Emmanuelle Fournier

The Ways of Coping Checklist (WCC): Validation in French-speaking cancer patients.

We explore the psychometric properties of the French version of the Ways of Coping Checklist Revised (WCC-R) for a cancer patient sample. The WCC-R was completed by 622 patients and 464 completed the State-Trait Anxiety Inventory (STAI). A confirmatory factor analysis (CFA) on the original factor structure did not fit the data. The sample was randomly divided into two subsamples. Exploratory factor analysis was conducted on one subsample and revealed three factors: ‘Seeking social support’, ‘Problem focused-coping’ and ‘Self-blame and avoidance’, including 21 items. A CFA confirmed this structure in the second subgroup. These scales correlated with the anxiety scores.

Young couples' experiences of breast cancer during hormone therapy: an interpretative phenomenological dyadic analysis.

Background: Young women are confronted with the same consequences of cancer as older women are. In addition, they face problems specifically related to their age, such as their children’s education and their family responsibilities, marital relationships, and career issues. Objective: The objective was to identify the functioning profiles of young couples confronted with hormone therapy. Methods: This study was both qualitative and dyadic. Interviews with 11 couples revealed 5 themes. Results: Initially, the partners reported increased intimacy and mutual support; however, during hormone therapy, a divergence developed between the patients and their partners. The partners wished for the couple to resume a normal life. The patients’ loved ones, also helpful in the beginning, were tempted to promote this resumption of normalcy, with the risk that the patients’ suffering would no longer be acknowledged. The risk of cancer recurrence appeared to immobilize the patients, who were unable to adopt a long-term perspective. Finally, the experience of the disease led the participants to reorganize their priorities and promoted self-centering. Conclusions: Breast cancer affects both the patient and her loved ones. Future research should focus on qualitative extensions to other stages of cancer treatment and quantitative studies to measure the phenomena revealed in the current work. Implications for Practice: Cancer and its treatment have impacts on the patient and her marriage; therefore, the focus for the clinical care should be on the couple rather than just the patient. Additionally, our findings suggest new areas of psychological dyadic counseling for cancer patients and their partners.

The subjective experience of young women with non-metastatic breast cancer: the Young Women with Breast Cancer Inventory

BackgroundThe subjective experience of young women with breast cancer has some particular features linked to the impact of the disease and its treatment on their age-related issues (e.g. desire for a child, couple relationship, career management). Despite these specific concerns, no questionnaire currently targets the young breast cancer patient’s quality of life, subjective experience or common problems when facing cancer. This study presents the psychometric validation of an inventory that aimed to measure the impact of breast cancer on the quality of life of young women (<45 years of age) with non-metastatic disease.Methods546 women aged <45 years when diagnosed with a non-metastatic breast cancer were recruited in 27 French cancer research and treatment centers. They answered a self-reported questionnaire created from verbatim collected by non-directive interviews carried out with 69 patients in a first qualitative study. Exploratory and confirmatory analyses were conducted in order to obtain the final structure of the scale. Internal consistency, test-retest reliability and concurrent validity with quality of life questionnaires currently used (QLQ-C30 and the QLQ-BR23 module) were then assessed.ResultsThe YW-BCI36 contains 36 items and highlights 8 factors: 1) feeling of couple cohesion, 2) negative affectivity and apprehension about the future, 3) management of child(ren) and of everyday life, 4) sharing with close relatives, 5) body image and sexuality, 6) financial difficulties, 7) deterioration of relationships with close relatives, and 8) career management. Psychometric analyses indicated good internal consistency (Cronbach’s alpha values ranging from 0.76 to 0.91) and temporal reliability (Bravais-Pearson correlations ranging from 0.66 to 0.85). As expected, there were quite strong correlations between the YW-BCI36 and the QLQ-C30 and QLQ-BR23 scores (r ranging from 0.20 to −0.66), indicating adequate concurrent validity.ConclusionsThe YW-BCI36 was confirmed as a valid scale for evaluating the subjective experience of breast cancer in young women. This instrument could help to identify the problems of these women more precisely, in order to respond to them better by an optimal care management. This scale may improve the medical, psychological and social care of breast cancer patients.

