Baseline psychosocial predictors of survival in localised breast cancer

Despite the large number of studies on the impact of psychosocial factors on breast cancer progression, there is no certainty about the contributing factors or processes involved. We investigated the relative impacts of socioeconomic, psychological, and psychosocial factors on survival in breast cancer. A consecutive sample of 102 patients (participation 82%) under 72 years of age with locoregional breast cancer completed validated questionnaires on coping with cancer, emotional expression (anger), perceived available support, noncancer life stresses, and quality of life 3−4 months after diagnosis. Survival times were measured from the date of diagnosis to the date of relapse and further to the date of death or date of last follow-up. Cumulative Cox regression analyses were carried out. After controlling for biological prognostic factors, age, and baseline treatment, longer survival was predicted by a long education and a minimising-related coping, while shorter survival was predicted by emotional defensiveness (antiemotionality), behavioural-escape coping, and a high level of perceived support. A shorter event-free time was also predicted by unemployment and depressive symptoms. Cancer survival is affected by a complex combination of psychosocial factors, among which minimising predicts a favourable prognosis and anger nonexpression and escape behaviour an unfavourable prognosis. Higher socioeconomic status is associated with longer survival. High scores in well-being scales may reflect emotional nonexpression

Social Support and Psychological Stress Processes in the Early Phase of Cancer

Psykososiaalisilla tekijöillä on esitetty olevan vaikutusta sekä syöpäpotilaan psyykkiseen hyvinvointiin että taudin biologiseen etenemiseen. Psyykkinen stressi saa aikaan monenlaisia fysiologisia muutoksia, mm. heikentää elimistön vastustuskykyä, mutta sen haitallisten vaikutusten synnyn kannalta on olennaista, kuinka yksilö pystyy hallitsemaan (coping) stressiä. Tärkein copingiin vaikuttava tekijä on henkilön ihmissuhteistaan saama tuki. On esitetty, että ihmissuhteista saatu tuki on keino muuttaa stressin hallintaa. Tutkimuksessa on käytetty psykologisia stressiteorioita kliinis-epidemiologisessa tutkimusasetelmassa. Psykososiaaliset tekijät mitattiin määrällisillä menetelmillä, joista saadaan numeerinen arvio ko tekijöistä. Tukea mittaava päämenetelmä on kehitetty tämän tutkimuksen puitteissa. Tutkimukseen kuului 175 ei-edenneeseen syöpään hiljattain sairastunutta alle 71 vuotiasta potilasta (72 melanooma ja 103 rintasyöpä). Heidän kokemaansa tukea, stressiprosesseja, persoonallisuustekijöitä ja koettua vointia/oireita mitattiin 3 - 4 kuukautta syövän toteamisen jälkeen psykologin (U-S L-J) haastattelun yhteydessä. Aineiston edustavuus oli hyvä. Tutkimuksen tärkeimmät tulokset olivat: 1. Kehitetty uusi potilaiden kokemia tukitekijöitä mittaava menetelmä, The Structural-Functional Social Support Scale (SFSS). Menetelmä mittaa, keiden kanssa potilas on puhunut sairaudestaan sekä paljonko ja millaista tukea hän heiltä on saanut. Tutkitut olivat puhuneet laajalti syövästään - syöpäsairautta ei oltu pidetty salaisuutena - ja jo pelkkä asiasta puhuminen oli lisännyt koettua tukea. Tunnetuki ja käytännöllinen tuki eivät olleet selkästi eroteltavissa, tuki oli parhaiten luokiteltavissa sen mukaan, keiltä sitä saatiin. Verrattuna SFSS:ään kaksi paljon käytettyä kansainvälistä menetelmää mittasivat vain joistakin tuen lähteistä koettua tukea, joten SFSS antoi olennaista lisätietoa syöpään sairastuneiden kokemasta tuesta. 2. Syövän lisähoidot (sädehoito, solunsalpaajahoito) johtivat suurempaan määrään koettua tukea tukea mm. sukulaisilta, ystäviltä ja tuttavilta (ks. edellä, puhuminen lisäsi tukea), jolloin pelkän leikkaushoidon läpikäyneet potilaat olivat saaneet psyykkisessäkin mielessä jotain vähemmän. Ne potilaat, jotka eivät saa lääketieteellisiä lisähoitoja, saattavat tarvita pykososiaalista lisähoitoa eli ammatti-ihmisen suorittaman psykososiaalisen intervention saavuttaakseen psyykkisesti tasaveroisen aseman muiden potilaiden kanssa. 