title: Understanding locally advanced breast cancer: what influences a woman's decision to delay treatment?
abstract: BACKGROUND
  Despite early detection having been identified as a key factor in long-term survival of patients with breast cancer, women with locally advanced breast cancer continued to present at many medical centers.
  
  
  METHODS
  Women with locally advanced breast cancer (LABC) (N = 11) and matched controls (N = 11) with Stage I or II breast cancer completed semi-structured interviews and the Hospital Anxiety and Depression Scale, Life Orientation Test, Multidimensional Health Locus of Control Scale, Body Investment Scale, Monitor-Blunter Style Scale, and Religious Coping Scale. Five spouses of the LABC group and eight control partners were similarly assessed.
  
  
  RESULTS
  On psychological tests, no significant differences were found between patient groups; however, LABC spouses reported significantly greater active religious surrender (t = 2.37, P = 0.037) and depression (t = 3.54, P = 0.047) than control spouses. The women's semi-structured interviews identified that LABC was associated with inattention to routine breast cancer screening, denial, fatalism and reliance on alternative therapies. Spouses of the LABC group tended to be more passive in their wives' medical care, and also utilized fatalistic thinking and denial.
  
  
  CONCLUSIONS
  It is important for health care providers to identify patients who will require extra encouragement to seek timely medical care and to follow through with treatment recommendations.
authors.affiliation: Medical College of Ohio, Toledo, OH 43614-5809, USA. kwilliams@mco.edu
authors.forename: Iman E
authors.initials: IE
authors.lastname: Mohamed
authors.forename: Kristi
authors.initials: K
authors.lastname: Skeel Williams
authors.forename: Marijob
authors.initials: M
authors.lastname: Tamburrino
authors.forename: Johnm
authors.initials: J
authors.lastname: Wryobeck
authors.forename: Sue
authors.initials: S
authors.lastname: Carter
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D016022:Case-Control Studies; D003717:Denial, Psychological; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D015146:Midwestern United States; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D018454:Spouses / Q000523:psychology