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Journal of Cancer Survivorship

Published in:

01-06-2009

Problem-solving style and adaptation in breast cancer survivors: a prospective analysis

Authors: P. Paul Heppner, Jane M. Armer, Brent Mallinckrodt

Published in: Journal of Cancer Survivorship | Issue 2/2009

Abstract

Introduction

Emotional care of the breast cancer patient is not well understood; this lack of understanding results in both a high cost to the patient, as well as the health care system. This study examined the role of problem-solving style as a predictor of emotional distress, adjustment to breast cancer, and physical function immediately post-surgery and 12 months later.

Methods

The sample consisted of 121 women diagnosed with breast cancer and undergoing surgery as a primary treatment. The survivors completed a measure of problem-solving style and three outcome measures immediately post-surgery, as well as at 1 year later. There was a 95.6% retention rate at 1 year.

Results

Multiple hierarchical regressions revealed, after controlling for patient demographics and stage of cancer, that problem-solving style (particularly personal control) was associated with emotional distress, adjustment to chronic illness, and physical function immediately following surgical intervention. In addition, a more positive problem-solving style was associated with less emotional distress, but not a better adaptation to a chronic illness or physical functioning 12 months later; the Personal Control again was the best single predictor of the emotional distress, adding 10% of the variance in predicting this outcome.

Conclusions

The utility of post-surgery assessment may help identify those in need for problem-solving training to improve these outcomes at 1 year. Future studies need to determine the impact of interventions tailored to levels of problem-solving styles in cancer survivors over time.

Implications for Cancer Survivors

Understanding the role of problem solving style in breast cancer survivors deserves attention as it is associated with emotional distress immediately and one year after medical intervention. Problem-solving style should be evaluated early, and interventions established for those most at risk for emotional distress.

Allen SM, Shah AC, Nezu AM, Nezu CM, Ciambrone D, Hogan J, et al. A problem-solving approach to stress reduction among younger women with breast cancer carcinoma: A randomized controlled trial. Cancer. 2002;94:3089–100. doi:10.1002/cncr.10586.PubMedCrossRef

Armer JM. The problem of post-breast cancer lymphedema: Impact and measurement issues. Cancer Investig. 2005;23:76–83. doi:10.1081/CNV-200048707.CrossRef

Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphatic Research and Biology. 2005;3(4):208–17. doi:10.1089/lrb.2005.3.208.PubMedCrossRef

Baum A, Andersen BL (2001). (eds.). Psychosocial interventions for cancer. Washington, DC: American Psychological Association; 2001.

Bloom JR, Kessler L. The risk and timing of counseling and support interventions for younger women with breast cancer. J Natl Cancer Inst Monographs. 1994;(16):99–106.

Bultz BD, Holland JC. Emotional distress in patients with cancer: the sixth vital sign. Community Oncology. 2006;3:311–4.

Carlson LE, Bultz BD. Efficacy and medical cost offset of psychosocial interventions in cancer care: making the case for economic analyses. Psycho-Oncology. 2004;13:837–49. doi:10.1002/pon.832.PubMedCrossRef

Carver CS, Pozo C, Harris SD, Noriega V, Sceier MF, Robinson DS, et al. How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. J Pers Soc Psychol. 1993;65:375–90. doi:10.1037/0022-3514.65.2.375.PubMedCrossRef

Carver CS, Smith RG, Derhagopian RP, Antoni MH, Petronis VM, Weiss S. Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychol. 2005;24:508–16. doi:10.1037/0278-6133.24.5.508.PubMedCrossRef

10.

Derogatis LR. The psychological adjustment to illness scale (PAIS). J Psychosom Res. 1986;30:77–91. doi:10.1016/0022-3999(86)90069-3.PubMedCrossRef

11.

D’Zurilla TJ, Nezu AM. Problem-solving therapy: A social competence approach to clinical intervention. 2nd ed. New York: Springer; 1999.

12.

Edgar L, Rosberger Z, Nowlis D. Coping with cancer during the first year after diagnosis: Assessment and intervention. Cancer. 1992;69:817–28. doi:10.1002/1097-0142(19920201)69:3<817::AID-CNCR2820690334>3.0.CO;2-S.PubMedCrossRef

13.

Elliott TR, Shewchuk RM, Richards JS. Family caregiver social problem-solving abilities and adjustment during the initial year of the caregiver role. J Couns Psychol. 2001;48:223–32. doi:10.1037/0022-0167.48.2.223.CrossRef

14.

Epping-Jordan JE, Compas BE, Osowiecki DM, Oppedisano G, Gerhardt C, Primo K, et al. Psychological adjustment in breast cancer: Processes of emotional distress. Health Psychology. 1999;18:315–26. doi:10.1037/0278-6133.18.4.315.PubMedCrossRef

15.

Fawzy NW. A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nursing. 1996;18:427–38.

16.

Fawzy FI, Cousins N, Fawzy NW, Kemeny ME, Elashoff R, Morton D. A structured psychiatric intervention for cancer patients: I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry. 1990;47:720–5.PubMed

17.

