Academic Scientific JournalsThe indirect effect of body image on distress in women with breast cancer undergoing chemotherapy
Keywords:
body image, breast neoplasms, adaptation psychological, optimism, psychological distressAbstract
Background
This study assessed the indirect effect of body image in the relationship between illness duration, optimism, coping strategies and psychological distress as well as the moderator role of being or not submitted to surgery and type of surgery, in women with breast cancer undergoing chemotherapy.
Participants and procedure
This cross-sectional study included eighty-seven women with breast cancer undergoing chemotherapy, who answered instruments that assessed sociodemographic and clinical issues, optimism, coping, concerns with body image and psychological distress. Bayesian statistics were performed to test the indirect effect model that included also the moderator effects.
Results
Lower optimism, lower use of humor, and higher denial and illness duration predicted lower body image and higher distress. Longer illness duration was associated with higher distress. Body image had an indirect effect in the relationship between optimism and distress; between denial coping and distress; between humor coping and distress and between illness duration and distress. Being submitted to surgery but not the type of surgery was a moderator in the indirect effect model.
Conclusions
Body image is critical to psychological distress. Future interventions for women with breast cancer should consider body image as a target, in order to promote adaptive coping strategies specially when women have had surgery.
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References
Al-Ghazal, S., Fallowfield, L., & Blamey, R. (2000). Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer, 36, 1938–1943. https:// doi.org/10.1016/s0959-8049(00)00197-0.
American Cancer Society (2019). Breast cancer facts & figures. Retrieved from https://www.cancer.org/ research/cancer-facts-statistics/breast-cancerfacts-figures.html [accessed June 4, 2019].
Brandão, T., Schulz, M. S., & Matos, P. M. (2016). Psychological adjustment after breast cancer: a systematic review of longitudinal studies. Psycho-Oncology, 26, 917–926. https://doi.org/10.1002/pon.4230.
Brandt-Salmeri, A., & Przybyła-Basista, H. (2019). Body image and self-esteem in women with breast cancer – the role of body acceptance. Psychoonkologia, 22, 1–10. https://doi.org/10.5114/pson.2018.81160.
Brunault, P., Champagne, A. L., Huguet, G., Suzanne, I., Senon, J. L., Body, G., Rusch, E., Magnin, G., Voyer, M., Réveillère, C., & Camus, V. (2015). Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psycho-Oncology, 25, 513–520. https://doi. org/10.1002/pon.3947.
Carver, C. S. (1997). You want to measure coping but your protocol’ too long: Consider the brief cope. International Journal of Behavioral Medicine, 4, 92– 100. https://doi.org/10.1207/s15327558ijbm0401_6.
Carver, C. S. (2015). Optimism and pessimism. In J. D. Wright (Ed.), International encyclopedia of the social & behavioral sciences (2nd ed.) (pp. 263–267). Elsevier.
Casellas-Grau, A., Vives, J., Font, A., & Ochoa, C. (2016). Positive psychological functioning in breast cancer: an integrative review. The Breast, 27, 136– 168. https://doi.org/10.1016/j.breast.2016.04.001.
Chow, R., Pulenzas, N., Zhang, L., Ecclestone, C., Leahey, A., Hamer, J., DeAngelis, C., Bedard, G., McDonald, R., Bhatia, A., Ellis, J., Rakovitch, E., Vuong, S., Chow, E., & Verma, S. (2015). Quality of life and symptom burden in patients with breast cancer treated with mastectomy and lumpectomy. Supportive Care in Cancer, 24, 2191–2199. https:// doi.org/10.1007/s00520-015-3027-8.
Di Mattei, V., Bernardi, M., Madeddu, F., & Sarno, L. (2016). Psychological distress and coping strategies among women who undergo cancer genetic testing. In C. Pracana (Ed.), Psychology applications and developments II (pp. 15–24). Science Press.
Dua, P., Heiland, M. F., Kracen, A. C., & Deshields, T. L. (2015). Cancer-related hair loss: a selective review of the alopecia research literature. Psycho-Oncology, 26, 438–443. https://doi.org/10.1002/pon.4039.
Fang, S. Y., Chang, H. T., & Shu, B. C. (2014). Objectified body consciousness, body image discomfort, and depressive symptoms among breast cancer survivors in Taiwan. Psychology of Women Quarterly, 38, 563–574. https://doi.org/10.1177/0361684314552652.
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D., & Bray, B. (2014). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136, E359–E386. https://doi.org/10.1002/ijc.29210.
Fernandes, S., McIntyre, T., & Leite, Â. (2018). Ajustamento psicossocial ao cancro da mama em função do tipo de cirurgia [Psychosocial adjustment to breast cancer according to the type of surgery]. Análise Psicológica, 36, 199–217. https://doi. org/10.15309/16psd170208.
Feudis, R. D., Lanciano, T., & Rinaldi, S. (2015). Coping strategies of southern Italian women predict distress following breast cancer surgery. Europe’s Journal of Psychology, 11, 280–294. https://doi. org/10.5964/ejop.v11i2.908.
