.
    Martino MA, Balar A, Cragun JM et al (2005) Delay in treatment of invasive cervical cancer due to intimate partner violence. Gynecol Oncol 99:507–509CrossRefPubMedGoogle Scholar
  22. 22.
    Kimerling R, Alvarez J, Pavao J et al (2009) Unemployment among women examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder. J Interpers Violence 24:450–463CrossRefPubMedGoogle Scholar
  23. 23.
    Coker AL, Smith PH, Thompson MP et al (2002) Social support protects against the negative effects of partner violence on mental health. J Women’s Health 11:465–476Google Scholar
  24. 24.
    Curry MA, Hassouneh-Phillips D et al (2001) Abuse of women with disabilities—an ecological model and review. Violence Against Women 7:60–79CrossRefGoogle Scholar
  25. 25.
    Pinquart M, Duberstein PR (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40:1797–1810CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Campbell JC, Kub J, Belknap RA et al (1997) Predictors of depression in battered women. Violence Victims 3:271–293Google Scholar
  27. 27.
    Johnson W, Pieters HC (2016) Intimate partner violence among women diagnosed with cancer. Cancer Nurs 39(2):87–96CrossRefPubMedGoogle Scholar
  28. 28.
    Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB (1996) The revised conflict tactics scales: development and preliminary psychometric data. J Fam Issues 17:283–316CrossRefGoogle Scholar
  29. 29.
    Follingstad DR (2011) A measure of severe psychological abuse normed on a nationally representative sample. J Interpers Violence 26:1194–1214CrossRefPubMedGoogle Scholar
  30. 30.
    Follingstad DR, Coker AL, Lee E, Willimas CM, Bush HM, Mendiondo MM (2015) Validity and psychometric properties of the measure of psychologically abusive behaviors among young women and women in distressed relationships. Violence Against Women 21(7):875–896CrossRefPubMedGoogle Scholar
  31. 31.
    Bonomi AE, Anderson ML, Reid RJ, Carrett D, Fishman PA, Rivara FP, Thompson RS (2007) Intimate partner violence in older women. Gerontologist 47(1):34–41CrossRefPubMedGoogle Scholar
  32. 32.
    Smith PH, Earp JA, DeVellis R (1995) Measuring battering: development of the Women’s Experience With Battering (WEB) Scale. Women’s Health 1:273–288PubMedGoogle Scholar
  33. 33.
    Derogatis LR, Lazarus L (2001) Brief symptom inventory 18: administration, scoring and procedures manual. NCS Pearson, Inc., Minneapolis, MNGoogle Scholar
  34. 34.
    Cohen S, Kamarck T, Mermelstein R (1983) A Global measure of perceived stress. J Health Soc Behav 24:385–396CrossRefPubMedGoogle Scholar
  35. 35.
    Peterman AH, Fitchett G, Brady MJ et al (2002) Measuring spiritual well-being in people with cancer: the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24:49–58CrossRefPubMedGoogle Scholar
  36. 36.
    Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMedGoogle Scholar
  37. 37.
    Rabin RF, Jennings JM, Campbell JC et al (2009) Intimate partner violence screening tools. Am J Prev Med 36:439–445CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Coker AL, Follingstad DR, Garcia LS, Bush HM (2016) Partner interfering behaviors affecting cancer quality of life. Psycho-oncology. doi: 10.1002/pon.4157 Google Scholar
  39. 39.
    MacMillan HL, Wathen CN, Jamieson E et al (2009) Screening for intimate partner violence in health care settings: a randomized trial. JAMA 302:493–501CrossRefPubMedGoogle Scholar
  40. 40.
    McFarlane JM, Groff JY, O’Brien JA et al (2006) Secondary prevention of intimate partner violence: a randomized controlled trial. Nurs Res 55:52–61CrossRefPubMedGoogle Scholar
  41. 41.
    Institute of Medicine (2011) Clinical preventive services for women: closing the gaps. The National Academies Press, WashingtonGoogle Scholar
  42. 42.
    Moyer VA, Force UPST (2013) Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med 158:1–28CrossRefGoogle Scholar
  43. 43.
    McFarlane J, Malecha A, Gist J et al (2002) An intervention to increase safety behaviors of abused women—results of a randomized clinical trial. Nurs Res 51:347–354CrossRefPubMedGoogle Scholar
  44. 44.
    Cesario SK, McFarlane J, Nava A et al (2013) Linking cancer and intimate partner violence: the importance of screening women in the Oncology setting. Clin J Oncol Nurs 18:65–73CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Ann L. Coker
    • 1
    • 2
    Email author
  • Diane R. Follingstad
    • 1
  • Lisandra S. Garcia
    • 2
  • Heather M. Bush
    • 1
  1. 1.Center for Research on Violence Against WomenUniversity of KentuckyLexingtonUSA
  2. 2.Department of Obstetrics and Gynecology, College of MedicineUniversity of KentuckyLexingtonUSA

Personalised recommendations