Thomas O. Blank

Facets of Spirituality as Predictors of Adjustment to Cancer: Relative Contributions of Having Faith and Finding Meaning

Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth.

The relationship of coping strategies, social support, and attachment style with posttraumatic growth in cancer survivors:

This cross-sectional study investigated attachment style, coping strategies, social support, and posttraumatic growth (PTG) in 54 cancer survivors. Secure attachment was significantly associated with active coping, positive reframing, and religion, and these were all associated with PTG. Insecure types of attachment and social support variables were unrelated to PTG. Regression analysis suggests that positive reframing and religion as coping strategies may mediate the relationship between secure attachment and PTG.

Self-identity After Cancer: “Survivor”, “Victim”, “Patient”, and “Person with Cancer”

BackgroundLiving through cancer often involves developing new identities which may strongly influence well-being and relationships with care providers, yet little is currently known about these post-cancer identities.ObjectivesTo examine (1) the extent to which four post-cancer identities (patient, person who has had cancer, victim, and survivor) are adopted, (2) relations between each identity and involvement in cancer-related activities and mental and physical well-being, and (3) correlates of these identities.DesignCross-sectional questionnaire-based study.Participants168 young to middle-aged adults who had previously experienced cancer.MeasurementsCancer identifications, background variables, psychological functioning, cancer risk appraisals and coping, cancer-related activities, and mental and physical well-being.ResultsAt least somewhat, 83% endorsed survivor identity, 81% identity of “person who has had cancer”, 58% “patient”, and 18% “victim”. Identities were minimally correlated with one another and differentially associated with involvement in cancer-related activities. Survivor and person who has had cancer identities correlated with involvement in most cancer-related activities such as wearing cancer-related items and talking about prevention (ps <  0.5). Survivor identity correlated with better psychological well-being and post-traumatic growth, victim identity with poorer well-being (ps <  0.5); neither identifying as a patient nor a person with cancer was related to well-being. Through regression analyses, identities were shown to be explained by unique combination of background, functioning, appraisal and coping variables.ConclusionsSurvivor identity appears most common and most associated with active involvement and better psychological well-being, but other identifications are also common and simultaneously held. Adoption of specific cancer identities is likely to impact interactions with health care providers, including those in general internal medicine, and health behavior changes.

Gay Men and Prostate Cancer: Invisible Diversity

In their recent commentary on cancer care outcomes research, Ayanian et al reflect the broader concern of the oncology community to understand better how to optimize cancer treatment and outcomes in ways that are appropriate to the racial, ethnic, age, and socioeconomic diversity of cancer experiences. Moreover, understanding the diversity of experiences with cancer adds to our broader comprehension of cancer treatment and outcomes themselves, and provides opportunities to develop more sophisticated theoretical and treatment models for all people. From prevention to treatment options to health-related quality of life and long-term survivorship, diversity clearly matters but is inadequately reflected in cancer research and practice. Yet, despite at least some attention to factors such as race, ethnicity, age, and socioeconomic status, one group remains almost totally invisible—the gay, lesbian, bisexual, and transgender (GLBT) community. Although this situation applies to all forms of cancer and all parts of the GLBT community, for purposes of illustration, this comment focuses on gay and bisexual men and the most common nonskin cancer among men, prostate cancer. Although it is also important to recognize and include male to female transgender persons, who may have uniquely complex issues related to prostate health, I will refer to gay and bisexual men because of sheer numbers, with the implicit understanding of recognizing and attending to the broadest range of gender identification and sexualities. With an estimate of 230,000 diagnoses in 2004 and nearly two million prostate cancer survivors just in the United States, understanding shortand long-term impact on men and their families is critically important for best practice. Correspondingly, there has been considerable research and discussion of best clinical treatment and disease management. A search of Medline on July 30, 2004, produced 42,179 article references, which reveal several clear patterns of results. Prostate cancer survivors maintain high health-related quality of life, with a return to baseline and comparability to national norms of noncancer comparison groups within 6 months to a year after treatment. The only exceptions to high quality of life are related to sexual dysfunction and, to a lesser degree, urinary incontinence and bowel problems caused by treatment; percentages of long-term effects vary by major treatment choices. Long term, most men live cancer free after primary treatment or, if not, live for long periods of survivorship with the disease, although approximately 30,000 die in a given year. Because of the numbers of men involved and the nature of treatment effects, it is essential that information about prostate cancer and its effects be as richly textured and varied as the range of men in our society, and the range of masculinities and sexualities in middle aged and older men. This range includes many men who are not exclusively heterosexual. Using the numbers of men dealing with prostate cancer and a conservative estimate of the percentage of gay and bisexual men of 2% to 3%, at least 5,000 gay or bisexual men are diagnosed each year and 50,000 or more are living after prostate cancer treatment. Millions of gay and bisexual men entering or beyond their 40s must deal in one way or another with the prospect of prostate cancer entering their lives; those in committed relationships with other men are obviously twice as likely as heterosexual men to have to deal directly with the disease within their couple. Thus, it is essential that the clinical oncology community is sensitive to the particular needs of gay and bisexual men because of their sexual and/or gender orientation. As with all men facing prostate cancer, of course this population needs appropriate and accessible information, treatment options, and support related to prevention, treatment, and survivorship. Despite all of the attention directed toward understanding treatment outcomes and quality of life of men dealing with prostate cancer, and the significant numbers of gay or bisexual men who are dealing or may deal with the disease, there have been literally no studies that have looked specifically at the impact of this exclusively male disease on gay men. In the same Medline search that produced 42,719 references, when “gay” and “homosexual” were added as keywords, two studies appeared, and on examination neither is directly focused on gay men. JOURNAL OF CLINICAL ONCOLOGY COMMENTS AND CONTROVERSIES VOLUME 23 NUMBER 12 APRIL 2