3. Ihmissuhteista saatu tuki auttoi syövän aiheuttaman stressin hallintaa. Koettu tuki ja persoonallisuustekijät vaikuttivat molemmat stressin hallintaan, mutta jälkimmäisten vaikutus oli tuen vaikutuksesta erillinen, eikä näin ollen sekoittanut tuen kykyä muokata stressin hallintaa. Tuen vaikutuksessa oli selviä sukupuolieroja siinä, mistä lähteestä saatu tuki vaikutti: kanssapotilailta ja tuttavilta saatu tuki paransi miesten stressinhallintaa, kun taas naisilla (sekä melanoomassa että rintasyövässä) vaikutti ystävien tuki. Sairauden lisäksi muuta samanaikaista stressiä kokeneet joutuivat kamppailemaan enemmän syövän aiheuttaman stressin kanssa. 4. Potilaiden kokemat oireet ja hyvinvointi olivat tutkituista biologisista parametreista riippumattomia: potilaiden kokemien oireiden määrä oli selvässä yhteydessä psyykkisiin tekijöihin, mutta ei mm. siihen, kumpi syöpätyyppi oli kyseessä tai mitä hoitoa oli annettu. 5. Tutkimuksessa on edistetty Suomessa vielä harvinaista psykososiaalista syöpätutkimusta, jota tehdään kuitenkin paljon mm. muissa Pohjoismaissa. Tutkimuksen tuloksia pyritään käyttämään kaikille syöpäpotilaille kohdennettavan psykososiaalisen interventiomenetelmän laatimiseen aikuisikäisille syöpäpotilaille, mm. tuen optimaalisten kohderyhmien ja ajoituksen arvioimiseen. Tutkimusta on jatkettu seuraamalla samojen potilaiden stressiprosessien kulkua sekä psykososiaalista ja biologista selviytymistä toistetuin mittauksin.Physical health is affected by different kinds of environmental factors. One of these factors is psychological stress. The effects of stress are mediated by coping, stress management, which is modified by social support and personality and initiated or interfered by stressors. These together contribute to the health status or illness of a patient. Coping is the major determinant in the process from stressful events to adaptational outcomes, such as psychological symptoms and somatic illness. There is strong evidence for a causal impact of social relationships on health. The social support of a person consists of the network of the social relationships (sources of support), and the functions of social support derived from these sources. The person's own subjective experiences of the supportiveness of the relationships are positively related to health outcomes. Social support protects the individual from the potentially harmful effects of stress and thus enhances coping. Besides! cancer related stressors, cancer patients may simultaneously experience various additional stress causing factors. The health consequences of the psychological stress processes may surface as various physical and/or psychosocial health outcomes. Factors in the psychological stress processes, namely experienced social support, coping with illness, Type C personality related anger expression, experienced cancer and non-cancer stressors, psychological and physical symptoms, well-being, breast cancer specific symptoms, and depression were measured in a consecutive sample of 72 melanoma (36 women, 36 men) and 103 breast cancer patients 3 - 4 months after diagnosis. The methods were the Structural-Functional Social Support Scale (SFSS), the MOS Social Support Survey, the Ways of Coping Questionnaire, the Coping With Illness Scale (CILL-26), the Anger Expression Scale, the Life Experience Survey, the Chronic Strains Survey, the Rotterdam Symptom Checklist, EORTC QLQ-Breast 23 module, and the Depression Scale (DEPS). Social support experienced by the patients was measured by a new method constructed within this study, the Structural-Functional Social Support Scale (SFSS), which evaluates both the number of people with whom th! e patients had discussed their disease (sources of support) and the amount of functional social support experienced from these sources. The experience of cancer was shared with others. The mere existence of a source of support, when the patient had it, was felt to be supportive. An increase in the number of members in a support source did not increase the support experienced. Experience of the amount of support was quite similar irrespective of its source. Breast cancer patients experienced more support than melanoma patients, which may be due to the amount of cancer treatment received. There were hardly any gender differences. Functional support was distinguished according to sources of support, whereas division by function (emotional and practical) was weaker and not present in