Aim: This longitudinal survey purposes to derive more penetration in both the alterations in personal control due to a chest malignant neoplastic disease diagnosing, every bit good as in the stress-buffering consequence of personal
control. Methods: Personal control and hurt were assessed in chest malignant neoplastic disease patients non treated
with chemotherapy ( n=47 ) , breast malignant neoplastic disease patients treated with chemotherapy ( n=32 ) and in
healthy adult females ( n=58 ) at 3, 9 and 15 months after diagnosing.
Consequences: Consequences indicate that personal control was affected merely in patients treated with
chemotherapy, peculiarly right after the completion of intervention. Furthermore, the crosssectional
and longitudinal consequences provide modest support for the stress-buffering potency of
control.
Decisions: The findings and future waies of research on the function of personal control in
the accommodation to malignant neoplastic disease will be discussed.
Copyright # 2008 John Wiley & A ; Sons, Ltd.
Keywords: malignant neoplastic disease ; oncology ; perceived control ; accommodation ; hurt
Introduction
Womans diagnosed with chest malignant neoplastic disease are confronted
with different stressors throughout the illness flight,
e.g. expecting diagnosing, holding surgery, expecting
the possibility that the malignant neoplastic disease has spread,
get bying with side effects and, eventually, confronting the hazard of
return. Despite the unsure and unmanageable
character of these stressors, personal control is
by and large believed to be an of import resource for
successful psychological accommodation.
Personal control refers to the belief that life is
non ruled by destiny but that one is personally able to
influence the of import events or state of affairss in life.
This belief is systematically shown to be related to a
assortment of positive results such as a lower hazard of
disease [ 1 ] , successful accommodation to illness [ 2 ] and
even survival [ 3 ] . Although a sense of control is
mostly shaped by personality, overpowering aversive
events challenge control perceptual experiences. Yet, it is
particularly in the face of overpowering negative
events that personal control might represent a
stress-buffering resource.
The first purpose of this survey is to analyze whether
personal control alterations after a chest malignant neoplastic disease
diagnosing. The surprisingly few surveies that examined
the impact of a malignant neoplastic disease diagnosing on personal
control yielded assorted consequences [ 4,5 ] . Most surveies
were cross-sectional and clip passed since diagnosing
varied greatly. As a effect, it remains ill-defined
at what point in clip alterations in personal control
occur and if alterations are lasting or impermanent in
nature. Additionally, most surveies did non take
differences in the stressors faced after diagnosing into
consideration. The present survey adopts a longitudinal
case-control design and takes into history
the impact of chemotherapy on control perceptual experiences.
Chemotherapy is prescribed when predictive features
are comparatively unfavourable, i.e. the tumour
is larger, more aggressive or has spread to the lymph
nodes. Furthermore, chemotherapy causes unpleasant
side effects and increases intervention continuance well.
For these grounds, it is expected that the
prescription of chemotherapy poses a significant
menace to command perceptual experiences throughout the unwellness
flight.
The 2nd purpose of this survey is to analyze the
stress-buffering consequence of personal control in adult females
with chest malignant neoplastic disease. Several research workers suggested
that the adaptative value of a basic sense of control
over life additions in nerve-racking fortunes, but
surveies that really test this premise are scarce.
A high sense of personal control might hold stressbuffering
potency in adult females with chest malignant neoplastic disease, as
it fosters effectual get bying schemes [ 6 ] , determines
the manner societal support is used [ 7 ] , influences the manner
Received: 5 February 2007
Revised: 13 December 2007
Accepted: 17 December 2007
Copyright # 2008 John Wiley & A ; Sons, Ltd.
Psycho-Oncology
Psycho-Oncology 18: 104-108 ( 2009 )
Published on-line 3 March 2008 in Wiley InterScience ( www.interscience.wiley.com ) . Department of the interior: 10.1002/pon.1333
the state of affairs is appraised [ 8 ] and promotes positive
ascriptions about one ‘s ain function in restricting the
negative impact of the disease [ 9 ] .
In decision, the current survey purposes to research the
reversible place of personal control in the emphasis
procedure [ 10 ] . It is hypothesized that personal control is
affected by the assorted stressors adult females with chest
malignant neoplastic disease face ( Aim 1 ) , but that a sense of control besides
regulates the impact of the disease ( Aim 2 ) .
Method
Procedure and sample
The informations used were portion of a larger dataset collected
in a longitudinal survey on dyadic get bying with malignant neoplastic disease.
The Medical Ethical Committees of the five participating
infirmaries approved the survey protocol. Newly
diagnosed chest malignant neoplastic disease patients were included if ( 1 )
they had a spouse willing to take part, ( 2 ) they
were between 30 and 75 old ages old, ( 3 ) their endurance
forecast was at least 15 months, ( 4 ) both spouses
had no old history of malignant neoplastic disease and ( 5 ) they both
understood Dutch. Women in the mention group
were selected from the registry office of several
townships and were matched to patients on the footing
of age and part. Merely adult females without a history of
malignant neoplastic disease and with a spouse willing to take part were
included ( nA?64 ) .