Positive and Negative Health Behavior Changes in Cancer Survivors A Stress and Coping Perspective

Cancer survivors often make health behavior changes in response to their increased risk for subsequent health problems. However, little is known about the mechanisms underlying these changes or whether they differ for positive and negative changes. This cross-sectional study applied a stress and coping model to examine both positive and negative health behavior changes in 250 middle-aged cancer survivors. A structural equation model showed that social support, sense of control over illness course, life meaning, and approach coping were related to positive health behavior changes; a lack of life meaning and avoidance coping were related to negative health behavior changes.

Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults

Objective: We examined whether post‐traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well‐being in a sample of younger adult survivors of various types of cancer.

Cancer-related identity and positive affect in survivors of prostate cancer

IntroductionDespite a shift in the cancer culture and language used to describe individuals diagnosed with this disease, the extent to which individuals with cancer adopt a particular cancer-related identity and the impact of these identities in relation to their well-being is virtually unknown.Materials and methodsUsing a cross-sectional study design and a metropolitan tumor registry, a mail questionnaire to examine post-treatment quality of life was sent to prostate cancer (PCa) survivors. The sample consisted of 490 PCa survivors, ranging in age from 49–88 (M = 69.7; SD = 7.8), one to eight years after diagnosis. The outcome measure used in these analyses was the PANAS to assess positive and negative affect.ResultsThe most frequently reported cancer-related identity was “someone who has had PCa” (57%). The least reported self view was “victim” (1%). Twenty-six percent of men self-identified as “survivors” while 6% thought of themselves as “cancer conquerors.” Only 9% self-identified as a “patient.” Multivariate analyses, adjusted for potential confounders, show respondents who identified themselves as “survivors” or “cancer conquerors” reported significantly higher scores on positive affect than men who self-identified as “patients” (p < .001).ConclusionsAlthough the majority of respondents identified themselves as “someone who has had cancer,” identifying as a “survivor” or “someone who has conquered cancer” appears to have adaptive value for positive mood.Implications for cancer survivorsThose who perceive themselves as survivors of prostate cancer may derive some benefit in well-being associated with this self assessment.

The who and the what of usage of two cancer online communities

The explosion of use of Internet-based communication for health requires attention to the ways survivors of specific diseases and those close to them participate in using resources. This research focuses on two cancer groups - breast and prostate - and how they use WebMD asynchronous bulletin boards. Four hundred and eighty two messages were coded for communicator (survivors, spouses, others) and content of messages. Most common communicators were survivors, but the two groups differed in percentages of communicator. Of four main categories of content - medical/treatment, intimacy/sexuality, emotional expression, and support - most common were support and medical/treatment. The groups differed significantly on those four categories, with breast cancer more support-dominated and prostate more medical/treatment-dominated and more intimacy/sexuality messages. There were no group differences in emotional-toned vs. social support seeking vs. providing support, or positive vs. negative emotions expressed. Generally, there was considerable commonality, and the differences found primarily supported gender-specific notions of communication and need.

Differences among breast and prostate cancer online support groups

Online support resources have become viable alternatives to face-to-face support groups for cancer patients. It is important to understand how individuals make use of such online support resources and what, if any, differences exist between groups. A content analysis was conducted on 3203 posted messages to prostate and breast cancer support sites on Google Groups and WebMD. Overall, post-treatment survivors were the most common posters followed by spouses; however, the proportion of posters varied by site. For both groups, messages of support were most frequent. However the type of support varied by cancer type. Support messages on the breast cancer sites were mostly offers of emotional support. Conversely, messages of support on the prostate cancer sites focused on informational support. Messages of emotional well-being and medical-related comments were next most common on the breast cancer sites, whereas medical issues and sexual intimacy were on the prostate cancer sites. Overall, these findings identify several key differences in the use and benefits of online support sites for breast and prostate cancer.

Religiousness/spirituality and health behaviors in younger adult cancer survivors: does faith promote a healthier lifestyle?

Positive health behaviors are crucial to cancer survivors’ well-being, yet little is known about the personal factors that may facilitate positive health behaviors. The current study focuses on the association of religion/spirituality (R/S) and health behaviors, examining links between health behaviors and religious attendance, daily spiritual experiences, and religious struggle in a sample of 167 younger adult survivors of a variety of cancers. The extent to which positive affect (self-assurance) and negative affect (guilt/shame) mediate these links was also investigated. Results revealed that religious attendance had little impact on health behaviors, but that daily spiritual experiences were related to greater performance of health behaviors, while religious struggle was related to less. Self-assurance partially mediated the effects of daily spiritual experiences, while guilt/shame partially mediated the effects of religious struggle. The findings suggest that aspects of R/S may play important and different roles in the lifestyle choices of cancer survivors.