every source. When SFSS was compared with MOS Survey and the Ways of Coping Questionnaire's Seeking Social Support items, MOS measured almost solely support from spouse and family and Seeking Social Support items support from friends, acquaintances, and other patients; these two scales measured social support from a different viewpoin! t than SFSS. SFSS is applicable for research purposes and capable of producing interesting additional information about social support. Five patterns of coping (Focusing on the Positive, Distancing, Seeking Social Support, Cognitive Escape-Avoidance, and Behavioral Escape-Avoidance) and three traits of anger expression, (anger-in, anger-out, and anger control) were identified. The effect of experienced social support, anger expression, stressors, and age on coping was investigated by stepwise regression analysis (RA). Each of these factors had an influence on coping with cancer. In melanoma, social support predicted in RA coping with the disease. Among men the influence was stronger than among women, whereas in breast cancer, the predicting power of social support was weaker. All the coping patterns were affected by social support. More support led in RA to more use of other coping patterns in general, but decreased the two escape-avoidance patterns. The influential sources of social support differed between genders. In men, the most influential sources of social support were other patients and acquaintances, ! whereas in women, the most influential source of support was friends. Support from spouse and family had only a minor effect on coping with cancer, and support from nurses had none. Anger expression factors did not explain away the influence of experienced social support on coping, but had an additional effect. Anger expression traits showed only weak connections to experienced social support. Non-cancer stressor load increased coping with cancer. Patients with adjuvant treatment experienced more support from several sources than patients who had only had surgery. Furthermore, the effect of the factors in the psychosocial stress processes on reported symptoms and well-being of the patients was also investigated by stepwise regression analysis (RA). Differences in the symptoms reported were explained by psychological factors in the stress processes, not by differences in the cancer type or treatment. The effect was stronger in melanoma and differed between genders. In the RA model, the effect of psychological stress processes on overall symptoms was strong, but minor on breast cancer specific, i.e., breast area symptoms. Psychological symptoms were increased by more Behavioral Escape-Avoidance in melanoma, more Cognitive Escape-Avoidance in breast cancer, more anger-out trait in men, more anger control trait in breast cancer, and greater number of negative non-cancer life events in both female groups. Patients with more non-cancer stress reported more physical symptoms. Quality of life was differently predicted by psychological factors b! etween genders, e.g., greater age predicted worse quality of life among men, but not among women. In melanoma, more use of coping pattern Behavioral Escape-Avoidance strongly predicted greater reported depression. In breast cancer, more depression was predicted by several variables. The presence of adjuvant cancer treatment was associated with more depressive symptoms. The results obtained concur with the hypotheses about factors involved in or influencing the psychological stress processes in chronic diseases. The only distinguishing psychosocial factor between the investigated cancer groups was the amount of experienced social support, which was higher when there had been more medical cancer treatment (operation only versus operation plus adjuvant treatments). This might have led to the observed differences between the two cancers and, further, to the changes in the psychological stress processes and in the amounts of symptoms reported. Adjuvant medical cancer treatments may have had an additional effect by producing more experienced social support, and, as a result, the patients with operation only gained something less in the psychosocial field of cancer care. The results permit the conclusion that adjuvant psychosocial cancer treatment (psychosocial intervention) - if it increases experienced social support - may benefit patients by hel! ping them to cope with cancer. This may be especially beneficial for patients who do not receive adjuvant medical cancer treatment, and consequently, do not receive social support through this extra attention

