Fear of cancer recurrence in breast cancer: A moderated serial mediation analysis of a prospective international study.

OBJECTIVE: Women dealing with breast cancer (BC) face many challenges, one of which is the fear of cancer recurrence (FCR). This study examined whether disease severity predicts FCR 6 months after cancer diagnosis through psychological distress and whether cognitive-emotion regulation moderates this effect. METHOD: The study sample included 656 women from Italy (27.5%), Finland (31.9%), Israel (19.8%), and Portugal (20.8%) diagnosed with Stages I-III of BC. Participants' age ranged between 40 and 70 years (M = 54.92, SD = 8.22). Participants were tracked following BC diagnosis and at 3 and 6 months follow-up. Participants filled out self-report questionnaires, including the FCR inventory-short form, the Hospital Anxiety and Depression Scale, and the cognitive-emotion regulation questionnaire along with medical-social-demographic data. RESULTS: Greater disease severity at baseline indicated by higher cancer stage predicted greater psychological distress, which in turn predicted greater psychological distress at 3 months. The latter predicted greater FCR at 6 months. This serial mediation model was moderated by negative cognitive-emotion regulation. The mediating effect of disease severity on FCR through psychological distress was significant only in women with mean or higher levels of negative cognitive-emotion regulation. CONCLUSION: This study suggests that facilitating psychological well-being and effective cognitive-emotion regulation in the early stages after a cancer diagnosis may protect women from FCR. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Protective Factors against Fear of Cancer Recurrence in Breast Cancer Patients: A Latent Growth Model.

The current study aimed to examine the fear of cancer recurrence (FCR) trajectory and protective predictors in women coping with breast cancer (BC). The study's model investigated whether a higher coping self-efficacy and positive cognitive-emotion regulation at the time of the BC diagnosis would lead to reduced levels of FCR at six months and in later stages (12 and 18 months) post-diagnosis. The sample included 494 women with stages I to III BC from Finland, Italy, Portugal, and Israel. They completed self-report questionnaires, including the Fear of Cancer Recurrence Inventory (FCRI-SF), the Cancer Behavior Inventory-Brief Version (CBI-B), the Cognitive-Emotion Regulation Questionnaire (CERQ short), and medical-social-demographic data. Findings revealed that a higher coping self-efficacy at diagnosis predicted lower FCR levels after six months but did not impact the FCR trajectory over time. Surprisingly, positive cognitive-emotion regulation did not predict FCR levels or changes over 18 months. FCR levels remained stable from six to 18 months post-diagnosis. This study emphasizes the importance of developing specific cancer coping skills, such as coping self-efficacy. Enhancing coping self-efficacy in the first six months after BC diagnosis may lead to lower FCR levels later, as FCR tends to persist in the following year.

Trajectories of Quality of Life among an International Sample of Women during the First Year after the Diagnosis of Early Breast Cancer: A Latent Growth Curve Analysis.

The current study aimed to track the trajectory of quality of life (QoL) among subgroups of women with breast cancer in the first 12 months post-diagnosis. We also aimed to assess the number and portion of women classified into each distinct trajectory and the sociodemographic, clinical, and psychosocial factors associated with these trajectories. The international sample included 699 participants who were recruited soon after being diagnosed with breast cancer as part of the BOUNCE Project. QoL was assessed at baseline and after 3, 6, 9, and 12 months, and we used Latent Class Growth Analysis to identify trajectory subgroups. Sociodemographic, clinical, and psychosocial factors at baseline were used to predict latent class membership. Four distinct QoL trajectories were identified in the first 12 months after a breast cancer diagnosis: medium and stable (26% of participants); medium and improving (47%); high and improving (18%); and low and stable (9%). Thus, most women experienced improvements in QoL during the first year post-diagnosis. However, approximately one-third of women experienced consistently low-to-medium QoL. Cancer stage was the only variable which was related to the QoL trajectory in the multivariate analysis. Early interventions which specifically target women who are at risk of ongoing low QoL are needed.