Fawzy FI, Fawzy NW, Arndt LA, Pasuan RO. Critical review of psychosocial interventions in cancer care. Arch Gen Psychiatry. 1995;52:100–13.PubMed

18.

Fiske M. Tasks and crises of the second half of life: The interrelationship of commitment, coping, and adaptation. In: Birren J, Sloan R, editors. Handbook of mental health and aging. Englewood Cliffs, NJ: Prentice-Hall; 1980. p. 337–73.

19.

Feuerstein M. Optimizing cancer survivorship. Journal of Cancer Survivorship: Research and Practice. 2006;1:1–5. doi:10.1007/s11764-006-0001-y.CrossRef

20.

Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J Natl Cancer Inst. 2002;94:39–49.PubMed

21.

Heppner PP. The Problem Solving Inventory (PSI): Manual. Palo Alto, CA: Consulting Psychologist; 1988.

22.

Heppner PP, Baker CE. Applications of the problem solving inventory. Meas Eval Couns Dev. 1997;29:229–441.

23.

Heppner PP, Baumgardner AH, Larson LM, Petty RE. The utility of problem-solving training that emphasizes self-management principles. Couns Psychol Q. 1988;1:129–43.CrossRef

24.

Heppner PP, Witty TE, Dixon WA. Problem-solving appraisal and human adjustment: A review of 20 years of research utilizing the problem solving inventory. [Major Contribution]. Couns Psychol. 2004;32:344–428.CrossRef

25.

Kornblith AB, Herndon JE II, Weiss RB, Zhang C, Zuckerman EL, Rosenberg S, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer. 2003;98:679–89.PubMedCrossRef

26.

McInerney-Leo A, Biesecker BB, Hadley DW, Kase RG, Giambarresi TR, Johnson E, et al. BRCA1/2 testing in hereditary breast and ovarian cancer families: Effectiveness of problem-solving training as a counseling intervention. Am J Med Genet Part A. 2004;130A:2121–227.CrossRef

27.

Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychol. 1995;14:101–8.PubMedCrossRef

28.

Moyer A, Salovey P. Psychosocial sequelae of breast cancer and its treatment. Annals Behav Med. 1996;18:110–25.CrossRef

29.

Nezu CM, Nezu AM, Friedman SH, Houts PS, Dellicarpini LA, Bildner C, et al. Cancer and psychological distress: two investigations regarding the role of social problem solving. J Psychosoc Oncol. 1999;16(3/4):27–40.CrossRef

30.

Nezu AM, Nezu CM, Felgoise SH, McClure KS, Houts PS. Project genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol. 2003;71:1036–48.PubMedCrossRef

31.

Platt JJ, Spivack G. Problem-solving thinking of psychiatric patients. J Consult Clin Psychol. 1972;39:148–51.PubMedCrossRef

32.

Schipper H, Clinch J, McMurray A, Levitt M. Measuring the quality of life of cancer patients: the functional living index-cancer: development and validation. J Clin Oncol. 1984;5(2):472–83.

33.

Scheier MF, Carver CS. Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cogn Ther Res. 1992;16:201–28.CrossRef

34.

Shure MB. Interpersonal problem solving: A cog in the wheel of social cognition. Social-cognitive development in context. New York: Guildford; 1982.

35.

Shure MB, Newman S, Silver S. Problem-solving thinking among adjusted, impulsive, and inhibited Head Start children. Washington, D.C: Paper presented at the meeting of the Eastern Psychological Association; 1973.

36.

Spiegel D, Bloom JR, Yalom ID. Group support for metastatic cancer patients: A randomized prospective outcome study. Arch Gen Psychiatry. 1981;38:527–33.PubMed

37.

Spivack G, Levine M. Self-regulation in acting-out and normal adolescents (Report M-4531). Washington, D.C.: National Institute of Mental Health; 1963.

38.

Stanton AL, Snider PR. Coping with a breast cancer diagnosis: A prospective study. Health Psychol. 1993;12:16–23.PubMedCrossRef

39.

Telch CF, Telch MJ. Group counseling skills instruction and supportive group therapy for cancer patients: A comparison of strategies. J Consult Clin Psychol. 1986;54:802–8.PubMedCrossRef

40.

Yurek D, Farrar W, Anderson BL. Breast cancer surgery: Comparing surgical groups and determining individual differences in postoperative sexuality and body-change stress. J Consult Clin Psychol. 2000;68:697–709.PubMedCrossRef

41.

Witty TE, Heppner PP, Bernard CB, Thoreson RW. Problem solving appraisal and psychological adjustment of persons with chronic low back pain. J Clin Psychol Med Settings. 2001;8:149–60.CrossRef

42.

Zabalegui A. Coping strategies and psychological distress in patients with advanced cancer. Oncol Nurs Forum. 1999;26(9):1511–8.PubMed

Title: Problem-solving style and adaptation in breast cancer survivors: a prospective analysis
Authors: P. Paul Heppner
Jane M. Armer
Brent Mallinckrodt
Publication date: 01-06-2009
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 2/2009
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-009-0085-2

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Abstract

Introduction

Methods

Results

Conclusions

Implications for Cancer Survivors

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