Social support as a buffer to the psychological impact of stressful life events in women with breast cancer†
Article first published online: 23 JAN 2001
Copyright © 2001 American Cancer Society
Volume 91, Issue 2, pages 443–454, 15 January 2001
How to Cite
Kornblith, A. B., Herndon, J. E., Zuckerman, E., Viscoli, C. M., Horwitz, R. I., Cooper, M. R., Harris, L., Tkaczuk, K. H., Perry, M. C., Budman, D., Norton, L., Holland, J. C. and for the Cancer and Leukemia Group B (2001), Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer, 91: 443–454. doi: 10.1002/1097-0142(20010115)91:2<443::AID-CNCR1020>3.0.CO;2-Z
The following institutions, principal investigators, and grants participated in this study: CALGB Statistical Office, Durham, NC, Stephen George, Ph.D.,CA 33601; Christiana Care Health Services, Inc. CCOP, Wilmington, DE, Irving M. Berkowitz, M.D., CA 45418; Community Hospital-Syracuse CCOP, Syracuse, NY, Jeffrey Kirshner, M.D., CA 45389; Dana-Farber Partners Cancer Care, Boston, MA, George P. Canellos, M.D., CA 32291; Dartmouth Medical School-Norris Cotton Cancer Center, Lebanon, NH, L. Herbert Maurer, M.D., CA 04326; Duke University Medical Center, Durham, NC, Jeffrey Crawford, M.D., CA 47577; Long Island Jewish Medical Center, Lake Success, NY; Marc Citron, M.D., CA 11028; Massachusetts General Hospital, Boston, MA, Michael L. Grossbard, M.D., CA 12449; Mount Sinai School of Medicine, New York, NY; James F. Holland, M.D., CA 04457; Rhode Island Hospital, Providence, RI; Louis A. Leone, M.D., CA 08025; Roswell Park Cancer Institute, Buffalo, NY, Ellis Levine, M.D., CA 02599; Southeast Cancer Control Consortium Inc. CCOP, Goldsboro, NC, James N. Atkins, M.D., CA 45808; Southern Nevada Cancer Research Foundation CCOP, Las Vegas, NV, John Ellerton, M.D., CA 35421; SUNY Health Science Center at Syracuse, Syracuse, NY, Stephen L. Graziano, M.D., CA 21060; University of California-San Diego, San Diego, CA, Stephen L. Seagren, M.D., CA 11789; University of Chicago Medical Center, Chicago IL, Gini Fleming, M.D., CA 41287; University of Maryland Cancer Center, Baltimore, MD, David Van Echo, M.D., CA 31983; University of Massachusetts Medical Center, Worchester, MA, F. Marc Stewart, M.D., CA 37135; University of Minnesota, Minneapolis, MN, Bruce A. Peterson, M.D., CA 16450; University of Missouri-Ellis Fischel Cancer Center, Columbia, MO, Michael C. Perry, M.D., CA 12046; University of Tennessee, Memphis, TN, Harvey B. Niell, M.D., CA 47555; Wake Forest University School of Medicine, Winston-Salem, NC, David D. Hurd, M.D., CA 03927; Walter Reed Army Medical Center, Washington, DC, John C. Byrd, M.D., CA 26806; Washington University School of Medicine, St. Louis, MO, Nancy L. Bartlett, M.D., CA 77440; Weill Medical College of Cornell University, New York, NY, Michael W. Schuster, M.D., CA 07968. %Alice B. Kornblith, Ph.D., is now at Beth Israel Medical Center, New York, New York. %Lyndsay Harris, M.D., is now at Dana-Farber Cancer Institute, Boston, Massachusetts.
- Issue published online: 23 JAN 2001
- Article first published online: 23 JAN 2001
- Manuscript Accepted: 16 OCT 2000
- Manuscript Received: 9 OCT 2000
- John D. and Catherine T. MacArthur Foundation
- National Cancer Institute. Grant Number: (CA31946)
- social support;
- quality of life
Three theoretical models by which social support may influence the impact of stressful life events on cancer patients' psychological state were tested: 1) the additive model, in which social support and stressful life events each directly influence cancer patients' adjustment, irrespective of the magnitude of the other; 2) the buffering hypothesis, in which stressful events occurring in the presence of social support should produce less distress than if they occur in its absence; and 3) both additive and buffering models.
One hundred seventy-nine patients who had Stage II breast cancer (median age, 56 yrs; 68% disease free), treated a mean of 6.8 years since entry to Cancer and Leukemia Group B (CALGB) 8541, were interviewed by telephone concerning their psychosocial adjustment. The following measures were used: Medical Outcome Study Social Support Survey (MOS-SSS), Life Experience Survey (LES) a measure of stressful life events within the past 12 months, European Organization for Research on the Treatment of Cancer (EORTC QLQ-C30) a measure of quality of life, Mental Health Inventory (MHI), and the Systems of Belief Inventory (SBI) a measure of spiritual and religious involvement.
Hierarchical regression analyses revealed that less than excellent levels of social support (P < 0.01), greater negative impact of LES fateful life events (e.g., death of family member) (P < 0.05), personal illness or injury (P < 0.05), and all other negative life events in the past year (< 4; P < 0.01) were significant predictors of greater MHI psychological distress, in addition to being divorced or separated (P < 0.001), and more recently treated for cancer on CALGB 8541 (P < 0.05). The interaction of LES scores with MOS-SSS or SBI social support, used to test the buffering hypothesis, did not significantly improve the prediction of MHI psychological distress.
The results supported the additive model, with both stressful life events and social support independently and significantly affecting patients' emotional state. However, the level of social support needed to be very high to reduce the likelihood of severe psychological distress. Cancer 2001;91:443–54. © 2001 American Cancer Society.