For the present survey, merely the informations of adult females
were examined. Informed consent was obtained
from 92 patients ( 32 % response rate ) . Hinnen et Al.
[ 11 ] reported consequences based on the same information and
presented elaborate information on response and
refusal. Participants did non differ from nonparticipants
with regard to age and part of
abode. The current survey studies on informations
collected at 3, 9 and 15 months post-diagnosis.
After the omission of drop-outs and uncomplete instances
( 13 patients and 6 healthy adult females ) , the complete
informations of 58 healthy adult females and 79 patients were
available for analysis. Drop-outs and non-completers
by and large reported less mastery and/or more
hurt than completers at the assorted occasions,
although none of these differences were important.
Instruments
Personal control was assessed with the 7-item
Mastery List [ 12 ] , which reflects perceived control
over events and jobs in life. The alphas scope
from 0.70 to 0.80. Psychological hurt was
assessed with the 12-item version of the General
Health Questionnaire [ 13 ] . Item tonss were
dichotomized conform the CGHQ marking method
of Goodchild and Duncan-Jones. Compared with
the original manner of marking, this method gives a
more accurate index of a topic ‘s present province
[ 14 ] . Alphas are higher than 0.80. Social-demographic
features included age, educational
degree, and two types of co-morbidity ( the figure of
diseases present in the past 12 months treated or
non treated by a medical specializer ) .
Analysis
Three groups were distinguished: healthy adult females
( nA?58 ) , breast malignant neoplastic disease patients non treated with
computed chemotherapy ( CT ) ( nA?47 ) and chest
malignant neoplastic disease patients treated with CT ( nA?32 ) . To
examine whether and when a chest malignant neoplastic disease
diagnosing affects perceptual experiences of personal control
( Aim 1 ) , an ANOVA repeated steps was
performed. Cohen ‘s vitamin D based on within- or between-
group differences in natural agencies will be
presented to bespeak consequence size ( ES ) .
To analyze the relationship between personal
control and hurt ( Aim 2 ) , three cross-sectional
arrested development analyses were performed. Possible confounders
were entered in the first measure. Two silent person
variables contrasting the two patient groups with
the mention group were entered in the 2nd measure,
followed by personal control in the 3rd measure. Two
interaction footings ( dummypersonal control ) were
entered in the concluding measure. A important negative
coefficient for an interaction term provides support
for a stress-buffer consequence. R2 will be presented for
each measure to bespeak ES.
The longitudinal control-distress relationships
were examined every bit good, one time with control at 3
months post-diagnosis as a forecaster of alterations in
hurt over the following 6 months and one time with
control at 9 months post-diagnosis as a forecaster of
alterations in hurt over the following 6 months. These
longitudinal relationships were examined in patients
merely. In patients, hurt was expected to be
highest shortly after diagnosing and to diminish over
clip as a consequence of psychological accommodation. Such
alterations were non expected in the mention group.
When a high degree of personal control is related to a
lessening in hurt, the stress-buffer hypothesis is
supported.
Consequences
Patients treated with CT were younger, reported
less extra diseases than the other two groups
and were more extremely educated than patients non
treated with CT ( Table 1 ) . The three groups were
non significantly different with regard to the
figure of diseases for which one consulted a
medical specializer. At 9 months post-diagnosis
( T2 ) , all patients completed intervention, with the
exclusion of endocrine therapy. A GLM repeated
steps analysis showed that, commanding for age
differences, the class of hurt in patients was
different from that in healthy adult females,
Ftimegroup ( 4,266 ) A?6.23, p50.01. Patients reported
most distress 3 months post-diagnosis
Copyright # 2008 John Wiley & A ; Sons, Ltd. Psycho-Oncology 18: 104-108 ( 2009 )
Department of the interior: 10.1002/pon
Personal control after a chest malignant neoplastic disease diagnosing 105
( T1 ) . In patients non treated with CT, hurt
decreased in the subsequent 6 months ( T2 ) . In
patients treated with CT, the degree of hurt was
no longer different from that in healthy adult females at
15 months post-diagnosis ( T3 ) .
Aim 1
Consequences show that, when commanding for group
differences in educational degree, in neither of the
groups did personal control alteration significantly
over clip, Ftime ( 2,256 ) A?1.08, pA?0.34 and
Ftimegroup ( 4,256 ) A?1.65, pA?0.16. Yet, the overall
average degree of personal control post-diagnosis did
differ across groups, Fgroup ( 2,128 ) A?3.68, pA?0.03.
Patients treated with CT reported less personal
control after diagnosing than the mention group of
healthy adult females, DEMA?1.67, SEA?0.74, pA?0.03.
Univariate analyses show that this difference in
personal control is largest at 9 months after diagnosing
( EST1A?0.04, EST2A?0.60, EST3A?0.37 ) . The general
degree of personal control in patients non treated with
CT did non differ from that in healthy adult females.