Social Support and Psychological Stress Processes in the Early Phase of Cancer

Psykososiaalisilla tekijöillä on esitetty olevan vaikutusta sekä syöpäpotilaan psyykkiseen hyvinvointiin että taudin biologiseen etenemiseen. Psyykkinen stressi saa aikaan monenlaisia fysiologisia muutoksia, mm. heikentää elimistön vastustuskykyä, mutta sen haitallisten vaikutusten synnyn kannalta on olennaista, kuinka yksilö pystyy hallitsemaan (coping) stressiä. Tärkein copingiin vaikuttava tekijä on henkilön ihmissuhteistaan saama tuki. On esitetty, että ihmissuhteista saatu tuki on keino muuttaa stressin hallintaa. Tutkimuksessa on käytetty psykologisia stressiteorioita kliinis-epidemiologisessa tutkimusasetelmassa. Psykososiaaliset tekijät mitattiin määrällisillä menetelmillä, joista saadaan numeerinen arvio ko tekijöistä. Tukea mittaava päämenetelmä on kehitetty tämän tutkimuksen puitteissa. Tutkimukseen kuului 175 ei-edenneeseen syöpään hiljattain sairastunutta alle 71 vuotiasta potilasta (72 melanooma ja 103 rintasyöpä). Heidän kokemaansa tukea, stressiprosesseja, persoonallisuustekijöitä ja koettua vointia/oireita mitattiin 3 - 4 kuukautta syövän toteamisen jälkeen psykologin (U-S L-J) haastattelun yhteydessä. Aineiston edustavuus oli hyvä. Tutkimuksen tärkeimmät tulokset olivat: 1. Kehitetty uusi potilaiden kokemia tukitekijöitä mittaava menetelmä, The Structural-Functional Social Support Scale (SFSS). Menetelmä mittaa, keiden kanssa potilas on puhunut sairaudestaan sekä paljonko ja millaista tukea hän heiltä on saanut. Tutkitut olivat puhuneet laajalti syövästään - syöpäsairautta ei oltu pidetty salaisuutena - ja jo pelkkä asiasta puhuminen oli lisännyt koettua tukea. Tunnetuki ja käytännöllinen tuki eivät olleet selkästi eroteltavissa, tuki oli parhaiten luokiteltavissa sen mukaan, keiltä sitä saatiin. Verrattuna SFSS:ään kaksi paljon käytettyä kansainvälistä menetelmää mittasivat vain joistakin tuen lähteistä koettua tukea, joten SFSS antoi olennaista lisätietoa syöpään sairastuneiden kokemasta tuesta. 2. Syövän lisähoidot (sädehoito, solunsalpaajahoito) johtivat suurempaan määrään koettua tukea tukea mm. sukulaisilta, ystäviltä ja tuttavilta (ks. edellä, puhuminen lisäsi tukea), jolloin pelkän leikkaushoidon läpikäyneet potilaat olivat saaneet psyykkisessäkin mielessä jotain vähemmän. Ne potilaat, jotka eivät saa lääketieteellisiä lisähoitoja, saattavat tarvita pykososiaalista lisähoitoa eli ammatti-ihmisen suorittaman psykososiaalisen intervention saavuttaakseen psyykkisesti tasaveroisen aseman muiden potilaiden kanssa. 3. Ihmissuhteista saatu tuki auttoi syövän aiheuttaman stressin hallintaa. Koettu tuki ja persoonallisuustekijät vaikuttivat molemmat stressin hallintaan, mutta jälkimmäisten vaikutus oli tuen vaikutuksesta erillinen, eikä näin ollen sekoittanut tuen kykyä muokata stressin hallintaa. Tuen vaikutuksessa oli selviä sukupuolieroja siinä, mistä lähteestä saatu tuki vaikutti: kanssapotilailta ja tuttavilta saatu tuki paransi miesten stressinhallintaa, kun taas naisilla (sekä melanoomassa että rintasyövässä) vaikutti ystävien tuki. Sairauden lisäksi muuta samanaikaista stressiä kokeneet joutuivat kamppailemaan enemmän syövän aiheuttaman stressin kanssa. 4. Potilaiden kokemat oireet ja hyvinvointi olivat tutkituista biologisista parametreista riippumattomia: potilaiden kokemien oireiden määrä oli selvässä yhteydessä psyykkisiin tekijöihin, mutta ei mm. siihen, kumpi syöpätyyppi oli kyseessä tai mitä hoitoa oli annettu. 