Psychological and somatic symptoms among breast cancer patients in four European countries: A cross-lagged panel model.

Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08-0.10), as well as vice-versa (beta 0.11-0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients-either from a somatic perspective or a psychological perspective-and adjust them to the specific experiences of the individual patient.

Can posttraumatic growth after breast cancer promote positive coping?-A cross-lagged study.

OBJECTIVES: The diagnosis of breast cancer can be associated with significant emotional distress, yet, over time, cancer survivors also may experience positive psychological changes labeled posttraumatic growth (PTG). Two alternative paths between coping strategies and PTG were tested among breast cancer patients, employing longitudinal design: Would PTG after medical treatment of breast cancer lead to an increase in reporting positive coping strategies; alternatively, would positive coping strategies after medical treatment of breast cancer lead to increased PTG. METHODS: A longitudinal study was conducted among 198 breast cancer patients who completed validated self-report scales, at five time points: at 3 months after completing active medical treatment (T1); after 6 months (T2); after 1 year (T3); after 2 years (T4); and after 7 years (T5). The current study analyzes three time points: T1, T3, and T5 using structural equation modeling. RESULTS: Our results support the path that describes the first alternative, that higher report of PTG after medical treatment of breast cancer patients would lead to increased report of positive coping strategies. In addition, positive coping strategies were found to be positively linked to PTG after 6 months, and the link was slightly stronger after 2 years. Nevertheless, 7 years after diagnosis, no association was found between positive coping strategies and PTG measurements. CONCLUSIONS: Finding positive meaning after coping with breast cancer, as reflected in PTG, may be a significant resource in coping with cancer, and it may lead to increase of positive coping strategies.

Premature ovarian aging in BRCA carriers: a prototype of systemic precocious aging?

PURPOSE: Though former evidence implies a correlation of breast cancer susceptibility gene (BRCA) mutation with reduced ovarian reserve, the data is yet inconsistent. Our aim was to investigate biomarkers of ovarian aging in a cohort of young healthy carriers of the BRCA mutation. We hypothesized that the role played by BRCA genes in aging pathways is not exclusive to the ovary. EXPERIMENTAL DESIGN: Healthy female BRCA carriers, 40 years or younger and healthy male BRCA carriers, 50 years or younger, were enrolled in the study. Serum anti-mullerian Hormone (AMH), fibroblast growth factor-23 (FGF-23), Klotho and IL-1 were measured by enzyme-linked immunosorbent assay (ELISA). Ovarian AMH and protein kinase B (AKT) mRNA from BRCA carriers who underwent prophylactic oophorectomy and from age-matched, healthy, non-carriers who underwent partial oophorectomy due to benign conditions were analyzed by qPCR. RESULTS: Thirty-three female (median age 35y) and 20 male (44y) BRCA carriers were enrolled into the study and matched to control non-carriers (34y and 43y, respectively). Serum AMH level was significantly lower in BRCA female carriers than in both non-carrier controls and age-matched nomograms. The levels of ovarian AMH and AKT mRNA were significantly lower in carriers than in controls. The systemic aging cytokines FGF-23, klotho and IL-1 displayed a differential expression in carriers of both genders. FGF-23 level was higher in carriers (P=0.06). CONCLUSIONS: Our results suggest a link between BRCA mutation, accelerated ovarian aging and systemic aging-related pathophysiology.

Factors Affecting Communication Patterns between Oncology Staff and Family Members of Deceased Patients: A Cross-Sectional Study.

OBJECTIVE: Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families. METHODS: This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale. RESULTS: Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant. CONCLUSIONS: Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.

Earlier Age of Breast Cancer Onset in Israeli BRCA Carriers-Is it a Real Phenomenon?

