title: Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors.
abstract: BACKGROUND
  Survival rates for women with early-stage breast cancer have increased significantly in recent years. However, little is known about the long-term impact of the cancer experience on women's psychological functioning. Theoretical and descriptive accounts suggest that cancer may evoke both perceptions of vulnerability and positive meaning, with potentially different effects on mental health.
  
  
  OBJECTIVE
  This study was designed to evaluate the prevalence and stability of these perceptions in a large sample of breast cancer survivors, to identify their antecedents, and to determine their impact on long-term adjustment.
  
  
  METHODS
  Breast cancer survivors (N = 763) were assessed longitudinally at 1 to 5 years and 5 to 10 years postdiagnosis. Participants completed surveys assessing perceptions of positive meaning and vulnerability and standard measures of psychological adjustment and quality of life.
  
  
  RESULTS
  The majority of women reported positive changes in outlook and priorities as well as feelings of vulnerability at both assessment points. Consistent with hypotheses, results showed that perceptions of positive meaning and vulnerability were positively correlated and were both associated with factors that increased the disruptiveness of the cancer experience. Vulnerability was strongly associated with negative affect, whereas meaning was associated with positive affect in cross-sectional and longitudinal analyses.
  
  
  CONCLUSIONS
  Results suggest that a cancer diagnosis may lead to enduring feelings of vulnerability as well as positive changes in meaning; however, these perceptions have very different mental health correlates.
authors.affiliation: Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7076, USA. jbower@ucla.edu
authors.forename: Julienne E
authors.initials: JE
authors.lastname: Bower
authors.forename: Beth E
authors.initials: BE
authors.lastname: Meyerowitz
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Desmond
authors.forename: Coen A
authors.initials: CA
authors.lastname: Bernaards
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000473:pathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008603:Mental Health; D008875:Middle Aged; D011379:Prognosis; D012649:Self Concept; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000523:psychology*