Dana H. Bovbjerg

Predictors of intrusive thoughts and avoidance in women with family histories of breast cancer

Having a family history of cancer is an important predictor of lifetime cancer risk. Individuals with family histories of cancer have been reported to experience symptoms of general distress and to have frequent intrusive thoughts and avoidance regarding cancer. To date, little is known about predictors of such distress. A relation between perception of cancer risk and distress has been suggested, but the possibility that prior cancer-related events may contribute to distress in these women has received little attention. The major aim of the study was to examine the contribution of the past experience of the death of a parent from cancer to distress in women at familiar risk for breast cancer.Women with family histories of breast cancer (Risk Group, N=46) were assessed on the day of their yearly mammography screening and four to eight weeks after normal result notification in order to confirm the generalizability of their distress. Their levels of intrusive thoughts, avoidance, and perceived lifetime risk for breast cancer were significantly higher than those of women with no family histories of cancer who were not undergoing mammography (Comparison Group, N=43), and this was true on both assessment days. Among the women in the Risk Group, those whose parent (s) had died of cancer had the highest levels of intrusive thoughts, avoidance, and perceived risk. Results suggested that perceived risk mediated the effect of this event on intrusive thoughts and avoidance regarding breast cancer. The findings are discussed in terms of theories of cognitive responses to traumatic and stressful life events. Implications for future research and interventions are discussed.

Looking forward and back: Distress among women at familial risk for breast cancer

Healthy women with family histories of breast cancer in a first-degree relative (FH+) have been reported to exhibit higher levels of breast cancer-related distress than women without family histories of breast cancer (FH−). Recent data suggest that this may be particularly true for women who had parent die of cancer. In live with theories emphasizing the psychological impacts of past stressors and concerns for the future, the present study examined the hypotheses that past cancer stressors (i.e. maternal breast cancer caregiving and death, “Looking Back”) and perceptions of one’s own heightened future risk for developing the disease (“Looking Forward”) would predict current levels of distress. One hundred forty-eight healthy women (57 FH+, 91 FH−) recruited from large medical centers in the New York City area completed measures of breast cancer-related distress, general psychological distress, and items assessing whether or not they had taken care of their mother with breast cancer or had had their mother die from the disease. Consistent with previous research, results indicated that FH+ women whose mothers had died of breast cancer had significantly higher breast cancer-related distress than either FH+ women whose mothers had not died of breast cancer or FH−women (p<.05). Further analyses revealed that FH+ women who had cared for their mothers with breast cancer had higher cancer-related distress than women who did not (p<.01), and that FH+ women whose experience included both caregiving and the death of their mother from breast cancer had the highest levels of cancer-related distress (p<.01) and depressive symptoms (p<.05). Findings also indicated that FH+ women with heightened perceptions of risk for breast cancer had higher levels of distress, independent of past stressors. These findings suggest that psychosocial interventions for women with family histories of breast cancer might be appropriately focused on these issues.

Anticipatory anxiety in women receiving chemotherapy for breast cancer.

This study examined (a) the prevalence and course of anxiety before the 1st 6 infusions of cancer chemotherapy and (b) the contribution of trait anxiety, side effect expectations, and prior occurrence of posttreatment side effects to anxiety before infusions. Fifty-three women receiving adjuvant chemotherapy for breast cancer participated. Anxiety was most prevalent and intense before the 1st infusion. Trait anxiety predicted anxiety before both the 1st and subsequent infusions. Prior occurrence of posttreatment nervousness also predicted anxiety before subsequent infusions, even after accounting for trait anxiety and other posttreatment side effects. Results are discussed in terms of the role that anxiety proneness, response expectancy, and classical conditioning may play in the development of anxiety before repeated chemotherapy infusions.

Development of Common Cold Symptoms Following Experimental Rhinovirus Infection is Related to Prior Stressful Life Events

Previous studies of rhinovirus infection indicate that about one third of the persons with confirmed viral infection do not show evidence of cold symptoms. Factors that determine which infected individuals will develop colds are not known. Using a rhinovirus inoculation protocol, the authors explored the possible role of recent life events, current mood, and perceived stress in the development of symptoms in individuals known to be infected. As part of a larger study, 17 subjects were exposed to a rhinovirus and were individually isolated for 5 consecutive days; cold symptoms, mucus weights, and tissue use were monitored on a daily basis during this period. Although all 17 subjects had confirmed rhinovirus infection, only 12 subjects developed clinical colds, as indicated by self-reported symptoms and by objective symptom indices. The average number of reported major life events for the previous year was significantly higher for those who developed colds than for those who did not (p < .05). Measures of affect and perceived stress before the inoculation were not different for those who did and did not develop colds. Complementing recent research demonstrating psychosocial influences on experimental infection rates, these results provide evidence that the development of cold symptomatology in experimentally infected individuals is related to prior life events.

Family and friends with disease:: their impact on perceived risk

BACKGROUND For many common diseases, having a family history is the strongest predictor of lifetime risk. Perceptions of personal risk, important for appropriate prevention efforts, have been found to be exaggerated in healthy individuals with family histories. These findings highlight the contribution of objective and experiential factors to perceived risk. This study examined, across a variety of diseases, whether (1) family history of the disease contributes to perceived risk, (2) history of disease in a friend or nonblood relative, which would not increase ones objective risk, nonetheless increases perceived risk, and (3) these effects are similar across genders. METHODS Participants (N = 522; 38% male; 56% Caucasian; mean age = 40 years) completed a brief health survey. RESULTS Analyses revealed an effect of having a family history of the disease on perceived risk for breast and colon cancers, heart disease, and diabetes (P < 0.001). Interestingly, having a friend diagnosed with the disease also contributed to perceived risk for breast and colon cancers, as well as heart disease and diabetes among women (P < 0.05), but not among men. CONCLUSIONS Results suggest that interventions to alter perceived risk of cancer should account for gender, as women appear to be impacted by who they know.