Data on genetic anticipation in breast cancer are sparse. We sought to evaluate age at diagnosis of breast cancer in daughters with a BRCA mutation and their mothers. A review of all carriers of the BRCA mutation diagnosed with breast cancer at the Genetics Institute of a tertiary medical center in 2000-2013 yielded 80 women who could be paired with a mother with breast cancer who was either a carrier of the BRCA mutation or an obligate carrier according to pedigree analysis. Age at diagnosis, type of mutation (BRCA1, BRCA2), year of birth, and ethnicity were recorded. Paired t-test was used to analyze differences in age at cancer diagnosis between groups and subgroups. Mean age at diagnosis of breast cancer was 50.74 years (range 22-88) in the mothers and 43.85 years (range 24-75) in the daughters. The difference was statistically significant (p < 0.001). These findings were consistent regardless of type of BRCA mutation, ethnicity, or mother's year of birth. However, on separate analysis of pairs in which the mother was diagnosed before the age of 50 years, there was no significant difference in mean age at diagnosis between mothers and daughters (~42 years for both). Daughters who carry a BRCA mutation are diagnosed with breast cancer at an earlier age than their carrier mothers, with the exception of pairs in which the mother was diagnosed before the age of 50 years. Future breast-screening guidelines may need to target specific subpopulations of BRCA mutation carriers.

Stability and transitions in posttraumatic growth trajectories among cancer patients: LCA and LTA analyses.

OBJECTIVES: The objectives of the current study were to identify (a) different post cancer treatment adaptation profiles; (b) factors that predict these adaptation profiles; and (c) transitions in post cancer-treatment adaptation profiles and trajectories in a sample (N = 198) of female breast cancer patients over a 2-year period. METHOD: Latent class analysis (LCA) was used to idenitfy profiles of post cancer treatment adaptation, based on a combined pattern of responses to observable indicators of distress, coping strategies, and posttraumatic growth. latent transition analysis (LTA) was used to track trajectories, based on the probabilities of transitions among latent classes. RESULTS: Four postcancer treatment adaptation profiles were found: (a) distressed, (b) resistant, (c) constructive growth, and (d) struggling growth. CONCLUSIONS: The majority of transitions between different adaptation profiles occurred between 6 and 12 months after treatment. These findings offer theoretical and practice implications regarding posttraumatic growth in breast-cancer patients by distinguishing between profiles of adaptation and highlights a previously unidentified profile-struggling growth. These results contribute to the theoretical understanding of the complex relationship between growth, distress, and coping. (PsycINFO Database Record

A Dedicated Follow-Up Clinic for BRCA Mutation Carriers.

BACKGROUND: Women who carry the BRCA gene mutation have an up to 80% chance of developing cancer, primarily of breast and ovarian origin. Confirmation of carrier status is described by many women as an overwhelming, life-changing event. Healthy individuals harboring a BRCA mutation constitute a high risk population with unique needs, often overlooked by health authorities. As such, we felt the need to create a specialized service dedicated specifically to this high risk population. The clinic staff comprises an experienced multidisciplinary team of health professionals who can support the medical and emotional needs of this population. Since its inception in 2001 the clinic has served 318 women. The mean age of patients is 46 years. With a median follow-up of 46 months, 21 women have developed malignancies, including 17 breast cancers, 1 ovarian cancer and 3 additional cancers. All but one of the patients above the age of 40 underwent bilateral salpingo-oophorectomy (BSO). The median and mean ages at BSO were 46.5 and 48 years, respectively (range 33-68). However, only 28.3% underwent bilateral preventive mastectomy. A multidisciplinary clinic for BRCA mutation carriers provides a "home" for this unique population with unmet needs. The high rate of BSO in women before natural menopause indicates that both the medical community and this population are aware of international guidelines supporting this procedure. We believe that a dedicated clinic, with a multidisciplinary team, is likely to contribute to the health, quality of life and survival of BRCA carriers.

Patients' Attitudes Towards Disclosure of Genetic Test Results to Family Members: The Impact of Patients' Sociodemographic Background and Counseling Experience.

