The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer

Sources of support and the physical and mental well-being of young women with breast cancer

Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.

Measuring supportive and unsupportive responses during cancer treatment: a factor analytic assessment of the partner responses to cancer inventory

This study examined the psychometric structure of a measure of positive and negative spouse responses to individuals with cancer, the Partner Responses to Cancer Inventory (PRCI). The forty-eight items were either developed by the authors or adapted from the Inventory of Socially Supportive Behaviors. Seven a priori subscales of the PRCI, four positive support scales and three negative spouse behavior scales, were hypothesized. The instrument was administered to 304 cancer patients undergoing cancer treatment. Exploratory factor analyses yielded four factors that were subsequently confirmed by confirmatory factor analysis: (a) Emotional and Instrumental Support, (b) Cognitive Information and Guidance, (c) Encouraging Distancing and Self-Restraint, and (d) Criticism and Withdrawal. The measure satisfied standard criteria for internal consistency and construct validity, and thus may be useful for social support theory and research.

The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes

OBJECTIVE

To explore the relationship between marital relationship domains (i.e., intimacy and adjustment) and glycemic control and psychosocial adaptation to diabetes.

RESEARCH DESIGN AND METHODS

A total of 78 insulin-treated adults with both type 1 and type 2 diabetes were assessed on a single occasion. They completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) and four quality-of-life measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey, Problem Areas in Diabetes Scale, and Positive and Negative Affect Scale). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical conditions, family history, disability, and years of education) were gathered from the chart and questionnaires.

RESULTS

Concerning psychosocial adaptation, both of the marital quality measures were predictors of aspects of adaptation. Better marital satisfaction was related to higher levels of diabetes-related satisfaction and less impact, as well as less diabetes-related distress and better general quality of life. Higher levels of marital intimacy were related to better diabetes-specific and general quality of life. Concerning glycemic control, there was a nonsignificant trend for marital adjustment scores to relate to HbA(1c) (P = 0.0568).

CONCLUSIONS

For insulin-treated adults with diabetes, quality of marriage is associated with adaptation to diabetes and other aspects of health-related quality of life. The suggestive finding that marital adjustment may relate to glycemic control warrants further study. Future work should also explore the impact of couples-focused interventions on adaptation, adherence, and glycemic control.

Evaluating the self-assessed support needs of women with breast cancer

AIMS OF THE STUDY

The first aim of the study was to identify the self-assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care.

BACKGROUND

It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women's own assessment of their needs at different stages of their illness.

DESIGN AND METHODS

A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long-term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi-structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from "of no importance" to "extremely important". Questionnaire data were analysed by means of a one-way analysis of variance (for three independent variables) or t-test for two independent variables. Results. The questionnaire was sent to 971 women and achieved a response rate of 50.4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question "why me?"

CONCLUSION

With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.

Social support, intrusive thoughts, and quality of life in breast cancer survivors

This study explores the moderating effect of social support on the relationship between cancer-related intrusive thoughts and quality of life. Sixty-four breast cancer survivors completed self-report measures of appraisal social support (the disclosure of thoughts and feelings to significant others), cancer-related intrusive thoughts, and quality of life. Controlling for demographic and treatment variables, the negative impact of cancer-related intrusive thoughts on both physical and mental quality of life measures was moderated by appraisal social support. For women with high levels of appraisal support, cancer-related intrusive thoughts had no significant relationship with quality of life. However, for women with low levels of appraisal support, the relationship between cancer-related intrusive thoughts and quality of life was significant and negative. These results suggest that appraisal social support can mitigate the impact of traumatic life events.

Experiences of women with a diagnosis of breast cancer: a clinical pathway approach

The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care.

Relationship issues of women with breast cancer

This in-depth, qualitative pilot study explored the impact of breast cancer on specific dimensions of the relationships and roles of women. It included interaction within the partner relationship as well as with family, friends, and colleagues. Data were obtained by individual and group interviews from 10 women with a diagnosis of breast cancer and 5 male partners. Both partnered and single women participated. There were four major findings seldom discussed in the literature, which have important implications for preventive intervention. First, partner relationships troubled before the diagnosis as well as those characterized by mutual caring faced challenges and negative changes. Second, in an effort to protect each other, communication within the partner dyad became less open, and there were changes in the usual manner of conflict resolution. Third, unpartnered women appeared to be more vulnerable to problems of negative adjustment, largely because of relationship issues. Fourth, participants confirmed the need for a comprehensive intervention to facilitate coping with issues relative to relationships, intimacy, and sexuality. Although the sample was small, in-depth data were obtained that provide a basis for specific areas in which further empirical investigation is needed, and they indicate that preventive intervention may well be warranted.