5. Tutkimuksessa on edistetty Suomessa vielä harvinaista psykososiaalista syöpätutkimusta, jota tehdään kuitenkin paljon mm. muissa Pohjoismaissa. Tutkimuksen tuloksia pyritään käyttämään kaikille syöpäpotilaille kohdennettavan psykososiaalisen interventiomenetelmän laatimiseen aikuisikäisille syöpäpotilaille, mm. tuen optimaalisten kohderyhmien ja ajoituksen arvioimiseen. Tutkimusta on jatkettu seuraamalla samojen potilaiden stressiprosessien kulkua sekä psykososiaalista ja biologista selviytymistä toistetuin mittauksin.Physical health is affected by different kinds of environmental factors. One of these factors is psychological stress. The effects of stress are mediated by coping, stress management, which is modified by social support and personality and initiated or interfered by stressors. These together contribute to the health status or illness of a patient. Coping is the major determinant in the process from stressful events to adaptational outcomes, such as psychological symptoms and somatic illness. There is strong evidence for a causal impact of social relationships on health. The social support of a person consists of the network of the social relationships (sources of support), and the functions of social support derived from these sources. The person's own subjective experiences of the supportiveness of the relationships are positively related to health outcomes. Social support protects the individual from the potentially harmful effects of stress and thus enhances coping. Besides! cancer related stressors, cancer patients may simultaneously experience various additional stress causing factors. The health consequences of the psychological stress processes may surface as various physical and/or psychosocial health outcomes. Factors in the psychological stress processes, namely experienced social support, coping with illness, Type C personality related anger expression, experienced cancer and non-cancer stressors, psychological and physical symptoms, well-being, breast cancer specific symptoms, and depression were measured in a consecutive sample of 72 melanoma (36 women, 36 men) and 103 breast cancer patients 3 - 4 months after diagnosis. The methods were the Structural-Functional Social Support Scale (SFSS), the MOS Social Support Survey, the Ways of Coping Questionnaire, the Coping With Illness Scale (CILL-26), the Anger Expression Scale, the Life Experience Survey, the Chronic Strains Survey, the Rotterdam Symptom Checklist, EORTC QLQ-Breast 23 module, and the Depression Scale (DEPS). Social support experienced by the patients was measured by a new method constructed within this study, the Structural-Functional Social Support Scale (SFSS), which evaluates both the number of people with whom th! e patients had discussed their disease (sources of support) and the amount of functional social support experienced from these sources. The experience of cancer was shared with others. The mere existence of a source of support, when the patient had it, was felt to be supportive. An increase in the number of members in a support source did not increase the support experienced. Experience of the amount of support was quite similar irrespective of its source. Breast cancer patients experienced more support than melanoma patients, which may be due to the amount of cancer treatment received. There were hardly any gender differences. Functional support was distinguished according to sources of support, whereas division by function (emotional and practical) was weaker and not present in every source. When SFSS was compared with MOS Survey and the Ways of Coping Questionnaire's Seeking Social Support items, MOS measured almost solely support from spouse and family and Seeking Social Support items support from friends, acquaintances, and other patients; these two scales measured social support from a different viewpoin! t than SFSS. SFSS is applicable for research purposes and capable of producing interesting additional information about social support. Five patterns of coping (Focusing on the Positive, Distancing, Seeking Social Support, Cognitive Escape-Avoidance, and Behavioral Escape-Avoidance) and three traits of anger expression, (anger-in, anger-out, and anger control) were identified. The effect of experienced social support, anger expression, stressors, and age on coping was investigated by stepwise regression analysis (RA). Each of these factors had an influence on coping with cancer. In melanoma, social support predicted in RA coping with the disease. Among men the influence was stronger than among women, whereas in breast cancer, the predicting power of social support was weaker. All the coping patterns were affected by social support. More support led in RA to more use of other coping patterns in general, but decreased the two escape-avoidance patterns. The influential sources of