title: Predicting stress-related problems in long-term breast cancer survivors.
abstract: BACKGROUND
  Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors.
  
  
  METHODS
  We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support.
  
  
  RESULTS
  Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R(2)=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R(2)=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations.
  
  
  CONCLUSIONS
  Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.
authors.affiliation: School of Psychology, University of Ottawa, Ontario, Canada. sophie.lebel@uottawa.ca
authors.forename: Sophie
authors.initials: S
authors.lastname: Lebel
authors.forename: Zeev
authors.initials: Z
authors.lastname: Rosberger
authors.forename: Linda
authors.initials: L
authors.lastname: Edgar
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Devins
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D012917:Social Adjustment; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*