Many factors predict the intention to disclose genetic information to relatives. The article examines the impact of patients' socio-demographic factors on their intention to disclose genetic testing results to their relatives. Data were collected in eight genetic clinics in Israel. Patients were requested to fill in a questionnaire after counseling. A convenience sample of 564 participants who visited these clinics was collected for a response rate of 85 %. Of them, 282 participants came for susceptibility testing for hereditary cancers (cancer group), and 282 for genetic screening tests (prenatal group). In the cancer group, being secular and having more years of education correlated positively with the intention to disclose test results to relatives. In the prenatal group, being married and female correlated positively with the intention to disclose. In the cancer group, being religious and with less years of education correlated positively with the view that the clinician should deliver the results to the family. In the prenatal group, being male and unmarried correlated positively with this belief. In both groups, being of young age correlated with the perception that genetic information is private. Varied sociodemographic factors affect the intention to inform family members. Thus, knowing the social background of patients will shed light on people's attitudes to genetic information and will help clinicians provide effective counseling in discussions with patients about the implications of test results for relatives.

ReCAP: Perspectives of Patients, Caregivers, and Medical Staff on Greetings in Oncology Practice: A Prospective Survey.

PURPOSE: Encounters between patients and medical staff are the foundation for building the patient­medical staff relationship, which is a keystone of care. We investigated perspectives of patients, caregivers, and medical staff related to greetings in oncology practice. METHODS: A total of 186 patients (median age, 62 years) and 104 caregivers (median age, 54 years) visiting the outpatient clinics at the Davidoff Cancer Institute completed a questionnaire about greeting-related preferences. Similar questionnaires were completed by 93 staff members (physicians, nurses, secretaries, and psychosocial team). RESULTS: Overall, patients preferred to be addressed informally (ie, by their given name) during first and subsequent meetings with their physician (59% and 75% of patients, respectively). However, most physicians (79%) addressed patients more formally (using surname or full name). Overall, 53% of patients wanted the physician to shake their hand. Physicians reported shaking hands with their patients at the beginning (46%) or end (71%) of the first meeting. Most patients (76%) wanted physicians to formally introduce themselves (by their full name) and mention their academic degree (65%). For other oncology professionals, a majority of patients (63%) preferred an informal introduction (by given name only). No major differences were observed between patients' and caregivers' perspectives. CONCLUSION: This survey provides insights that may help oncology professionals in building relationships with their patients. Specifically, our findings suggest that patients with cancer in Israel prefer a casual environment; yet, they prefer that physicians introduce themselves in a more formal manner.

The Effectiveness of Group Intervention on Enhancing Cognitive Emotion Regulation Strategies in Breast Cancer Patients: A 2-Year Follow-up.

Purpose To evaluate the long-term effect of group intervention on enhancing cognitive emotion regulation (CER) strategies in female patients with early-stage breast cancer. Methods The sample included 174 patients who were diagnosed with early-to-mid stage breast cancer, completed adjuvant therapy, and agreed to fill out demographic and cognitive emotion regulation questionnaires (CERQ). About half of the patients (86, 49.4%) chose to participate in an 8-session group intervention (intervention group) while the others (88, 50.6%) did not (comparison group). The structured intervention for enhancing coping strategies with special emphasis on emotion regulation was conducted at the oncology unit at Rabin Medical Center by 2 experienced therapists. Preliminary effects on CER evaluated 6, 12, and 24 months postintervention were compared to the CER of a group of patients that opted not to participate in the group intervention. Results In the intervention group, the long-term effect (from baseline to 24 months) was assessed using the mix models module. Significant interaction effects were found for both the Negative CER scales (F(3, 268 ,404) = 3.66, P = .01) and for the Positive CER scales (F(3, 271 ,660) = 5.12, P = .002). No statistically significant differences in socio-demographic characteristics and medical variables were observed between the intervention and comparison groups. Conclusion Our findings indicate that a group intervention aimed at empowerment of coping strategies had positive long-term outcomes that reinforce adaptive coping strategies and improve less effective strategies of cognitive emotion regulation.

Posttraumatic Growth in Breast Cancer Survivors: Constructive and Illusory Aspects.

This study investigated the impact of a building-resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two-sided Janus face model (Maercker & Zoellner, 2004). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8-session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self-report questionnaires at baseline and at 6 months follow-up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η(2) = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors.

