Skip to main content

Advertisement

Log in

Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To examine the roles of both patient symptoms, and subjective appraisals of stress (self-efficacy, symptom barriers, symptom distress), in understanding well-being (anxiety, depression, cancer-specific quality of life, mental health quality of life, and physical health quality of life) in breast cancer patients.

Methods

We examined data from 104 female breast cancer patients. Using a stress process model, we hypothesized that while high levels of patient symptoms would be associated with poorer patient well-being, these effects would be mediated by subjective appraisals, including patient self-efficacy, perceived symptom barriers, and symptom distress.

Results

As expected, higher levels of patient symptoms were associated with poorer well-being on all five indicators. Subjective appraisals of stress added significantly to predictors of well-being, and were mediators of this relationship across all five outcomes.

Conclusions

While patient symptoms are important predictors of patient well-being, subjective appraisals of the stressfulness of symptoms, and of patients’ self-efficacy in managing symptoms, are also key factors. The findings suggest the utility of a stress process model in understanding well-being in breast cancer patients, and point to the potential value of targeting patient appraisals as well as symptoms to improve psychological well-being and quality of life.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society, (2017) Cancer facts & figures, American Cancer Society, Atlanta

  2. Boehmke MM (2004) Measurement of symptom distress in women with early-stage breast cancer. Cancer Nurs 27:144–152

    PubMed  Google Scholar 

  3. Liao MN, Chen SC, Chen SC, Lin YC, Chen MF, Wang CH, Hsu YH, Hung HC, Jane SW (2015) Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis. J Formos Med Assoc 114:246–253

    PubMed  Google Scholar 

  4. Rosedale M, Fu MR (2010) Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncol Nurs Forum 37:E28–E33

    PubMed  Google Scholar 

  5. Byma EA, Given BA, Given CW, You M (2009) The effects of mastery on pain and fatigue resolution. Oncol Nurs Forum 36:544–552

    PubMed  Google Scholar 

  6. Chou FY, Dodd M, Abrams D, Padilla G (2007) Symptoms, self-care, and quality of life of Chinese American patients with cancer. Oncol Nurs Forum 34:1162–1167

    PubMed  Google Scholar 

  7. Pud D, Ben Ami S, Cooper BA, Aouizerat BE, Cohen D, Radiano R, Naveh P, Nikkhou-Abeles R, Hagbi V, Kachta O, Yaffe A, Miaskowski C (2008) The symptom experience of oncology outpatients has a different impact on quality-of-life outcomes. J Pain Symptom Manag 35:162–170

    Google Scholar 

  8. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, Le N, Budhrani P (2012) Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med 35:86–94

    PubMed  Google Scholar 

  9. McMillan SC, Small BJ (2007) Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: a clinical trial. Oncol Nurs Forum 34:313–321

    PubMed  Google Scholar 

  10. Yeom H, Heidrich SM (2009) Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors. Cancer Nurs 32:309–316

    PubMed  PubMed Central  Google Scholar 

  11. Scott SE, McGurk M, Grunfeld EA (2007) The process of symptom appraisal: cognitive and emotional responses to detecting potentially malignant oral symptoms. J Psychosom Res 62:621–630

    PubMed  Google Scholar 

  12. Lazarus RS, Folkman S (1987) Transactional theory and research on emotions and coping. Eur J Personal 1:141–169

    Google Scholar 

  13. McCorkle R, Young K (1978) Development of a symptom distress scale. Cancer Nurs 1:373–378

    CAS  PubMed  Google Scholar 

  14. Mystakidou K, Parpa E, Tsilika E, Galanos A, Vlahos L (2008) General perceived self-efficacy: validation analysis in Greek cancer patients. Support Care Cancer 16:1317–1322

    PubMed  Google Scholar 

  15. Hoffman AJ, von Eye A, Gift AG, Given BA, Given CW, Rothert M (2009) Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nurs Res 58:32–41

    PubMed  PubMed Central  Google Scholar 

  16. Liang SY, Yates P, Edwards H, Tsay SL (2008) Factors influencing opioid-taking self-efficacy and analgesic adherence in Taiwanese outpatients with cancer. Psychooncology 17:1100–1107

    PubMed  Google Scholar 

  17. Shelby RA, Edmond SN, Wren AA, Keefe FJ, Peppercorn JM, Marcom PK, Blackwell KL, Kimmick GG (2014) Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy. Support Care Cancer 22:2851–2859

    PubMed  Google Scholar 

  18. Kreitler S, Peleg D, Ehrenfeld M (2007) Stress, self-efficacy and quality of life in cancer patients. Psychooncology 16:329–341

    PubMed  Google Scholar 

  19. Curtis R, Groarke A, Sullivan F (2014) Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer. Sci Rep 4:5569

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Motl RW, Snook EM, McAuley E, Gliottoni RC (2006) Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis. Res Nurs Health 29:597–606

