Psychological responses to cancer recurrence

A controlled prospective study

Authors

  • Barbara L. Andersen Ph.D.,

    Corresponding author
    1. Department of Psychology, The Ohio State University, Columbus, Ohio
    2. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
    • Department of Psychology, The Ohio State University, 1885 Neil Avenue, Columbus, OH 43210-1222
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    • Fax: (614) 688-8261

  • Charles L. Shapiro M.D.,

    1. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
    2. Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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  • William B. Farrar M.D.,

    1. Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
    2. Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio
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  • Timothy Crespin Ph.D.,

    1. Primetrics, Inc., Columbus, Ohio
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  • Sharla Wells-DiGregorio Ph.D.

    1. Department of Psychology, The Ohio State University, Columbus, Ohio
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Abstract

BACKGROUND

There is a dearth of knowledge regarding the psychological responses to a diagnosis of cancer recurrence.

METHODS

An ongoing randomized clinical trial provided the context for prospective study. Women with Stage II/III breast carcinoma (N = 227) were initially assessed after their diagnosis/surgery and before adjuvant therapy and then reassessed every 6 months. Eight years into the trial, 30 patients had recurred (R) and were assessed shortly after receiving their second diagnosis. Their data were compared with a sample of trial patients who had no evidence of disease (disease free [DF]; n = 90). The groups were matched on study arm, disease stage, estrogen receptor status, menopausal status, and time since initial diagnosis.

RESULTS

As hypothesized, patients' cancer-specific stress at recurrence in the R group was higher (P < 0.05) than stress levels for the DF group at the equivalent point in time. Importantly, the R group reported stress for their recurrent diagnosis equivalent to that reported for their initial diagnosis. Identical results were found for measures of health status and symptomatology. In contrast, analyses for emotional distress and social functioning showed no pattern of disruption for the R group at cancer recurrence and levels equivalent to that of the DF group.

CONCLUSIONS

To the authors' knowledge, this was the first controlled, prospective psychological analysis of patients' responses to cancer recurrence. The findings were consistent with a learning theory conceptualization of the cancer stressor. Patients' stress was “compartmentalized” and did not, at least in the early weeks, result in diffuse emotional distress and quality of life disruption, underscoring the resilience of patients when confronted with cancer recurrence. Cancer 2005. © 2005 American Cancer Society.

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