The Quality of Life of Young Women with Nonmetastatic Breast Cancer and their Partners’: Specific Needs Require Development of Specific Questionnaires for Each of them

To the Editor: In developed countries, approximately 13% of women with breast cancer are younger than 45 years of age. Improved therapy in expectation of cure highlights these young women’s specific problems (1,2). These, like the wish to have children, are sometimes incompatible with the treatments. Furthermore, children’s education, family responsibilities, sexuality, marital relationship, body image, and professional activity are also sources of concern. Some studies seem to indicate that young women (< 45–50 years) have a worse quality of life and are more vulnerable to the negative effects of the disease than older ones (3–5). Patients are in search of social and emotional support which is most frequently provided by a member of the family and particularly the partner (6). Life and daily tasks can be upset. This correlates directly and ⁄ or indirectly with depression, anxiety and the physical state of health called ‘‘subjective burden’’ (7). The deterioration of the quality of life and sexual problems in women with breast cancer can affect the marital relationship. This can result in a break up of married life, especially if marital difficulties were present previously. On the other hand, it can bring the couple closer. Thus, it appears essential for women with breast cancer to involve their partner (8,9). The objectives of the study were to measure the impact of breast cancer on the quality of life of young women (< 45 years of age) with nonmetastatic disease and the quality of life of their partners; to study the convergent and ⁄ or divergent points between the patients and partners in the course of treatment; and to create specific tools to deal with these issues. The psychological, emotional, family, and social effects of cancer on the patient and her partner were analyzed by the verbatim of nondirective talks. Patients younger than 45 years of age at the time of the diagnosis, with nonmetastatic breast cancer, in treatment by chemotherapy and their partner ⁄ spouse took part. Each couple must have been living together for at least 6 months. Open conversations, without directive questions, were conducted by expert psychologists. From February 2007 to June 2008, 69 couples were interviewed: 24 during chemotherapy, 11 during Trastuzumab treatment, 15 during hormonotherapy and 19 during follow up. The patients’ median age was 39 (range: 27–52) and 41 (range: 28–60) for the partners. The couple per se and the psychological dimensions were specifically mentioned by, respectively, 79% and 78% of the participants. Family matters were raised by 64%, and 51% mentioned professional and physical repercussions. Forty three percent, 24%, and 12% spoke of, respectively, social, domestic, and economic spheres. However, spiritual and medical aspects were under represented (less than 5% of the participants). The analysis of the subjective quality of life of the patient compared with the partner’s showed significant differences in five areas: the patients spoke more often about the psychological, familial, physical, professional and social impact than their partners (p < 0.05) (Fig. 1). Globally, the subjective feelings were comparable between the treatment periods (chemotherapy, Trastuzumab, hormonal therapy, and follow up). Nevertheless, Address correspondence and reprint request to: Dr. Laurence Vanlemmens, MD, 3 rue Frederic Combemale, BP 307, F-59020 Lille Cedex, or e-mail: l-vanlemmens@o-lambret.fr. Proposed by Medical Centre Oscar Lambret Supported by the Institut National Contre le Cancer, Ligue Nationale Contre le Cancer, Roche, Novartis Pharma, and Sanofi-Aventis, France

Qualité de vie des femmes jeunes ayant un cancer du sein localisé et de leur partenaire : nécessité de développement de questionnaires spécifiques pour la patiente et le partenaireQuality of life of young women with early breast cancer and their partners: specific needs result in the necessity of development of specific questionnaires for the patient and the partner*

Purpose. To determine the feelings of young women with early breast cancer concomitantly with their partners at different treatment periods in order to create a specific quality of life (QOL) scale for this population. Materiel and methods. It was a prospective, multicentre, qualitative study, in patients younger than 45 years old at diagnosis and living with a partner for at least six months. Patients and partners were interviewed by a psychologist, from the diagnosis disclosure until follow up, using non-directing individual talks. Results. Sixty-nine couples were interviewed. Analyses of the interviews have highlighted the impact of disease on eight dimensions: psychological, physical, family, social, couple, sexuality, domestic, professional and economic dimensions. These impacts are mostly negative and are present in all periods and even after treatment for follow up. Discussion. A multidimensional profile of this specific population was established. A QOL scale dedicated to this population is being validated.