Joan R. Bloom

Group Therapy and Hypnosis Reduce Metastatic Breast Carcinoma Pain

The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5p < 0.02) and suffering (t = 2.17, p < 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p < 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.

Social support, accommodation to stress and adjustment to breast cancer☆

A womans emotional adjustment to breast cancer is the focus of this study. The social support the woman experiences is predicted to affect the adjustment process by improving her ability to cope. Current clinical research indicates that background factors, such as marital status, age, SES and life change, also affect adjustment; these variables are incorporated into the model as controls. Using multiple regression analysis (N = 130), the control variables are entered simultaneously with the indicators of social support to assess the independent effect of social support on adjustment. The relationship between social support, coping, and adjustment, as measured by psychological distress, self concept, and sense of power, is then examined. Two indicators of social support, perception of family cohesiveness and the amount of social contact have direct effects on coping and indirect effects on all three measures of adjustment, indicating that coping mediates the relationship between social support and adjustment. Contrary to predictions, being employed and of higher social status have significant effects on adjustment when it is measured by either self concept or sense of power.

The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer.

Of interest to the field is the mechanism through which social support acts as a resistance resource for individuals undergoing stressful life circumstances. Women with advanced breast cancer (N = 86) were interviewed to determine how their outlook on life and social functioning were affected by the social support they received. Emotional support provided by the family was predicted to affect the womans sense of well-being whereas the opportunities for social exchange provided by ones social activities were expected to effect the womans social functioning. Consistent with the predictions, the data indicate that social support is multidimensional. Emotional support was strongly related to ones outlook. However, ones opportunities for social exchange affect not only ones social functioning, but also ones outlook on life, suggesting an interactive process whereby family support improves outlook, both outlook and opportunities for social exchange are related to ones sense of social functioning. These data explain the erosion of social support during life-threatening illness such as cancer as a result of the limitations imposed by the illness on ones opportunities for social exchange.

Sources of support and the physical and mental well-being of young women with breast cancer

Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.

Quality of life research in oncology. Past achievements and future priorities.

The status of quality of life research in oncology is assessed, and priorities for future research with regard to conceptual and theoretical developments, focus and content of research, research designs and practical strategies for research implementation, and transferring information to clinical practice and medical policy decision‐making are identified. There is general agreement that quality of life is a subjective and multidimensional construct, yet comprehensive theoretical models have not been developed and applied fully. We recommend that future research be based on conceptual models that explicate the interrelationships among quality of life domains throughout the stages of cancer care. These models, and the longitudinal research that follows from them, should attend specifically to cross‐class and cross‐cultural issues to avoid overgeneralization from theory and research that are based largely on the views of the majority culture. We encourage the inclusion of this theory‐based quality of life assessment as a standard component of clinical trials. Success in this endeavor will require additional standardization of quality of life measures for use across a range of cancer patient populations, including the development of age‐specific norms and instruments designed to assess the entire family system.

The relationship of social support and health

The objective of this research note is to challenge the research community to develop a cumulative body of knowledge on the relationship between social support and health. Fruitful approaches to this end include further explication of the concept of social support and its measurement, studies of the causal pathways between social supports and health, and further understandings of the relationship between the different dimensions of support and mental and physical health.

Psychosocial outcomes of cancer: a comparative analysis of Hodgkin's disease and testicular cancer.

PURPOSE The psychosocial outcomes of testicular cancer and Hodgkins disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a sexual organ. Since those with Hodgkins disease could more easily deny the disease, poorer psychosocial adjustment was predicted. PATIENTS AND METHODS The sample consists of 85 men with Hodgkins disease and 88 men with testicular cancer (seminomatous, n = 39; or nonseminomatous, n = 49). They were interviewed once, at least 1 year following the end of treatment. Measures of sociodemographic characteristics, physical functioning, psychologic distress, and social outcomes were collected. Treatment data were collected from medical records. RESULTS Men with testicular cancer report more focused symptoms: less sexual enjoyment and poor health habits. Men with Hodgkins disease report more generalized symptoms: fatigue, energy loss, and work impairment. Multivariate analysis indicates that most of these differences are site-related; independent effects of treatment on outcomes were found for more generalized symptoms. Contrary to expectations, both groups reported similar levels of infertility and erectile dysfunction. CONCLUSION The response to testicular cancer is site-specific, while the response to Hodgkins disease is related to both site and treatment (stage-related).

Emotional support following cancer: a test of the stigma and social activity hypotheses

Reports of changes in emotional support following surgery for breast cancer can be attributed to one of two factors: (1) the stigma associated with cancer, or (2) illness-imposed restrictions in ones activities. These explanations were assessed using data from a longitudinal study of women, following their surgical treatment for early breast cancer (N = 145), gallbladder disease (N = 90), benign breast disease (N = 87), or no surgery (N = 90). Multiple regression analysis was used to test the two models. Contrary to the cancer stigma hypothesis, women with breast cancer initially perceived themselves to have more emotional support, rather than less. Type of surgery did not explain the level of emotional support as post-surgery time increased. Instead, support for the social activity hypothesis was found. The results are interpreted as indicating that breast cancer no longer carries with it a stigma, at least not to the extent of reducing the level of womens emotional support.

Perceptual Measures of Task Characteristics: The Biasing Effects of Differing Frames of Reference and Job Attitudes

The study reported here examines the extent to which variations in the perceptions of job characteristics may be associated, not with objective task characteristics, but with perceptual biases refl...

The effect of social support on patient adjustment after breast surgery

Abstract After breast surgery for cancer, a woman must adapt to changes in bodily appearnce and to altered views of the future. Assuming that adaptation to these changes can be facilitated by the provision of supportive care, an intervention program was designed. Counselling and information were offered to patients by an intedisciplinary team before, during, and after hospitalization. Women receiving these services (n=21) were compared with women receiving standard medical care (n=18) immediately after surgery and again two months later. The results indicated that the affective responses of the group in the intervention program were more labile than those of the control group immediately after surgery; these differences diminished over time. After surgery, both groups were equivalent on the measure of self-efficacy. Two months later, however, women in the intervention group scored significantly higher on this measure. These results are seen as evidence that the social-support, intervention program was effective.