An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.     

The Impact of Breast Cancer and Its Treatment on Marital Functioning

This article reviews the research that has examined the impact of breast cancer and its treatment on the patient's marital relationship. Breast cancer and its treatment affect not only the patient, but also her intimate partner and their relationship, including their communication, sexual relationship, and role identities. Both positive and negative effects of the experience have been identified. Predictors of marital adjustment following breast cancer are also reviewed, including demographic factors, illness factors, and characteristics of the couple. The strongest predictor of the impact of the cancer experience appears to be the premorbid quality of the relationship. A methodological critique identifies limitations of past research, and suggestions for future research are addressed. Finally, two theoretical paradigms that may account for the impact of breast cancer on relationships are discussed.     

关于高龄恶性肿瘤与人类自然死亡

“天寿癌”指的是高寿者经历漫长和满足的生命历程后平和地几乎没有痛苦地死于恶性肿瘤。癌症在高龄人群中十分常见,故高龄者死于癌症亦可被认为是一种形式的生命自然终结过程。因此,“天寿癌”的提出可能有助于老年人较实际地面对致死性肿瘤性疾病。对“天寿癌”的概念、诊断、治疗及其医学伦理学的问题进行简要的讨论。     

Psychological impact of breast cancer on the patient and the family: A clinical perspective

Breast cancer is the most frequently occurring cancer in women, with 182,000 new cases diagnosed in 1993. Breast cancer will strike a sizable percentage of women during the child-rearing years impacting, therefore, not only on the woman, but on the significant others in her life. This article explores the impact of breast cancer for the patient's life partner, parents, and children. A model intervention program for cancer patients with young children, piloted at the Derner Institute and developed in conjunction with the American Cancer Society, is also discussed.     

Caregivers of adults with cancer: Multidimensional correlates of psychological distress

The relationship between psychological distress and intrapersonal, family, and socioecological variables was examined in 77 caregivers of adults actively receiving cancer treatment. Results indicated that a sizable minority (29%) of caregivers was experiencing clinically significant psychological distress. Furthermore, family disturbances and maladaptive coping strategies were most predictive of psychological distress in this sample. The clinical implications of these findings in relation to the assessment and treatment of both patients and caregivers are discussed.     

Couples coping with cancer: Research issues and recent findings

The diagnosis of cancer in one partner can impose numerous changes for both the individual diagnosed with cancer and his or her healthy spouse. In this article, the literature on spouse social support in the context of cancer is reviewed. The importance of understanding support given and received within a close relationship using an interactional, contextual perspective is emphasized. Examining support-related interactions and understanding the personal characteristics that determine the type and amount of support that providers give and the kind of support individuals prefer, and investigating why significant others respond in supportive or critical ways is important. In addition, the study of support interactions must be placed in the both in the context of a marriage and in the context of a catastrophic life event such as cancer. A longitudinal study of patients with gastrointestinal cancer and their healthy partners was undertaken to examine these issues, and the design of this study is described. General problems conducting research with couples undergoing a severe life stressor as well as specific problems our research group has encountered while setting up a research program in the cancer setting are reviewed.     

Breast cancer risk analysis: A genetic epidemiology service for families

Breast Cancer Risk Analysis, a service for women with breast cancer and their families, makes use of information drawn from fields such as genetics, epidemiology, and counseling. Its aim is to provide individuals with background information and information regarding the etiology and risks of breast cancer. Based on this information, individuals are helped to make appropriate decisions pertaining to treatment and follow-up. While making use of some of the information and processes used in genetic counseling, Breast Cancer Risk Analysis differs from most types of genetic counseling for reproductive decisions. Some of these differences are discussed here.     

BEHAVIORAL COMMUNITY INTERVENTION TO REDUCE THE RISK OF SKIN CANCER

Peer leader modeling, posted feedback, posted goals, and a commitment raffle were used at two swimming pools to increase behaviors associated with skin cancer prevention. During the intervention condition, pool lifeguards modeled the protective behaviors by wearing sunglasses, t-shirts, and hats, using zinc oxide and sunscreen, and staying in the shade. Children and adolescents (1 to 16 years old) increased their use of two or more protective behaviors from a baseline mean of 6.5% to 26.9% during the intervention. Adults (older than 16 years) increased their protective behaviors from a baseline mean of 22% to 37.95% during the intervention. The lifeguards increased their use of all the protective behaviors from a baseline mean of 16.7% to 63.5% during intervention. Ways to improve and expand this intervention are discussed.     

Environmental risks: Scientific concepts and social perception

Using the example of air pollution, I criticize a restricted utilitarian view of environmental risks. It is likely that damage to health due to environmental pollution in Western countries is relatively modest in quantitative terms (especially when considering cancer and comparing such damage to the effects of some life-style exposures). However, a strictly quantitative approach, which ranks priorities according to the burden of disease attributable to single causes, is questionable because it does not consider such aspects as inequalities in the distribution of risks. Secondly, the ability of epidemiological research to identify some health effects is limited. Third, the environment has symbolic and aesthetic components that overcome a strict evaluation of damage based on the impairment of human health. It is not acceptable that priorities be set just balancing the burden of disease caused by pollution in the environment against economic constraints. As an example of a computation that inherently includes economic analysis, I refer to the proposal of an estimator of mortality in coal mining, i.e., a rate which puts deaths in the numerator and tons of coal extracted in the denominator. According to this estimator, mortality due to accidents decreased from 1.15 to 0.42 in the period 1950–1970 in the United States, for each million tons of coal extracted. However, considering the steep decline in the workforce in the same period, the traditional mortality rate (deaths over persons-time) actually increased. The proposal of a measure of mortality based on the amount of coal extracted is just one example of the attempts to influence decisions by including an economic element (productivity) in risk assessment. This paper has three purposes: One, to describe empirical research concerning the health effects of environmental pollutants; two, to discuss the scientific principles and methods used in the identification of environmental hazards; and three, to critically discuss some of the ethical principles which are applied in medicine and in the assessment and management of risk.     

Associations between narrative transportation,risk perception and behaviour intentions following narrative messages about skin cancer

Objective: Narrative messages may be an effective strategy to increase risk perceptions and motivate preventive behaviours related to cancer. The aim of this research was to examine associations between narrative transportation (i.e. psychological absorption into a narrative), risk perceptions, and intentions following narrative messages about skin cancer.

Design: In two studies, women who reported indoor tanning read first-person narrative messages about skin cancer. We examined associations between narrative transportation and the women’s responses to the narratives, including risk perceptions for skin cancer and behaviour intentions to reduce risk. Associations between transportation, knowledge and worry were also examined.

Results: Greater transportation was associated with higher intentions to perform skin self-examination, talk to one’s doctor about skin cancer, and look for more information. Greater transportation was also associated with higher gut feelings of risk and higher worry about skin cancer, but not deliberative risk perceptions or knowledge from the message. Additional analyses showed that after controlling for risk perception and worry, transportation had unique associations with some behaviour intentions.

Conclusion: Findings suggest that narrative transportation may be an important component to the persuasion of cancer narratives. Future research should explore ideas such as the role of the experiential system in narratives’ influence.