Predicting anxiety and depression among cancer patients: a clinical model

The aim of this study was to investigate the possibility of predicting anxiety and depression 6 months after the cancer diagnosis on the basis of measures of anxiety, depression (Hospital Anxiety and Depression, HAD scale), subjective distress (Impact of Event, IES scale) and some aspects of social support in connection with the diagnosis. A further purpose was to attempt identification of individual patients at risk of prolonged psychological distress, and to develop an easily applicable clinical tool for such detection. A consecutive population-based series of 522 newly diagnosed patients with breast, colorectal, gastric and prostate cancer were interviewed in connection with the diagnosis and 6 months later. Anxiety and depression close to the diagnosis explained 39% of the variance in anxiety and depression 6 months later. Patients scoring as doubtful cases/cases for HAD anxiety and/or depression were more than 11 times more likely than non-cases to score as doubtful cases/cases at 6 months. Additional risk factors were having an advanced disease and nobody in addition to the family to rely on in case of difficulties. Levels of anxiety and depression at diagnosis predict a similar status 6 months later. The results also indicate that the HAD scale in combination with a single question about social support may be a suitable screening tool for clinical use.

Distress, Coping, and Social Support Among Rural Women Recently Diagnosed with Primary Breast Cancer

This study examined distress, coping, and group support among a sample of rural women who had been recently diagnosed with breast cancer. We recruited 100 women who had been diagnosed with primary breast cancer at one of two time points in their medical treatment: either within a window up to 3 months after their diagnosis of breast cancer, or within 6 months after completing medical treatment for breast cancer. Their mean age was 58.6 years (SD = 11.6), and 90% were of white/European American ethnicity. Women completed a battery of demographic and psychosocial measures prior to being randomized into a psychoeducational intervention study, and then again 3 months later at a follow-up assessment. The focus of this article is on the women's self-reported psychosocial status at baseline. Many of the women experienced considerable traumatic stress regarding their breast cancer. However, this distress was not reflected in a standard measure of mood disturbance that is frequently used in intervention research (the Profile of Mood States). The average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. Also, women on average reported a high level of helplessness/hopelessness in coping with their cancer. On average, women felt that they "often" (but not "very often") received instrumental assistance, emotional support, and informational support. Women varied considerably in which kind of social group provided them with the most support, with as many reporting that they found the greatest support in spiritual/church groups or within their family units as with breast or general cancer groups. These results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance. Furthermore, the kinds of groups that rural women with breast cancer experience as most supportive need to be identified so that psychosocial interventions can be matched to breast cancer patients' individual needs.

Coping with breast cancer: patient, spouse, and dyad models

OBJECTIVE

The objectives of this study were 1) to assess similarities and differences between patients with breast cancer and their spouses in terms of coping strategies and adjustment (psychosocial and psychological) to cancer and 2) to investigate the pattern of relationships between the patients' and spouses' coping strategies and between each of these strategies and the patient's adjustment to the illness using three types of models: patient, spousal, and dyadic coping.

METHODS

Seventy-three patients with breast cancer and their spouses completed questionnaires that measured distress (Brief Symptom Inventory), psychosocial adjustment, and coping strategies.

RESULTS

The patients' distress was greater than their spouses', but a similar level of psychosocial adjustment was reported. The patients used more strategies involving problem-focused coping than their spouses. The use of emotion-focused coping, which included ventilation and avoidance strategies, was highly related to distress and poor adjustment on the part of the patient. The spouses' emotion-focused coping and distress were related to that of the patients. Dyad emotion-focused coping measures were highly associated with the patients' distress and adjustment.

CONCLUSIONS

Spousal and dyad coping are important factors in a patient's adjustment to breast cancer.

Stage of life course and social support as a mediator of mood state among persons with disability

OBJECTIVE

This research seeks to determine which aspects of social support are most effective in mediating mood state among working-age and elderly adults with disability (N = 442).

METHODS

Participants were identified through random-digit dialing of telephone exchanges and administration of a disability screen. Multiple regression was used to model multiple aspects of social support while holding sociodemographic and disability indicators constant.