Griffiths, S., Hay, P., Mitchison, D., Mond, J. M., Mclean, S. A., Rodgers, B., Massey, R., & Paxton, S. J. (2016). Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Australian and New Zealand Journal of Public Health, 40, 518–522. https://doi.org/10.1111/1753-6405.12538.
van de Grift, T. C., Cohen-Kettenis, P. T., de Vries, A. L. C., & Kreukels, B. P. C. (2018). Body image and selfesteem in disorders of sex development: a European multicenter study. Health Psychology, 37, 334–343. https://doi.org/10.1037/hea0000600.
Helms, R. L., Ohea, E. L., & Corso, M. (2008). Body image issues in women with breast cancer. Psychology, Health & Medicine, 13, 313–325. https:// doi.org/10.1080/13548500701405509.
Hopwood, P., & Hopwood, N. (2019). New challenges in psycho-oncology: an embodied approach to body image. Psycho-Oncology, 28, 211–218. https:// doi.org/10.1002/pon.4936.
Hopwood, P., Fletcher, I., Lee, A., & Ghazal, S. A. (2001). A body image scale for use with cancer patients. European Journal of Cancer, 37, 189–197. https://doi.org/10.1016/s0959-8049(00)00353-1.
Kowalczyk, R., Nowosielski, K., Cedrych, I., Krzystanek, M., Glogowska, I., Streb, J., Kucharz, J., & Lew-Starowicz, Z. (2019). Factors affecting sexual function and body image of early-stage breast cancer survivors in Poland: a short-term observation. Clinical Breast Cancer, 19, e30-e39. https:// doi.org/10.1016/j.clbc.2018.09.006.
Laranjeira, C. A. (2008). Tradução e validação portuguesa do revised life orientation test (LOT-R) [Portuguese translation and validation of the Revised Life Orientation Test (LOT-R)]. Universitas Psychologica, 7, 469–476.
Li, Y., Qiao, Y., Luan, X., Li, S., & Wang, K. (2019). Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. European Journal of Cancer Care, 28, e12984. https://doi.org/10.1111/ecc.12984.
Millar, K., Purushotham, A. D., Mclatchie, E., George, W. D., & Murray, G. D. (2005). A 1-year prospective study of individual variation in distress, and illness perceptions, after treatment for breast cancer. Journal of Psychosomatic Research, 58, 335– 342. https://doi.org/10.1016/j.jpsychores.2004.10.005.
Moreira, H., Silva, S., Marques, A., & Canavarro, M. C. (2010). The Portuguese version of the Body Image Scale (BIS) – psychometric properties in a sample of breast cancer patients. European Journal of Oncology Nursing, 14, 111–118. https://doi.org/10.1016/j. ejon.2009.09.007.
Pais-Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225–237. https://doi.org/10.1080/13548500500524088.
Reich, M., Lesur, A., & Perdrizet-Chevallier, C. (2007). Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Research and Treatment, 110, 9–17. https://doi.org/10.1007/s10549-007-9706-5.
Ribeiro, J., & Rodrigues, A. (2004). Questões acerca do coping: a propósito do estudo de adaptação do Brief COPE [Some questions about coping: The study of the Portuguese adaptation of the Brief COPE]. Psicologia, Saúde & Doenças, 5, 3–15.
Ristevska-Dimitrovska, G., Filov, I., Rajchanovska, D., Stefanovski, P., & Dejanova, B. (2015). Resilience and quality of life in breast cancer patients. Open Access Macedonian Journal of Medical Sciences, 3, 727–731. https://doi.org/10.3889/oamjms.2015.128.
Rogers, C. B., Webb, J. B., & Jafari, N. (2018). A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011–2018). Body Image, 27, 43–60. https://doi.org/10.1016/j.bodyim.2018.08.003.
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078. https://doi.org/10.1037//0022-3514.67.6.1063.
Song, X. Y., & Lee, S. Y. (2006). Bayesian analysis of structural equation models with nonlinear covariates and latent variables. Multivariate Behavioral Research, 41, 337–365. https://doi.org/10.1207/s15327906mbr4103_4.
Stanton, A. L. (2012). What happens now? Psychosocial care for cancer survivors after medical treatment completion. Journal of Clinical Oncology, 30, 1215– 1220. https://doi.org/10.1200/JCO.2011.39.7406.
Teo, I., Novy, D. M., Chang, D. W., Cox, M. G., & Fingeret, M. C. (2015). Examining pain, body image, and depressive symptoms in patients with lymphedema secondary to breast cancer. Psycho-Oncology, 24, 1377–1383. https://doi.org/10.1002/pon.3745.
van de Schoot, R., & Depaoli, S. (2014). Bayesian analyses: Where to start and what to report. The European Health Psychologist, 16, 75–84. World Health Organization (2019). Cancer. Retrieved from https://www.who.int/en/news-room/factsheets/detail/cancer [accessed June 4, 2019].
You, S., Shin, K., & Kim, A. Y. (2016). Body image, selfesteem, and depression in Korean adolescents. Child Indicators Research, 10, 231–245. https://doi. org/10.1007/s12187-016-9385-z.
Yuan, Y., & Mackinnon, D. P. (2009). Bayesian mediation analysis. Psychological Methods, 14, 301–322. https://doi.org/10.1037/a0016972.
Zigmond, A. S., & Snaith, R. P. (1983). Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j. 1600-0447.1983.tb09716.x.
