Annals of Behavioral Medicine

, Volume 31, Issue 3, pp 195–204 | Cite as

Predicting negative mood state and personal growth in African American and white long-term breast cancer survivors

  • Laura S. Porter
  • Margaret F. Clayton
  • Michael Belyea
  • Merle Mishel
  • Karen M. Gil
  • Barbara B. Germino


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.


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  1. (1).
    Ries LAG, Eisner MP, Kosary CL, et al. (eds):SEER Cancer Statistics Review, 1975-2002. Retrieved October 22,2004 from Scholar
  2. (2).
    Mandelblatt J, Figueiredo M, Cullen J: Outcomes and quality of life following breast cancer treatment in older women: When, why, how much, and what do women want?Health and Quality of Life Outcomes. 2003,1:45.PubMedCrossRefGoogle Scholar
  3. (3).
    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.PubMedGoogle Scholar
  4. (4).
    Kroenke CH, Rosner B, Chen WY, et al.: Functional impact of breast cancer by age of diagnosis.Journal of Clinical Oncology. 2004,22:1849–1856.PubMedCrossRefGoogle Scholar
  5. (5).
    Tomich VS, Helgeson HL: Surviving cancer: A comparison of 5-year disease-free breast cancer survivors with healthy women.Psycho-Oncology. 2005,14:307–317.PubMedCrossRefGoogle Scholar
  6. (6).
    Deimling GT, Kahana B, Bowman KF, Schaefer ML: Cancer survivorship and psychological distress in later life.Psycho-Oncology. 2002,11:479–494.PubMedCrossRefGoogle Scholar
  7. (7).
    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.CrossRefGoogle Scholar
  8. (8).
    Bower JE, Meyerowitz BE, Desmond KA, et al.: Perceptions of positive meaning and vulnerability following breast cancer: Predictors and outcomes among long-term breast cancer survivors.Annals of Behavioral Medicine. 2005,29:236–245.PubMedCrossRefGoogle Scholar
  9. (9).
    Nelson JP: Struggling to gain meaning: Living with the uncertainty of breast cancer.Advances in Nursing Science. 1996,18:59–76.PubMedGoogle Scholar
  10. (10).
    Mishel MH: Uncertainty in illness.Image: Journal of Nursing Scholarship. 1988,20:225–232.CrossRefGoogle Scholar
  11. (11).
    Mishel MH: Reconceptualization of the uncertainty in illness theory.Image: Journal of Nursing Scholarship. 1990,22:256–262.CrossRefGoogle Scholar
  12. (12).
    Mast ME: Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress.Oncology Nursing Forum. 1998,25:555–562.PubMedGoogle Scholar
  13. (13).
    Baum A, Friedman AL, Zakowski SG: Stress and genetic testing for disease risk.Health Psychology. 1997,16:8–19.PubMedCrossRefGoogle Scholar
  14. (14).
    Thornton A: Perceiving benefits in the cancer experience.Journal of Clinical Psychology in Medical Settings. 2002,9:153–165.CrossRefGoogle Scholar
  15. (15).
    Bloom JR: Surviving or thriving?Psycho-Oncology. 2002,11:89–99.PubMedCrossRefGoogle Scholar
  16. (16).
    Wenzel LB, Fairclough DL, Brady MJ, et al.: Age-related differences in the quality of life of breast carcinoma patients after treatment.Cancer. 1999,86:1768–1774.PubMedCrossRefGoogle Scholar
  17. (17).
    Sammarco A: Psychosocial stages and quality of life of women with breast cancer.Cancer Nursing. 2001,24:272–277.PubMedCrossRefGoogle Scholar
  18. (18).
    Bleiker EMA, Pouwer F, van der Ploeg HM, Leer JH, Ader HJ: Psychological distress two years after diagnosis of breast cancer: Frequency and prediction.Patient Education and Counseling. 2000,40:209–217.PubMedCrossRefGoogle Scholar
  19. (19).
    Maly RC, Umezawa Y, Leake B, Silliman RA: Mental health outcomes in older women with breast cancer: Impact of perceived family support and adjustment.Psycho-Oncology. 2005,14:535–545.PubMedCrossRefGoogle Scholar
  20. (20).
    Silliman RA, Dukes KA, Sullivan LM, Kaplan SH: Breast cancer care in older women: Sources of information, social support, and emotional health outcomes.Cancer. 1998,83:706–711.PubMedCrossRefGoogle Scholar
  21. (21).
    Mishel MH, Braden CJ: Uncertainty: A mediator between support and adjustment.Western Journal of Nursing Research. 1987,9:43–57.PubMedCrossRefGoogle Scholar
  22. (22).
    Mishel M, Belyea M, Germino B, et al.: Helping patients with localized prostate cancer manage uncertainty and treatment side effects: Nurse delivered psycho-educational intervention via telephone.Cancer. 2002,94:1854–1866.PubMedCrossRefGoogle Scholar
  23. (23).
    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.PubMedGoogle Scholar
  24. (24).
    Sullivan MJL, Thorn B, Haythornthwaite JA, et al.: Theoretical perspectives on the relation between catastrophizing and pain.Clinical Journal of Pain. 2001,17:52–64. 204PubMedCrossRefGoogle Scholar
  25. (25).
    Lazarus RS, Folkman S:Stress, Appraisal, and Coping. New York: Springer, 1984.Google Scholar
