Younger Women's Perceptions of Coping With Breast Cancer

Janeen C. Manuel, PhD; Stephanie R. Burwell, PhD; Sybil L. Crawford, PhD; Renee H. Lawrence, PhD; Deborah F. Farmer, PhD; Anita Hege, RN, MPH; Kimberly Phillips, RN, PhD; Nancy E. Avis, PhD


Cancer Nurs. 2007;30(2):85-94. 

In This Article

Abstract and Introduction

Numerous studies have demonstrated an association between coping strategies and better quality of life after breast cancer. Because younger women consistently show greater psychological morbidity than older women after breast cancer diagnosis, there is great interest in the coping strategies of younger women. The present cross-sectional study used quantitative and qualitative methods to examine coping strategies used by 201 women who were aged 50 years or younger at diagnosis and were 6 months to 3.5 years postdiagnosis. Quantitative results from a modified version of the Ways of Coping scale revealed that the most frequently used coping strategies were positive cognitive restructuring, wishful thinking, and making changes. Qualitative analyses based on open-ended questioning of how women best coped with different stressful aspects of their diagnosis showed that women reported finding different strategies useful depending on the stressor. For example, social support was helpful in dealing with anger or depression, whereas positive cognitive restructuring was more helpful for concerns about the future. Analyses also confirmed that most coping strategies cited in commonly administered coping scales were used frequently by these women. However, several coping strategies not generally measured were also deemed valuable, including engaging in physical activity, using medications, and resting. These findings suggest that clinicians should identify patients' particular stressors and help with coping techniques targeting particular concerns.

An estimated 212,920 new cases of invasive breast cancer are expected to occur among women in 2006, making it the most common cancer among women in the United States.[1] Over the years, numerous studies have been conducted on the psychosocial sequelae of breast cancer (for reviews, see Glanz and Lerman,[2] Irvine et al,[3] Moyer,[4] and Moyer and Salovey[5]). Several studies have demonstrated a wide variation in women's responses to cancer, with many women adjusting relatively well and others having more problems.[2,3,6,7,8,9] The variability in adjustment to breast cancer diagnosis and treatment has led researchers to examine how factors such as demographics, disease and treatment characteristics, social support, and personality (eg, coping style) are associated with adjustment.[10,11,12,13,14,15] Of these factors, coping strategies in particular have been shown to be highly associated with adjustment and quality of life (QOL) after breast cancer diagnosis.[10,11,16,17,18,19,20,21,22]

The research described here reports on coping strategies used by women diagnosed with breast cancer and is based on a modified Ways of Coping-Cancer Version (WOC-CA)[23] scale and additional responses to open-ended questions. The focus of the research is on younger women diagnosed with breast cancer before age 50, as studies have consistently found that younger women show greater psychological distress in response to breast cancer than older women.[12,24,25,26,27,28,29] The open-ended responses are particularly important because they provide the opportunity to explore whether existing scales adequately cover the strategies used by younger women and how women cope with specific problem areas. The objectives of the research are 3-fold: (1) to describe coping strategies used by younger women in response to being diagnosed with breast cancer, (2) to determine if younger women use additional coping strategies that are not covered by generally used coping scales, and (3) to examine how different coping strategies are used by women in handling different stressful aspects of cancer diagnosis and treatment. The analyses are part of a larger study of psychosocial adjustment to breast cancer among women aged 50 years and younger at the time of diagnosis. We have previously reported on the concerns and problems faced by these women[7] and their QOL.[16]

Coping strategies are a particularly important area of focus. Glanz and Lerman[2] estimated that half of the variance in psychological adjustment to breast cancer can be attributed to coping style. Our previous research with younger women found positive cognitive restructuring (ie, trying to find something positive about having breast cancer) was consistently related to better QOL and that wishful thinking was related to worse QOL as measured by the Functional Assessment of Cancer Therapy-Breast.[16] These coping strategies were more strongly related to QOL than were medical factors. Others have also found that strategies directed toward active engagement of the illness situation are associated with better psychosocial adjustment and QOL, whereas avoidant coping strategies are related to poorer outcomes.[11,17,18,20,22]

Women diagnosed with breast cancer at a younger age are receiving increasing attention.[30,31,32] With increasing absolute numbers and declining mortality rates, younger breast cancer survivors are a growing group.[1,33] It is important to understand how younger women cope with specific difficulties and what strategies they consider successful. Younger women often face very different issues and problems than older women, including concerns about children; concerns about having children when faced with a life-threatening illness; premature menopause leading to loss of fertility, sudden onset of vasomotor symptoms, and long-term consequences of early ovarian decline; greater concerns about body image and sexuality; and more career and work concerns related to productivity and job security.[7,9,27,34,35] These unique concerns of younger women with breast cancer may influence their adjustment and warrant particular coping strategies.

A review of the coping literature suggests that 4 of the most frequently used measures of coping in breast cancer studies are the COPE,[36] the WOC,[37] Coping Responses Inventory (CRI),[38] and the Coping Strategies Inventory (CSI).[3] These scales were originally developed on college undergraduates (COPE) or general populations (WOC, CRI, CSI), although the WOC was later adapted for cancer-WOC-CA.[23] It is important to know if these scales adequately cover the types of coping strategies used by younger women in response to breast cancer.

Furthermore, studies using the WOC-CA, COPE, CSI, and CRI typically ask respondents how they have coped with cancer in general. However, coping with cancer requires dealing with a number of specific problems such as pain and fatigue, anger, changes in appearance, and relationships with partners and family. To be effective, coping strategies may need to vary according to specific stressor. Previous studies ofcoping have not looked at particular stressors other than chemotherapy,[19] yet these specifics may help target interventions. For example, coping with fatigue and pain may require different strategies than coping with changes in appearance.

Given the importance of coping to overall adjustment and the growing group of younger women with breast cancer, greater insight into coping strategies of younger women may provide some direction for ways to improve the adjustment among this group of cancer patients.


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