RESULTS

Analyses revealed that network size and confidence in the reliability of helping networks are significantly and negatively related to depressed mood. Confidant support was related to lower levels of depressed mood for younger respondents only. Neither marital status, advisor support, nor social integration were related to mood.

DISCUSSION

Both instrumental and emotional support are key in mediating depressed mood among this population. We conclude that all types of social support are not equally effective in mediating mood among people with disability.

A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients

Partners of breast cancer patients are relied upon for support at a time when their own coping abilities are taxed by the challenge of cancer, yet few studies have investigated psychosocial interventions that include or target the patient's 'significant other'. Of the 118 consecutive patients approached, 36 patients and their partners participated in a randomized controlled trial of a brief psychoeducational group program for partners only. Psychometric instruments (including the Profile of Mood States (POMS), the Index of Marital Satisfaction (IMS) and DUKE-UNC Functional Social Support Scale (FSSS)) were administered pre-test, post-test and at 3 months follow-up. The Mental Adjustment to Cancer Scale (MAC) was also completed by patients. Three months after the intervention, partners had less mood disturbance than did controls. Patients whose partners received the intervention reported less mood disturbance, greater confidant support (CS) and greater marital satisfaction.

Terminal illness and coping with loneliness

Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the coping strategies used by HIV/AIDS patients, by individuals diagnosed with cancer, and by the general population. Forty-three HIV/AIDS patients, 38 cancer patients, and 53 participants from the general population answered a 34-item questionnaire. Results indicated that with the exception of reflection and acceptance and religion and faith, those afflicted with HIV/AIDS cope with loneliness significantly differently from members of the other two groups. The findings of this exploratory study suggest that cancer patients and the general population do not differ in the ways they cope with loneliness.

The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer

In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power implies that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients' psychosocial distress. Using a burden questionnaire, relatives of 73 women with cancer (41 cervical and 32 breast, mean age of caregivers 35.6 years) were interviewed, in out-patient clinics. While the caregivers admitted high frequency of all indices of 'objective' burden, emotional ties at home and social relationships in the neighbourhood seemed intact, indicating tolerance and lack of social stigma. The financial burden was more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden. The severity of patient's worries and psychopathological symptoms were not significantly correlated with care-giver global rating of burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care of patients.

Health needs of lone elderly Chinese men with heart disease during their hospitalization

Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often influence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect.

Psychosocial concerns of Nigerian women with breast and cervical cancer

Cancer has the potential to provoke worries which should be assessed in order to adequately respond to patients' problems. We highlight in this paper the problems that concerned 30 women with cervical cancer (mean age 51.2) and 76 with breast cancer (mean age 44.9), how these concerns affected their emotional lives, and the factors associated with these worries. They were interviewed with the 33-item modified version of a German questionnaire rating psychosocial concerns (FBS) by Sullwold, and Goldberg's General Health Questionnaire (GHQ-12) for psychopathological symptoms. Cervical cancer patients had significantly higher FBS and GHQ-12 scores than breast cancer. Breast cancer cases had FBS scores similar to those of women with sickle cell disease and insulin-dependent diabetes mellitus. The commonest recurrent worries in both groups were depression about their condition (45%), thoughts of death (37%), insomnia (33.3%), bodily odour (30%), impairment of work efficiency (30%) terrifying dreams (27%) and fear of illness being life-long (25%). Over 90% denied experience of worries indicating social stigma. FBS scores were significantly correlated with GHQ scores and both were negatively associated with adequacy of social contacts. These data suggest the need for psychosocial intervention in such cases in Nigeria.

Specification of social support behaviours and network dimensions along the HIV continuum for gay men

This study aimed to investigate social supports that HIV-infected persons find helpful and unhelpful, and the size and composition of networks along the disease continuum. Ninety six HIV-infected and 33 seronegative gay men were interviewed. The HIV continuum was represented by seronegative, HIV asymptomatic and symptomatic groups. Emotional and physical support were the most frequently identified helpful supports. Symptomatic persons identified physical support as helpful more often than asymptomatic persons. Availability, acceptance and nurturing were the most frequently identified helpful emotional support behaviours, while domestic support was the most frequently identified physical support behaviour. The most frequently mentioned unhelpful support was overprotectiveness. Overall, HIV-infected people had adequate social networks. Composition of the networks of HIV-infected persons differed from that of seronegative participants in that the former had markedly more professional and family persons and fewer friends in their network. HIV education and counseling interventions should provide emotional support, facilitate physical support for symptomatic persons, offer support that matches specific needs, include significant others, incorporate peer-help and be gay-sensitive.

