Skip to main content
SpringerLink
Log in

Direct and Buffering Effects of Social Support Among Gynecologic Cancer Survivors

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

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.

Purpose

The present study examines whether social support moderates the relationship between physical functioning and psychological outcomes by testing the stress-buffering hypothesis.

Methods

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

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Because participants were consecutive clinic patients, these data could be considered missing completely at random, i.e., bias was not an issue. As a precaution, we replicated the regression analyses for the other social support measures (ISEL, PSS-Fa, PSS-Fr) restricting the sample to the subset of participants who completed the SNI. The pattern of results was identical; thus, we elected to include all available data in the primary analyses.

References

  1. Aziz NM. Cancer survivorship research: State of knowledge, challenges and opportunities. Acta Oncol. 2007; 46: 417-432.

    Article  PubMed  Google Scholar 

  2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin. 2009; 59: 225-249.

    Article  PubMed  Google Scholar 

  3. 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.

  4. 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.

  5. Carlsson M, Strang P, Bjurstrom C. Treatment modality affects long-term quality of life in gynaecological cancer. Anticancer Res. 2000; 20: 563-568.

    PubMed  CAS  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Li C, Samsioe G, Iosif C. Quality of life in endometrial cancer survivors. Maturitas. 1999; 31: 227-236.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003; 30: 799-813.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98: 310-357.

    Article  PubMed  CAS  Google Scholar 

  24. Spira JL, Reed GM. Group Psychotherapy for Women with Breast Cancer. Washington, D.C.: American Psychological Association; 2002.

    Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Antoni MH. Stress Management Intervention for Women with Breast Cancer. Washington, D.C.: American Psychological Association; 2002.

    Google Scholar 

  28. Andersen BL. Biobehavioral outcomes following psychological interventions for cancer patients. J Consult Clin Psychol. 2002; 70: 590-610.

    Article  PubMed  Google Scholar 

  29. Spiegel D, Classen C. Group Therapy for Cancer Patients: A Research-based Handbook of Psychosocial Care. New York: Basic Books; 2000.

    Google Scholar 

  30. Brothers BM, Andersen BL. Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence. Psychooncology. 2009; 18: 267-275.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  CAS  Google Scholar 

  33. Hays RB, Turner H, Coates TJ. Social support, AIDS-related symptoms, and depression among gay men. J Consult Clin Psychol. 1992; 60: 463-469.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

    Chapter  Google Scholar 

  35. 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.

    Article  PubMed  CAS  Google Scholar 

  36. 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.

    Article  PubMed  CAS  Google Scholar 

  37. 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.

  38. 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.

    PubMed  CAS  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  CAS  Google Scholar 

  41. Bower JE, Ganz PA, Desmond KA, et al. Fatigue in long-term breast carcinoma survivors. Cancer. 2006; 106: 751-758.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  PubMed  CAS  Google Scholar 

  43. 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.

    Article  PubMed  CAS  Google Scholar 

  44. 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.

    Google Scholar 

  45. 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.

    PubMed  CAS  Google Scholar 

  46. Cortina JM. What is coefficient alpha? J Appl Psychol. 1993; 78: 98-104.

    Article  Google Scholar 

  47. 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.

    Google Scholar 

  48. Shapinsky AC, Rapport LJ, Henderson MJ, Axelrod BN. Civilian PTSD scales: Relationships with trait characteristics and everyday distress. Assessment. 2005; 12: 220-230.

    Article  PubMed  Google Scholar 

  49. 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.

    Article  PubMed  CAS  Google Scholar 

  50. Cohen J, Cohen P, West S, Aiken L. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Mahwah: Lawrence Erlbaum Associates; 2003.

    Google Scholar 

  51. Preacher K. A Primer on Interaction Effects in Multiple Linear Regression. Chapel Hill, NC: copyrighted manuscript; 2003.

  52. 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.

    Article  PubMed  CAS  Google Scholar 

  53. 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.

