Breast cancer: Psychosocial adjustment and health outcomes

Sue Steele (1997)

Currently, 44,000 women die of breast cancer every year, and 184,000 more women are diagnosed with this dreaded disease which, with subsequent image changing surgery and treatments, is traumatic in their lives. Much of what has been written on the adjustment to breast cancer has focused on denial and a repressive coping style as defenses for managing trauma. This study attempted to operationalize these theoretical concepts of denial and repressive coping style within the structure of a contemporary model of mental functioning called Multiple Code Theory. This theory demonstrates that denial or a repressive coping style may be considered as naturally occurring derivatives of the processes of assimilation and accommodation to a traumatic event which can be measured objectively as referential activity in speech. Referential Activity is the process of translating inner experiences (imagery, affect, nonverbal ideation) into verbal content. In this study, one hundred and twenty two women with stage one or stage two breast cancer, six to nine months following surgery and treatment, were given four monologue tasks from which a measure of referential activity was determined. The Psychosocial Adjustment to Illness Scale, Health Rating Scale, Personal Resource Questionnaire and a Breast Disease Survey were also administered. Relationships between levels of RA in speech, social support and type of surgery were examined in relationship to psychosocial adjustment to illness and physical health. Adequate reliability for RA was attained through the use of a computerized referential activity program. The results revealed significant findings. First, women had higher RA when discussing past and future experiences than present experiences when rating health. Women with higher RA more readily articulated health care concerns, job dissatisfaction, and less distress regarding their future. Social support measures revealed that women with higher overall social support had higher overall ratings of health and better psychosocial adjustment in most categories. Last, women who had lumpectomies revealed no better ratings of health, but better outcomes in overall psychosocial adjustment, vocational environment, sexual relationship and social environment than women with mastectomies. Implications of these findings and recommendations for future studies are discussed.