Concern about aspects of body image and adjustment to early stage breast cancer

OBJECTIVE

Several authors have suggested that patients adjust more poorly to breast cancer if they are heavily invested in body image as a source of their sense of self-worth. This prospective study examined this possibility, looking at two aspects of concern about body image as predictors of several indices of adjustment over the first postoperative year.

METHODS

At diagnosis (and again a year later) 66 women with early stage breast cancer reported how much they valued a) a sense of body integrity (or intactness) and b) a good physical appearance. The day before surgery, a week afterward, and at 3-month, 6-month, and 12-month follow ups, they reported on their mood. At presurgery and at follow ups they also rated their attractiveness and sexual desirability and reported on frequency of sexual interaction. At follow-ups they also indicated how much their illness and treatment were interfering with social and recreational activities.

RESULTS

Initial investment in appearance was related to distress across the postsurgical year. In contrast, investment in appearance made women more resilient against deterioration in their perceptions of attractiveness. Concern about body integrity did not strongly predict emotional distress, but it related to adverse impact on social and recreational activities in the follow-up period, to deterioration in feelings of sexual desirability, and to feelings of alienation from the self (feeling "not like yourself anymore").

CONCLUSIONS

Body image is often thought of in terms of physical appearance, but there is also a body image pertaining to integrity, wholeness, and normal functioning. People who are greatly concerned about either aspect of their body image are vulnerable to poorer psychosocial adjustment when confronting treatment for breast cancer. The poorer adjustment takes a different form, however, depending on the nature of the patient's body-image concern.

Social support, life stress, pain and emotional adjustment to advanced breast cancer

The purpose of this study was to examine relationships between emotional adjustment to advanced breast cancer, pain, social support, and life stress. The cross-sectional sample was compromised of 102 women with metastatic and/or recurrent breast cancer who were recruited into a randomized psychosocial intervention study. All women completed baseline questionnaires assessing demographic and medical variables, social support, life stress, pain, and mood disturbance. Three types of social support were assessed: (1) number of persons in support system; (2) positive support; and (3) aversive support. On the Profile of Mood States (POMS) total score, we found significant interactions between life stress and social support; having more people in the patient's support system was associated with less mood disturbance, but only among patients who had undergone greater life stress. Also, aversive social contact was significantly related to total mood disturbance (POMS), and having more aversive social contact was particularly associated with total mood disturbance (POMS) among patients who had undergone greater life stress. Pain intensity was associated with greater total life stress, and was not significantly related to social support. These results are consistent with the 'buffering hypothesis' that social support may shield women with metastatic breast cancer from the effects of previous life stress on their emotional adjustment; however, aversive support may be an additional source of life stress associated with emotional distress. Also, pain is greater among women with greater life stress, regardless of social support.

Differences in religiousness among black and white women with breast cancer

Black women are less likely to be diagnosed with breast cancer than white women but more likely to be adversely affected. However, little attention has been paid to how these women cope with the disease. Using a comparative design, this study analyzes the differences in religiousness between black and white women with breast cancer. Findings suggest that black women rely on religiousness as a coping resource to a greater extent than white women. Implications for how this information can be used in social work practice with black women are discussed.

Impact of breast cancer on Asian American and Anglo American women

This pilot study constitutes the first exploration of the impact of breast cancer on Asian American women. Three hypotheses guided this study: (1) Asian American women would choose breast conserving therapy and breast reconstruction at a lower rate than the Anglo American women due to cultural differences in body image, (2) Asian American women with breast cancer would express psychological distress somatically and Anglo American women would express distress emotionally, and acculturation levels of the Asian American women would modify the expressions of distress such that women with high acculturation will express distress more emotionally and less acculturated women would express distress more somatically, and (3) Asian American women would seek assistance for psychosocial problems at a significantly lower rate than Anglo women. Ethnicity, age, and levels of acculturation were found to be significant variables that had to be considered simultaneously. The three hypotheses were only partially supported: (1) Asian American women chose breast conserving therapy and adjuvant therapy at a significantly lower rate than the Anglo American women, (2) Contrary to the hypothesis, somatization did not appear to be a dominant form of symptom presentation for Asian American women regardless of level of acculturation, and (3) Asian American women sought professional assistance for psychosocial problems at a significantly lower rate than Anglo women. Asian American women reported using different modes of help-seeking behavior for emotional concerns and receiving different sources of social support than the Anglo American women. Cultural interpretations of the findings are offered to explain the differences in the physical, emotional, and social responses to the breast cancer experience of Asian American women compared with the Anglo Americans, and notably between the Chinese- and Japanese Americans as well. The findings of this study warrant more refined exploration in order to improve the medical, psychological and social outcomes for Asian American women with breast cancer.

