Stressors and Coping Strategies Among Female Cancer Survivors After Treatments

Diane Ruth Lauver, PhD, APRN, BC, FAAN; Kira Connolly-Nelson, BS, RN; Vang, Pa BS, RN

Disclosures

Cancer Nurs. 2007;30(2):101-111. 

In This Article

Abstract and Introduction

Abstract

Although cancer survivors often face stressors and experience psychologic symptoms and distress, research on the particular stressors and coping strategies upon finishing cancer treatments is rare. The study purposes were to identify the stressors experienced and the strategies used by women cancer survivors at this phase of survivorship. The specific aims were to describe the stressors at the end of primary cancer treatments and delineate coping strategies that were used and helpful. Using a longitudinal design, interviews were conducted within 4 weeks and 3 to 4 months after treatment. Participants (N = 51) were women aged 34 to 77, and had radiation and/or chemotherapy for primary breast or gynecologic cancers. Participants' primary stressors at the end of treatment included feelings of uncertainty about treatment, follow-up, and symptoms; physical concerns; difficulty concentrating, attitudes about body, and dealing with mortality. Participants used acceptance, religion, and distraction as primary coping strategies. These strategies also were rated highly as helpful coping strategies. Clinicians can provide anticipatory guidance, based upon previous survivors' strategies, as well as assess and address particular stressors at this phase. Nurses can design and test patient-centered interventions that address women's specific stressors and promote effective coping strategies among women at this phase of survivorship.

Introduction

Although most cancer survivors do not experience major psychopathology, they often face stressors and experience psychologic symptoms and distress.[1,2] Some researchers have concluded that the diagnosis of cancer produces a greater amount of distress than other diagnoses.[3] A stress-coping model could be helpful in understanding issues for survivors at the end of their treatments for primary cancer.

We used the stress-coping model described by Dr Jean E. Johnson, a nationally recognized nurse researcher in oncology, to guide our study of cancer survivors. In this model, a stressor is identified as a stimulus that an individual perceives as challenging, threatening, or demanding.[4] In general, cancer survivors' stressors may include fears of recurrence and death, intrusive thoughts about cancer, altered relationships, negotiating in the healthcare system, and physical symptoms from treatment.[1,5,6,7]

Researchers and clinicians have noted that the type and degree of stressors may vary by phase of cancer survivorship.[8,9,10,11] One team of researchers found that ending chemotherapy orradiation for primary cancers has been described as particularly stressful.[12] It can be a time of uncertainties, the end of initial medical interventions for the cancer, and less frequent contacts with health practitioners from whom patients often have received information and support. However, we could not find other studies describing the particular stressors and coping strategies at the end of treatments. In this study, we use the term "end of treatments" to mean the time when patients have completed needed surgery, chemotherapy, and/or radiation treatments for primary cancer. We recognize that some survivors may self-administer chemotherapeutic agents after this time (eg, tamoxifen) to enhance their rates of cure.

According to Johnson's stress-coping model, coping strategies are efforts directed toward managing or dealing with a stressor.[4,13] Cancer survivors' coping strategies may include logical analysis, positive reappraisal, guidance/support, problem solving, cognitive avoidance, and resigned acceptance.[14,15] Depending upon how effectively individuals cope with their stressors, they may experience either desired emotional states of acceptance, peace and equanimity, or undesired emotional consequences such as depression, anxiety, and anger.[3,4,14] Many psychoeducational programs have been effective in improving cancer patients' coping strategies and outcomes of coping, such as moods.[16,17,18] Yet, rarely have these psychoeducational programs targeted individuals who are finishing primary cancer treatments.[19]

The purpose of this study was to determine the stressors that survivors experienced and the coping strategies they used at the end of treatments for primary breast and gynecologic cancers. More specifically, the research questions were:

  1. What are the stressors experienced at the end of treatments for primary cancers, as named by women cancer survivors?

  2. What are strategies used to cope with such stressors by these survivors?

The study focused only on women with reproductive cancers because gender could influence the cancer survivorship experience. Women with cancer are challenged to reconcile potentially competing roles: caretaker for others and caretaker for themselves.[5,10,20] Additionally, survivors of breast and gynecologic cancers may face changes in body image and sexuality, especially after treatment.[1,2,9,21,22,23]

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