Expectations and Level of Satisfaction of Patients and Their Physicians: Concordance and Discrepancies.

BACKGROUND: Identifying discrepancies between patients׳ expectations for support provided by their physicians, and physicians׳ appraisal of the support they provide to their patients, is a key factor in constructing effective doctor-patient communication. OBJECTIVE: The current study proposes and explores a paradigm for assessing possible gaps and overlaps between perceptions of patients with cancer and physicians about the "actual" and the "ideal" (desired) emotional and cognitive support oncologists provide to patients. METHODS: Participants included 1027 patients with cancer and 47 senior oncologists. Patients׳ and physicians׳ levels of expectations and satisfaction with the emotional and cognitive support offered by physicians were assessed using a quantitative measure of discrepancy between the actual and the ideal situation. The measure was developed for this study and tested on a random sample of 200 patients and 17 oncologists. RESULTS: The results indicated consistency between physicians׳ and patients׳ perceptions of the needs and support that the patients received. Nevertheless, oncologists did not feel highly trusted by their patients, oncologists desired less involvement of patients in the treatment plan than the patients expected. Oncologists thought that they actually provided the desired levels of explanation to patients׳ families, whereas patients thought their families got less explanations than expected. CONCLUSION: Actual and ideal levels of communication should be described from the points of view of both physicians and patients to better understand the complex picture of patient satisfaction. Oncologists should consider patients׳ expectations for support vs their own expectations to effectively address patients׳ needs.

Preliminary report of the relationship between experience of death of a relative, illness perception, and psychological outcome among BRCA carriers.

With recent advances in mapping the genetic mutations involved in breast cancer and the availability of genetic testing, it has become necessary to explore the psychological consequences of women who have tested positive for the gene mutations involved in breast cancer (BReast CAncer gene one and two, BRCA1/2). Findings regarding psychological consequences of positive results in genetic testing for breast cancer are ambiguous and insufficient. The aim of the current study was to explore the relationship between experience of the death of a relative due to breast cancer, perception of the illness, distress, and well-being among BRCA1/2 mutation women carriers. Forty asymptomatic carriers who attended BRCA1/2 clinics in Israel completed self-administered questionnaires assessing socio-demographic variables, illness perception, and well-being. It was found that experiencing the death of a relative as a result of breast cancer was significantly correlated with illness perception. Carriers who experienced the death of a relative perceived breast cancer as having a stronger identity (i.e. as having severe symptoms), dire consequences, and as being uncontrollable in comparison to carriers who had not experienced the death of a relative. Nevertheless, psychological distress and well-being were not found to be significantly correlated to either an experience of death of a relative as a result of breast cancer or to illness perception. Implications and limitations are discussed in light of these findings. Among these is the need to consider the illness perception of healthy BRCA carriers women.

Factors affecting participation in group intervention in patients after adjuvant treatment for early-study breast cancer.

BACKGROUND AND PURPOSE: According to studies of patients with cancer, support groups can help in three areas: 1) improve mood; 2) introduce new, adaptive ways of handling potentially difficult situations; and 3) impart strategies for managing stress. Nevertheless, the decrease in the quality of life of cancer patients or survivors does not always translate into their utilization of available psychosocial services. The aim of the current study was to explore the factors affecting the decision of patients with breast cancer to participate in group intervention based on an enhancing-resilience approach. METHODS: One hundred eighty-nine patients who were diagnosed with early-stage breast cancer at a tertiary hospital and had completed adjuvant therapy at least three months previously were asked to enroll in the study with or without group intervention. One hundred and one (53.4%) completed the battery of psychological questionnaires, of whom 56 agreed to participate in the intervention. Sociodemographic and medical data were collected for all 189 subjects from the medical files. RESULTS: No significant differences in sociodemographic or medical data were found between intervention-group participants (N = 56) and non-participants (N = 133). Group participants reported significantly higher levels of psychological pathology. Subjects who completed the questionnaires but did not participate in the intervention reported significantly higher levels of positive cognitive emotion regulation and flexibility than participants. CONCLUSION: Low participation in group interventions may be more strongly associated with psychological characteristics than sociodemographic and medical factors. It seems that patients know to perceive whether their personal resources are inadequate for facing a life-threatening illness. Like individual therapy, group interventions should be more sensitive to perceived individual needs and to the art of tailoring suitable contents according individual needs.