Behavioral research to enhance adjustment and quality of life among adults with cancer

The purpose of this article is to recommend future directions for behavioral research to enhance adjustment and quality of life for adults diagnosed with cancer. As context for the recommendations, the domain of behavioral research in psychosocial oncology is briefly described, the state of the science measuring quality of life is summarized, and research results from behavioral research on quality of life are reviewed.

The impact of psychosocial and clinical variables on duration of inpatient treatment for depression

The duration of psychiatric hospital stays becomes increasingly important as economic pressures on medicine mount. Psychiatric hospitals, in particular, search for ways to cut costs without sacrificing efficiency. There is no doubt that clinical depression is one of the most important cost factors in psychiatry. Former studies have concentrated mainly on the influence of clinical variables such as the severity or subtype of depression on the length of stay (LOS). However, it can also be assumed that life situations or psychosocial variables in general might influence LOS. Data from 736 admissions between January 1983 and 1991 with a diagnosis of depression were examined to test the hypothesis that psychosocial and clinical variables influence LOS. Results showed a significant influence of age, marital status and gender, as well as severity and type of depression, on duration of inpatient treatment. Age, female gender, being widowed or divorced, the diagnosis of "endogenous depression" and severity were all associated with longer LOS. There was an interaction of gender, marital status and perceived loneliness, as well as an interaction of severity of depression with gender, both of which were associated with LOS.

Openness to discuss cancer in the nuclear family: scale, development, and validation

OBJECTIVE

To describe the development and validation of a scale for assessing openness to discuss cancer in the family.

METHOD

Two studies were conducted. Study 1 was a cross-sectional study designed to test the factor structure of the scale. Four hundred ninety-eight patients with either breast cancer or Hodgkin's disease were interviewed. In Study 2, a longitudinal study, 133 patients with cancer in the head and neck were tested at four points in time: just before treatment, 6 weeks, 13 weeks and 52 weeks after treatment. Study 2 aimed to confirm the factor structure established in Study 1, to test for construct validity in a new population, to test the psychometric properties of the Openness Scale, and to test the scale's sensitivity to change.

RESULTS

In Study 1, a one-factor solution was revealed, resulting in a scale of eight items. In Study 2, the factor structure found in Study 1 was confirmed. In line with theoretical expectations, subjects who perceived their communication about cancer as more open showed more positive rehabilitation outcomes especially at 13 weeks after treatment (less uncertainty, fewer negative feelings, more control, higher self-esteem, fewer psychological and physical complaints). Furthermore, more open communication related with more support by family members and more discussion with the partner. The scale was found to be stable over time.

CONCLUSIONS

The scale's construction and subsequent analysis show that open discussion of problems (related to cancer) in the family can be measured reliably with an eight-item instrument. Additional validation of the scale is indicated.

Perceived social support, family environment and psychosocial recovery in bone marrow transplant long-term survivors

This report examines perceptions of social support and family dynamics in bone marrow transplant (BMT) long-term survivors, as part of a larger study examining issues of quality of life and psychosocial adjustment in this patient group. Ninety one BMT survivors participated in the study. Their responses were compared with those of a matched control group of 73 patients receiving maintenance chemotherapy (MC). The results indicated that the BMT group received more social support than the MC group. Main sources of support were the patients' immediate family members. No significant differences in the typology and dynamics of family environments were observed between groups. However, the groups were significantly different compared with healthy, non-distressed families in cohesion, control and conflict. It was of importance to note that a considerable number of BMT subjects reported at least one nurse as a person who provides support to them, indicating the potential important role of nurses in the psychosocial adjustment of BMT long-term survivors. Strong family relationships were associated in both the BMT and MC groups with significantly better adjustment with respect to their domestic, extended family or social environment, and psychological distress. Social support and family relationships might be two of the main spheres of life contributing to higher levels of quality of life, and their important role as a stressor-filter is highlighted.

