title: Stress and quality of life in breast cancer recurrence: moderation or mediation of coping?
abstract: OBJECTIVE
  Diagnosis with breast cancer recurrence often brings high levels of stress. Successful coping to alleviate stress could improve patients' quality of life (QoL). The intervening role coping plays between stress and QoL may depend on the types of stress encountered and the types of coping strategies used. The present study investigates the longitudinal relationships between stress, coping, and mental health QoL.
  
  
  METHODS
  Breast cancer patients recently diagnosed with recurrence (N = 65) were assessed shortly after the diagnosis and 4 months later. Four moderation and four mediation models were tested using hierarchical multiple regressions and path analyses. In the models, either traumatic stress or symptom-related stress at recurrence diagnosis was a predictor of mental health QoL at follow-up. Both engagement and disengagement coping strategies were tested as moderators or mediators between stress and QoL.
  
  
  RESULTS
  Engagement coping moderated the effect of symptom stress on mental health QoL, whereas disengagement coping mediated the effects of both traumatic stress and symptom stress on mental health QoL.
  
  
  CONCLUSIONS
  The findings imply that interventions teaching engagement coping strategies would be important for patients experiencing high symptom stress, while discouraging the use of disengagement coping strategies would be important for all patients.
authors.affiliation: Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210-1222, USA.
authors.forename: Hae-Chung
authors.initials: HC
authors.lastname: Yang
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Brothers
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Andersen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D003674:Defense Mechanisms; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D008960:Models, Psychological; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D010555:Personality Inventory; D011788:Quality of Life / Q000523:psychology*; D012803:Sick Role; D040921:Stress Disorders, Traumatic / Q000175:diagnosis / Q000523:psychology*