Meeting expectations of patients with cancer: relationship between patient satisfaction, depression, and coping.

PURPOSE: This study assessed satisfaction of patients with cancer and the correlation between patient levels of satisfaction and the sociodemographic, medical, and psychological variables. Satisfaction measures were based on patient expectations for emotional and cognitive support by the oncologists. PATIENTS AND METHODS: A total of 1,027 patients with cancer were recruited from the outpatient departments and daycare treatment centers of four oncology institutes in Israel. Patient levels of expectations and satisfaction were assessed by using measures developed for this study. Patient psychological variables were assessed by using the Brief Symptoms Inventory, Impact of Events Scale, and Mental Adjustment to Cancer. chi(2) and Student t tests were used to assess differences between the highly satisfied group and the less satisfied group. RESULTS: Lower values of satisfaction were reported on the dimensions that included the patient in the treatment plan and that included explanations to the family. Higher percentages of women, single patients, younger patients, and patients in stages II to III were found in the less satisfied group. This group reported significantly higher levels of psychological distress, anxious preoccupation, and helplessness and lower levels of fighting spirit. CONCLUSION: Given the importance of patient satisfaction to treatment compliance, oncologists should consider evaluating patient expectations for support, especially in issues concerning planning the treatment and involving the family in medical decisions. Oncologists should take into account the possible interdependence between psychological variables and medical-care satisfaction.

Gender and psychological distress among middle- and older-aged colorectal cancer patients and their spouses: an unexpected outcome.

The population in the western world has been aging while the cancer survival rates have been systematically increasing. Knowledge is lacking about psychological processes and effects of gender difference among middle-aged cancer patients and their healthy spouses. This study assesses psychological distress, coping and social support among middle-aged couples, where one of the partners was diagnosed with colon cancer. A repeated-measure MANOVA and Pearson's correlation coefficient were used to assess the relationships between the variables. Levels of social support were found to be negatively correlated to levels of psychological distress among all of the participants. Surprisingly, men (healthy or sick) were found to be more distressed than their wives (p<0.0001). Men also reported receiving more support from their wives than did the female spouses (p<0.0005). The gender differences found in our study imply that men (healthy or sick) tend to receive more support than they give to their wives. It also implies that men do not use the support they receive as effectively as their wives. Thus, although men report higher levels of support from their spouses, they also report higher levels of psychological distress. Practical implications are discussed.

How relevant is marital status and gender variables in coping with colorectal cancer? A sample of middle-aged and older cancer survivors.

OBJECTIVE: While the population in the western world is aging and cancer survival rates are increasing, there is a lack of knowledge concerning factors affecting social support and its relation to coping and distress among older patients. The aim of the current study is to assess the impact of marital status and gender upon levels of psychological distress, coping, and social support among middle-aged and older unmarried (divorced/widowed) and married colorectal cancer patients. METHODS: Samples of 339 male and female colorectal patients were recruited from three major cancer centers in Israel. Participants' psychological distress, coping styles and social support were assessed using four self-report standardized instruments. RESULTS: Two-way MANOVAs and Pearson's correlation coefficient were used to assess the relationships between the study variables. High levels of distress were found among unmarried and male patients. Married men reported on significantly higher levels of spouse support than married women. Family support was correlated with psychological distress only among married patients. Surprisingly, spiritual-religious support was found to be correlated among some of the study groups with Helplessness and Fatalism. CONCLUSIONS: The results support the assumption that married patients cope better with cancer than unmarried patients and that women cope better than men. These differences may be related to the cultural mores of Israeli society in which men are expected to play the 'hero' role or to a generally lower ability of men to use social support and of unmarried patients to get family support. Practical conclusions in terms of intervention are discussed.