Coping with chemotherapy for breast cancer

Relations among coping, physical symptoms, and affect were investigated in 43 women undergoing adjuvant chemotherapy for breast cancer. Patients were assessed at the same point in their treatment so that the time for which coping was reported would be equivalent across individuals. Patients were asked how they coped specifically with chemotherapy, rather than how they coped with cancer in general, to make the domain specific. Positive and negative affect were assessed separately, using a scale free of somatic content. Relations between coping and affect were consistent with prior studies that have employed a general approach to assessing coping. Coping correlates of positive and negative mood differed. When the relations between physical symptoms and affect were examined, physical symptoms were related to negative affect but not to positive affect. Findings are discussed in terms of their implications for coping with cancer as well as their implications for the general coping literature.

Psychological Distress, Health Beliefs, and Frequency of Breast Self-Examination

Although monthly breast self-examination (BSE) is recommended for early breast cancer detection, most women do not comply. Few studies have examined the impact of psychological distress on BSE frequency. Recent research suggests that it may be particularly important to examine the role of distress in the recently identified phenomenon of BSE overperformance (>1/month). One hundred thirty-five healthy women with and without family histories of breast cancer completed sociodemographic, health belief, general and cancer-specific psychological distress, and BSE frequency questionnaires. The central finding of the study was that BSE underperformance and overperformance had two distinct sets of predictors: health beliefs, specifically barriers against BSE and low confidence in BSE performance, were related to BSE underperformance, while higher levels of psychological distress, particularly cancer-specific intrusive thoughts, were related to BSE overperformance. Findings underscore the need to evaluate BSE under- and overperformance separately and to develop problem-specific interventions to increase compliance with monthly BSE.

Effects of dopamine D2 receptor (DRD2) and transporter (SLC6A3) polymorphisms on smoking cue-induced cigarette craving among African-American smokers.

Cue-induced craving for addictive substances has long been known to contribute to the problem of persistent addiction in humans. Research in animals over the past decade has solidly established the central role of dopamine in cue-induced craving for addictive substances, including nicotine. Analogous studies in humans, however, are lacking, especially among African-American smokers, who have lower quit rates than Caucasian smokers. Based on the animal literature, the studys objective was to test the hypothesis that smokers carrying specific variants in dopamine-related genes previously associated with risk for addictive behaviors would exhibit heightened levels of cigarette craving following laboratory exposure to cues. To this end, cigarette craving was induced in healthy African-American smokers (n=88) through laboratory exposure to smoking cues. Smokers carrying either the DRD2 (D2 dopamine receptor gene) TaqI A1 RFLP or the SLC6A3 (dopamine transporter gene) 9-repeat VNTR polymorphisms had stronger cue-induced cravings than noncarriers (Ps <0.05 and 0.01, respectively). Consistent with the separate biological pathways involved (receptor, transporter), carriers of both polymorphisms had markedly higher craving responses compared to those with neither (P<0.0006), reflecting additive effects. Findings provide support for the role of dopamine in cue-induced craving in humans, and suggest a possible genetic risk factor for persistent smoking behavior in African-American smokers.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer.

Nausea and immune function were assessed in 20 cancer patients in the hospital prior to chemotherapy and compared with assessments conducted at home. Proliferative responses to T-cell mitogens were lower for cells isolated from hospital blood samples than for home samples obtained several days earlier. Patients also experienced increased nausea in the hospital. Hierarchical multiple regression analyses indicated that decreased immune function in the hospital was not related to increased anxiety. The observed anticipatory immune suppression is consistent with the hypothesis that chemotherapy patients may develop conditioned immune suppression as well as conditioned nausea after repeated pairings of hospital stimuli with the emetic and immunosuppressive effects of chemotherapy.

The application of a shortened version of the profile of mood states in a sample of breast cancer chemotherapy patients

Objectives. The Profile of Mood States (POMS) is a 65-item mood measure with demonstrated reliability and validity; however, its length can be of concern to researchers. The present study investigated the utility of a 37-item shortened version of the POMS (SV-POMS) developed by Shacham (1983). Design. In samples of breast cancer chemotherapy patients (patient group 1) and healthy volunteers, correlations between the subscales of the measures and internal consistencies were examined; these samples were also used to compare mood ratings of healthy women and patients. In another sample of breast cancer chemotherapy patients (patient group 2), the sensitivity to changes in mood of the measures was investigated. Methods. Patient group 1 comprised 114 women; patient group 2 comprised 48 women. Healthy volunteers were 55 women recruited through newspaper advertisements. Results. The correspondence between the measures was demonstrated by significant correlations of the shortened with the full-length scales. Internal consistencies of the measures were comparable. Both measures demonstrated mood differences between patients and volunteers. The responsiveness of the measures to change were comparable as demonstrated by changes in distress scores across chemotherapy infusions. Conclusions. Results suggest that the SV-POMS can be used when participant burden is of concern.