  26. (26).
    Antoni MH, Lehman JM, Klibourn KM, et al.: Cognitive-Behavioral stress management intervention decreases the prevalence of depression and enhances benefit among women under treatment for early-stage breast cancer.Health Psychology. 2001,20:20–32.PubMedCrossRefGoogle Scholar
  27. (27).
    Gil KM, Wilson JJ, Edens JL, et al.: Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease.Health Psychology. 1996,15:3–10.PubMedCrossRefGoogle Scholar
  28. (28).
    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.CrossRefGoogle Scholar
  29. (29).
    Ashing-Giwa KT, Padilla GV, Tejero JS, Kim J: Breast cancer survivorship in a multiethnic sample: Challenges in recruitment and measurement.Cancer. 2004,101:450–465.PubMedCrossRefGoogle Scholar
  30. (30).
    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.CrossRefGoogle Scholar
  31. (31).
    Meyerowitz BE, Richardson J, Hudson S, Leedham B: Ethnicity and cancer outcomes: Behavioral and psychosocial considerations.Psychological Bulletin. 1998,123:47–70.PubMedCrossRefGoogle Scholar
  32. (32).
    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).Google Scholar
  33. (33).
    Koenig HG: An abbreviated Mini-Mental State Examination for medically ill older adults.Journal of the American Geriatrics Society. 1996,44:215–216.PubMedGoogle Scholar
  34. (34).
    Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research. 1975,12:189–198.PubMedCrossRefGoogle Scholar
  35. (35).
    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.PubMedGoogle Scholar
  36. (36).
    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.CrossRefGoogle Scholar
  37. (37).
    McCorkle R, Young K: Development of a symptom distress scale.Cancer Nursing. 19781:373–378.PubMedCrossRefGoogle Scholar
  38. (38).
    McCorkle R, Quint-Benoliel J: Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease.Social Science and Medicine. 1983,17:431–438.PubMedCrossRefGoogle Scholar
  39. (39).
    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.Google Scholar
  40. (40).
    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.CrossRefGoogle Scholar
  41. (41).
    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.Google Scholar
  42. (42).
    Gil KM, Williams DA, Keefe FJ, Beckman JC: The relationship of negative thoughts to pain and psychological distress.Behavior Therapy. 1990,21:349–362.CrossRefGoogle Scholar
  43. (43).
    Rosenstiel AK, Keefe FJ: The use of coping strategies in low back pain patients: Relationship to patient characteristics and current adjustment.Pain. 1983,17:33–40.PubMedCrossRefGoogle Scholar
  44. (44).
    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.Google Scholar
  45. (45).
    Shacham S: A shortened version of the Profile of Mood States.Journal of Personality Assessment. 1983,47:305–306.PubMedCrossRefGoogle Scholar
  46. (46).
    Mishel MH, Fleury J: The growth through uncertainty scale. Unpublished manuscript.Google Scholar
  47. (47).
    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.CrossRefGoogle Scholar
  48. (48).
    Norris AE: Structural Equation Modeling. In Munro BH (ed),Statistical Methods for Health Care Research, 4th Edition. Philadelphia: Lippincott, 2001, 379–404.Google Scholar
  49. (49).
    Byrne BM:Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2001.Google Scholar
  50. (50).
    Ashing-Giwa K, Ganz PA, Petersen L: Quality of life of African-American and White long term breast carcinoma survivors.Cancer. 1999,85:418–426.PubMedCrossRefGoogle Scholar
  51. (51).
    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.CrossRefGoogle Scholar
  52. (52).
    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.Google Scholar
  53. (53).
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al.: Race, gender, and partnership in the patient-physician relationship.Journal of the American Medical Association. 1999,282:583–589.PubMedCrossRefGoogle Scholar
  54. (54).
    Henderson PD, Gore SV, Davis BL, Condon EH: African American women coping with breast cancer: A qualitative analysis.Oncology Nursing Forum. 2003,30:641–647.PubMedCrossRefGoogle Scholar
  55. (55).
    Tomich PL, Helgeson VS: Is finding something good in the bad always good? Benefit finding among women with breast cancer.Health Psychology. 2004,23:16–23.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2006

Authors and Affiliations

  • Laura S. Porter
    • 1
  • Margaret F. Clayton
    • 2
  • Michael Belyea
    • 2
  • Merle Mishel
    • 2
  • Karen M. Gil
    • 2
  • Barbara B. Germino
    • 2
  1. 1.Duke University Medical CenterDurham
  2. 2.School of NursingUniversity of North Carolina at Chapel HillChapel Hill

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