social support differed between genders. In men, the most influential sources of social support were other patients and acquaintances, ! whereas in women, the most influential source of support was friends. Support from spouse and family had only a minor effect on coping with cancer, and support from nurses had none. Anger expression factors did not explain away the influence of experienced social support on coping, but had an additional effect. Anger expression traits showed only weak connections to experienced social support. Non-cancer stressor load increased coping with cancer. Patients with adjuvant treatment experienced more support from several sources than patients who had only had surgery. Furthermore, the effect of the factors in the psychosocial stress processes on reported symptoms and well-being of the patients was also investigated by stepwise regression analysis (RA). Differences in the symptoms reported were explained by psychological factors in the stress processes, not by differences in the cancer type or treatment. The effect was stronger in melanoma and differed between genders. In the RA model, the effect of psychological stress processes on overall symptoms was strong, but minor on breast cancer specific, i.e., breast area symptoms. Psychological symptoms were increased by more Behavioral Escape-Avoidance in melanoma, more Cognitive Escape-Avoidance in breast cancer, more anger-out trait in men, more anger control trait in breast cancer, and greater number of negative non-cancer life events in both female groups. Patients with more non-cancer stress reported more physical symptoms. Quality of life was differently predicted by psychological factors b! etween genders, e.g., greater age predicted worse quality of life among men, but not among women. In melanoma, more use of coping pattern Behavioral Escape-Avoidance strongly predicted greater reported depression. In breast cancer, more depression was predicted by several variables. The presence of adjuvant cancer treatment was associated with more depressive symptoms. The results obtained concur with the hypotheses about factors involved in or influencing the psychological stress processes in chronic diseases. The only distinguishing psychosocial factor between the investigated cancer groups was the amount of experienced social support, which was higher when there had been more medical cancer treatment (operation only versus operation plus adjuvant treatments). This might have led to the observed differences between the two cancers and, further, to the changes in the psychological stress processes and in the amounts of symptoms reported. Adjuvant medical cancer treatments may have had an additional effect by producing more experienced social support, and, as a result, the patients with operation only gained something less in the psychosocial field of cancer care. The results permit the conclusion that adjuvant psychosocial cancer treatment (psychosocial intervention) - if it increases experienced social support - may benefit patients by hel! ping them to cope with cancer. This may be especially beneficial for patients who do not receive adjuvant medical cancer treatment, and consequently, do not receive social support through this extra attention

Health surveys: evaluation and recommendations : subproject reports of phase 2 of the project Health surveys in the EU: HIS and HIS/HES evaluations and models

The project Health Surveys in the EU: HIS/HES evaluations and models (HIS/HES project) aims to support Health Monitoring by producing an up to date overview of methods and contents of existing and planned Health Interview Surveys (HIS), Health Examination Surveys (HES), combinations of HIS/HES, and other population surveys with a significant health component in the member states (MS) and EFTA/EEA countries. The project was carried out under the auspices of the European Commission (in the framework of the Health Monitoring Program / HMP). This report includes reports from the subprojects carried out during the second phase of the HIS/HES project. The specific aims of this second phase of the HIS/HES project were to identify, define and evaluate survey indicators and measurement methods for the main health status components required for the system of Community Health Indicators