    Article  PubMed  Google Scholar 

  54. Janda M, Obermair A, Cella D, et al. The functional assessment of cancer-vulvar: Reliability and validity. Gynecol Oncol. 2005; 97: 568-575.

    Article  PubMed  Google Scholar 

  55. 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.

    Article  PubMed  CAS  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. 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.

    Article  PubMed  CAS  Google Scholar 

  58. 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.

    Article  PubMed  CAS  Google Scholar 

  59. 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.

    Article  PubMed  CAS  Google Scholar 

  60. 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.

    PubMed  CAS  Google Scholar 

  61. Vickberg SMJ, Duhamel KN, Smith MY, et al. Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology. 2001; 10: 29-39.

    Article  Google Scholar 

  62. Horowitz MJ. Stress Response Syndromes. 2nd ed. New York: Jason Aronson; 1986.

    Google Scholar 

  63. Wenger DM. Ironic processes of mental control. Psychol Rev. 1994; 101: 34-52.

    Article  Google Scholar 

  64. Bootzin RR. Examining the theory and clinical utility of writing about emotional experiences. Psychol Sci. 1997; 8: 167-169.

    Article  Google Scholar 

  65. 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.

    Article  PubMed  CAS  Google Scholar 

  66. 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.

    Article  PubMed  CAS  Google Scholar 

  67. 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.

    Article  Google Scholar 

  68. 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.

    Article  Google Scholar 

  69. 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.

    Article  PubMed  CAS  Google Scholar 

  70. 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.

    Article  PubMed  CAS  Google Scholar 

  71. 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.

    Article  PubMed  Google Scholar 

  72. Schnoll RA, Knowles JC, Harlow L. Correlates of adjustment among cancer survivors. J Psychosoc Oncol. 2002; 20: 37-60.

    Article  Google Scholar 

  73. Helgeson VS. Social support and quality of life. Qual Life Res. 2003; 12(Suppl 1): 25-31.

    Article  PubMed  Google Scholar 

  74. 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.

    Article  PubMed  CAS  Google Scholar 

  75. 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.

    Article  PubMed  CAS  Google Scholar 

  76. 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.

    Article  PubMed  CAS  Google Scholar 

  77. 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.

    Article  PubMed  CAS  Google Scholar 

  78. 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.

    Article  PubMed  Google Scholar 

  79. Kaufmann PG. Psychosocial interventions in breast cancer: To light a candle. Cancer. 2009; 115: 5617-5619.

    Article  PubMed  Google Scholar 

  80. 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.

    Article  PubMed  Google Scholar 

  81. 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.

    Article  PubMed  Google Scholar 

  82. Hogan BE, Linden W, Najarian B. Social support interventions: Do they work? Clin Psychol Rev. 2002; 22: 381.

    Article  Google Scholar 

  83. 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Supported by Henry M. Jackson Foundation for Military Medicine (DODGCC-2004-1), National Cancer Institute (R01CA92704, K05CA098133), and the Graduate School of The Ohio State University.

Author information

Authors and Affiliations

  1. Department of Psychology, The Ohio State University, 1835 Neil Avenue, 159 Psychology Building, Columbus, OH, 43210, USA

    Kristen M. Carpenter Ph.D & Barbara L. Andersen Ph.D.

  2. Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA

    Jeffrey M. Fowler M.D. & Barbara L. Andersen Ph.D.

  3. Gynecologic Disease Center and U.S. Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA

    G. Larry Maxwell M.D.

Authors
  1. Kristen M. Carpenter Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey M. Fowler M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Larry Maxwell M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara L. Andersen Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristen M. Carpenter Ph.D.

About this article

Cite this article

Carpenter, K.M., Fowler, J.M., Maxwell, G.L. et al. Direct and Buffering Effects of Social Support Among Gynecologic Cancer Survivors. ann. behav. med. 39, 79–90 (2010). https://doi.org/10.1007/s12160-010-9160-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-010-9160-1

Keywords

Search

Navigation