Factors influencing adjustment of patients suffering from nasopharynx carcinoma--implications for oncology social work

A longitudinal study has been conducted in Hong Kong to identify important factors that affect short-term adjustment of patients suffering from nasopharynx carcinoma (NPC). A total of 125 newly diagnosed NPC patients were interviewed in the diagnostic phase, the number dropping to 119 in the treatment phase, and 111 in the post-treatment phase. Data were gathered by a pre-tested structured measuring instrument via face-to-face interviews. Those patients with poor adjustment in each phase of the illness were found to have higher perceived stress; they tended to interpret their illness as more threatening and less controllable, and they employed problem-focused coping less frequently but used emotion-focused coping more frequently. The health locus of control and the overall perceived social support had differential effects on short-term adjustment in different phases of the illness. Current stress was identified to be the most important factor accounting for patients' adjustment in the treatment phase, while adjustment in the post-treatment phase was predominantly accounted for by previous adjustment. Based on the results of this study, a new model of practice is proposed for oncology social workers in Hong Kong, which is proactive, comprehensive, preventive and stage-specific. This model of practice is applicable to other countries like USA.

Adjustment to breast cancer: the psychobiological effects of psychosocial interventions

This review focuses on the effects of psychosocial interventions on psychological and biological functioning of breast cancer patients. Once in their lifetime, one out of eleven women receive a diagnosis of breast cancer. A diagnosis of breast cancer is a severe stressful life event with profound consequences on all aspects of human life. Whether a woman will regain emotional balance and accept the idea of living with a potentially life threatening disease depends on her psychological resiliency. Provision of psychosocial interventions can improve these women's coping abilities and reduce emotional distress and feelings of isolation, and improve psychosexual functioning. Additionally, there exists some evidence that psychotherapy may prolong survival. Prolongation of survival may be related, in part, to an increase in certain aspects of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth. Therefore, future research should examine the degree to which the effects on mammary tumor growth relate to immune system changes.

Confiding in crisis: gender differences in pattern of confiding among cancer patients

Social support has been identified as a key predictor of psychological morbidity following adverse life-events. However, the majority of the research has focused exclusively on women, despite evidence of significant gender difference in the utilisation and role of social support. To examine gender differences in patterns of confiding crisis, 520 subjects were interviewed within 8 weeks of a cancer diagnosis. Men were as likely as women to have confided their main concern in others (61% mainly or fully confided vs 67% of women, P = 0.308) but were much more likely to have used only one confidante (45% vs 25% of women, P < 0.001) while women made use of a wider circle of family, friends and partner and used more confidantes overall. The results confirm marked gender differences in the utilisation of social support at times of crisis and call into question the extent to which support research using exclusively female samples can be generalized.

Predictors of psychiatric morbidity in cancer patients

BACKGROUND

A significant proportion of cancer patients experience psychiatric morbidity in association with diagnosis and treatment. If this morbidity is to be reduced, a better understanding is needed of the factors which influence adjustment to cancer.

METHOD

A review of the literature was carried out to explore those factors associated with poor psychological adjustment to cancer. These are described under four heading: characteristics of the patient; disease and treatment variables; the interaction between patient and illness; and environmental factors.

RESULTS

A number of risk factors for psychiatric morbidity can be identified from each of the four areas. Methodological limitations are highlighted, in particular the preponderance of cross-sectional study designs.

CONCLUSIONS

Increased awareness of the risk factors for psychiatric morbidity should lead to earlier detection and more appropriate treatment. Future research should focus on those risk factors which are potentially modifiable.

Loneliness, depression, and social support of patients with COPD and their spouses

Thirty clients with chronic obstructive pulmonary disease (COPD) and their spouses were interviewed to examine differences in the relationships among loneliness, depression, and social support. Data were collected during structured in-home interviews using the UCLA loneliness scale, the Center for Epidemiological Studies depression scale, and the social support questionnaire. The clients and spouses did not differ significantly on measures of loneliness and depression, with mean scores for both groups higher than those in other comparable groups. Spouses, however, tended to be a little lonelier than clients, and clients tended to be a little more depressed than spouses. The two groups were also similar with respect to the number of people in their social networks but different as to network composition. Spouses were less satisfied with their networks than clients. Social support satisfaction was linked to loneliness and depression for clients but not for spouses. Results of the study suggest that community nurses working in home settings must be sensitive to clients' and spouses' psychologic reactions to COPD, which may be expressed in feelings of loneliness and depression.