Compliance with chemotherapy among breast cancer patients.

This study explored the extent of and reasons for noncompliance with intravenously-administered chemotherapy among a sample of breast cancer patients. Overall, chemotherapy compliance was high (92%). The few cases of non-compliance identified were indirect. In particular, two patients rejected chemotherapy outright and two alcoholic patients used alcohol to avoid chemotherapy. The high rate of chemotherapy compliance was judged to be due to its perceived centrality to recovery from cancer, the "medical" nature of its administration, the ease with which non-compliance can be detected, and patients' spontaneous use of successful coping techniques.

Attributions, beliefs about control, and adjustment to breast cancer.

Attributions for cancer and beliefs about control over cancer were examined for their association with adjustment to breast cancer. Although 95% of the respondents made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming another person. In contrast, both the belief that one could now control one's cancer and the belief that others (e.g. the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. The theoretical and practical implications of these results are discussed.

Social comparison in adjustment to breast cancer.

We investigated four theoretical perspectives concerning the role of social comparison (Festinger, 1954) in coping with a threatening event in a sample of breast cancer patients. According to the supercoper perspective, personal contact with comparison others is often unavailable to patients, and contact with media "supercopers"--fellow victims presented as adjusting very smoothly--may make patients feel inadequate by comparison. According to the similarity perspective, patients select comparison targets who are similar to themselves because those comparisons should be the most informative. The upward comparison perspective is predictive of comparisons to relatively advantaged or superior individuals. The downward comparison perspective leads to the prediction that under conditions of threat, individuals make comparisons to people who are inferior or less fortunate in order to enhance their self-esteem. We interviewed 78 breast cancer patients, and results of both closed-ended questions and spontaneously offered comparisons yielded a preponderance of downward comparisons. The results point to the value of using naturalistic methods for studying comparisons, and suggest a more active and cognitive role for social comparison than is usually portrayed.

Breast self-examination among diagnosed breast cancer patients.

The practice of breast self-examination (BSE) was explored by personal interview in a sample of women with diagnosed breast cancer. Despite physician recommendations to practice BSE, only 43% of those interviewed were examining themselves regularly, a figure that is little different from that of the general population. Predictors of BSE were age (older women were less likely to practice) and practice of BSE before diagnosis. Factors contributing to nonpractice were judged to be: (1) the patients' beliefs that occasional examinations by physicians are a sufficient substitute for BSE; (2) the patients' perceptions that BSE is discretionary and not truly "medical"; and (3) the fact that BSE may raise patients' anxiety over cancer without affecting its likelihood. It was concluded that the practice of BSE among diagnosed patients could be increased if physicians stress its importance and provide systematic instruction or reinstruction in its practice.

Illness-related and treatment-related factors in psychological adjustment to breast cancer.

Seventy-eight breast cancer outpatients were interviewed and their medical records were reviewed to document illness-related and treatment-related factors associated with psychosocial adjustment. Poor prognosis and more radical surgery both independently predicted poor psychological adjustment. The effect of type of surgery appeared to be mediated by the patient's sense of disfigurement and by changes in the sexual and affectional patterns in the marriage, rather than by prognosis or disability. Degree of dysfunction and whether or not the patient had radiation therapy or chemotherapy had no independent effects on psychological adjustment. Results point to the problematic psychosocial outcomes associated with mastectomy and, more generally, to the illness- and treatment-related factors that may place a breast cancer patient at risk for psychosocial adjustment problems.