    PubMed  Google Scholar 

  21. Kurtz ME, Kurtz JC, Given CW, Given BA (2008) Patient optimism and mastery-do they play a role in cancer patients’ management of pain and fatigue? J Pain Symptom Manag 36:1–10

    Google Scholar 

  22. Riley-Doucet C (2010) Beliefs about the controllability of pain: congruence between older adults with cancer and their family caregivers. J Fam Nurs 11:225–241

    Google Scholar 

  23. Bagcivan G, Tosun N, Komurcu S, Akbayrak N, Ozet A (2009) Analysis of patient-related barriers in cancer pain management in Turkish patients. J Pain Symptom Manag 38:727–737

    Google Scholar 

  24. Haley WE, LaMonde LA, Han B, Burton AM, Schonwetter R (2003) Predictors of depression and life satisfaction among spousal caregivers in hospice: application of a stress process model. J Palliat Med 6:215–224

    PubMed  Google Scholar 

  25. Bigatti SM, Stiener JL, Miller KD (2012) Cognitive appraisals, coping and depressive symptoms in breast cancer patients. Stress & Health 28:255–261

    Google Scholar 

  26. McMillan S, Tofthagen C, Choe R, Reingans J (2015) Assessing symptoms experienced by patients with cancer: occurrence, intensity, distress, interference and frequency. J Hosp Palliat Nurs 17:56–65

    Google Scholar 

  27. Merluzzi TV, Nairn RC, Hegde K, Martinez Sanchez MA, Dunn L (2001) Self-efficacy for coping with cancer: revision of the Cancer Behavior Inventory (version 2.0). Psychooncology 10:206–217

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Wells N, Johnson RL, Wujcik D (1998) Development of a short version of the Barriers Questionnaire. J Pain Symptom Manag 15:294–297

    CAS  Google Scholar 

  29. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA

    Google Scholar 

  30. Challis GB, Stam HJ (1992) A longitudinal study of the development of anticipatory nausea and vomiting in cancer chemotherapy patients: the role of absorption and autonomic perception. Health Psychol 11:181–189

    CAS  PubMed  Google Scholar 

  31. Heim HM, Oei TPS (1993) Comparison of prostate cancer patients with and without pain. Pain 53:159–162

    CAS  PubMed  Google Scholar 

  32. Julian LJ (2011) Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 63(Suppl 11):S467–S472

    Google Scholar 

  33. Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Google Scholar 

  34. Hann D, Winter K, Jacobsen P (1999) Measurement of depressive symptoms in cancer patients: evaluation of the center for epidemiological studies depression scale (CES-D). J Psychosom Res 46:437–443

    CAS  PubMed  Google Scholar 

  35. Cheng ST, Chan AC (2005) The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms. Int J Geriatr Psychiatry 20:465–470

    PubMed  Google Scholar 

  36. Rustøen T, Moum T, Padilla G, Paul S, Miaskowski C (2005) Predictors of quality of life in oncology outpatients with pain from bone metastasis. J Pain Symptom Manag 30:234–242

    Google Scholar 

  37. Ware JE, Sherbourne CD (1992) The MOS 36-item Short-Form Health Survey (SF-36). Med Care 30:473–483

    Google Scholar 

  38. Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 Health Survey manual and interpretation guide. The Health Institute, Boston: MA

    Google Scholar 

  39. A.F. Hayes,(2012) PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling, The Ohio State University,

  40. Tojal C, Costa R (2015) Depressive symptoms and mental adjustment in women with breast cancer. Psychooncology 24:1060–1065

    PubMed  Google Scholar 

  41. McMillan S, Small BJ, Weitzner M, Schonwetter R, Tittle M, Moody L, Haley WE (2006) Impact of coping skills intervention with family caregivers of hospice patients with cancer. Cancer 105:214–222

    Google Scholar 

  42. Baik OM, Adams KB (2011) Improving the well-being of couples facing cancer: a review of couples-based psychosocial interventions. J Marital Fam Ther 27:250–266

    Google Scholar 

  43. Lee V, Cohen SR, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62:3133–3145

    PubMed  Google Scholar 

Download references

Funding

Research reported in this article was funded in part through a Patient-Centered Outcomes Research Institute (PCORI) Award (CE-12-11-4025). The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adrian N. S. Badana.

Ethics declarations

The study was approved by the Institutional Review Board at the University of South Florida [Pro00013488].

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Badana, A.N.S., Marino, V.R., Templeman, M.E. et al. Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients. Support Care Cancer 27, 4245–4252 (2019). https://doi.org/10.1007/s00520-019-04707-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-04707-2

Keywords

Navigation