Aim 2
Consequences presented in Table 2 indicate that the
diagnosing of chest malignant neoplastic disease explained a important
per centum of discrepancy in hurt at T1 and T2 but
non in hurt at T3. The per centum of explained
discrepancy added by personal control was important
at all three occasions. Merely at 9 months postdiagnosis
( T2 ) , a important interaction consequence was
found. At that clip, the control-distress relationship
was significantly stronger in patients treated
with CT than in healthy adult females. Longitudinal
analyses showed that merely in patients treated with
CT a higher degree of control at T1 was significantly
related to diminutions in hurt over the following 6
months. Control at T2 was significantly related to
alterations in hurt over a period of 6 months ( T3 )
in neither of the two patient groups.
Table 1. Sample features, agencies and standard divergences of personal control and hurt
Healthy adult females Patients non-CT Patients CT
Age, M ( SD ) a 52.8 ( 10.1 ) 54.9 ( 9.1 ) 48.3 ( 7.6 )
Educational degree, n ( % ) a
Elementary/lower professional 23 ( 39.7 % ) 26 ( 55.3 % ) 8 ( 25.0 % )
Intermediate-level professional 13 ( 22.4 % ) 10 ( 21.3 % ) 14 ( 43.8 % )
Higher professional/academic 22 ( 37.9 % ) 11 ( 23.4 % ) 10 ( 31.3 % )
Diseases non treated by specializer, n ( % ) B
0 19 ( 32.8 % ) 20 ( 42.6 % ) 23 ( 71.9 % )
1or 2 22 ( 37.9 % ) 10 ( 21.3 % ) 6 ( 18.8 % )
34 17 ( 29.3 % ) 17 ( 36.2 % ) 3 ( 9.4 % )
Diseases treated by specializer, n ( % ) degree Celsius
0 38 ( 65.5 % ) 27 ( 57.4 % ) 21 ( 65.6 % )
1or 2 13 ( 22.4 % ) 12 ( 27.7 % ) 8 ( 25.0 % )
34 7 ( 12.1 % ) 7 ( 14.9 % ) 3 ( 9.4 % )
Treatment modes
Breast surgery } 47 ( 100 % ) 32 ( 100 % )
Radiotherapy } 33 ( 70.2 % ) 2 ( 6.3 % )
Hormone } 19 ( 40.4 % ) 12 ( 37.5 % )
Personal control, M ( SD ) vitamin D
3 months ( T1 ) 24.60 ( 4.04 ) 24.43 ( 4.74 ) 24.44 ( 4.57 )
9 months ( T2 ) 25.43 ( 3.71 ) 25.04 ( 4.07 ) 23.19 ( 3.92 )
15 months ( T3 ) 25.47 ( 3.68 ) 25.11 ( 5.05 ) 24.06 ( 3.94 )
Distress, M ( SD ) vitamin D
3 months ( T1 ) 4.07 ( 2.09 ) 5.15 ( 3.22 ) 6.91 ( 3.01 )
9 months ( T2 ) 3.50 ( 3.50 ) 3.68 ( 3.68 ) 5.25 ( 3.29 )
15 months ( T3 ) 3.91 ( 2.90 ) 3.04 ( 2.96 ) 3.97 ( 3.29 )
Entire n 58 47 32
a Groups differ significantly, p50.05.
B Groups differ significantly, p50.01.
degree Celsius Groups do non differ significantly.
500 Test consequences are reported in the text.
106 I. Henselmans et Al.
Copyright # 2008 John Wiley & A ; Sons, Ltd. Psycho-Oncology 18: 104-108 ( 2009 )
Department of the interior: 10.1002/pon
Discussion
Consequences indicate that lone patients treated with
chemotherapy, who face a longer intervention flight
and comparatively less good predictive chances,
study lower degrees of personal control than healthy
adult females ( Aim 1 ) . Although personal control was
shown to be related to lower degrees of hurt, the
consequences provide merely modest support for the stressbuffering
potency of control ( Aim 2 ) . Longitudinally,
personal control 3 months post-diagnosis
predicted a lessening in hurt merely in patients
treated with chemotherapy. Cross-sectionally, adult females
treated with chemotherapy were shown to gain
more from a high sense of control over life than
healthy adult females at 9 months after diagnosing. Interestingly,
it is besides in this stage of the illness flight,
merely after the completion of intervention, that the
care of sense of control seemed hardest in
this group. Patients are no longer monitored purely
and are assumed to acquire back to life as usual, without
malignant neoplastic disease playing a major function. There is eventually clip to
reflect on the malignant neoplastic disease experience and to confront the hazard of
return [ 15,16 ] . Apparently, personal control is a
valuable but threatened personal resource in this
peculiar stage.
Patients who were non treated with chemotherapy
resembled healthy adult females with regard to the
reported degrees of personal control and hurt
( with the exclusion of 3 months post-diagnosis ) .
This survey indicates that it is non the chest malignant neoplastic disease
diagnosing but the needed intervention mode and
possibly the related predictive chances that
specify the emphasis experience [ 17 ] . Although some
research workers suggest that nonsubjective clinical features
make non impact psychosocial results in
malignant neoplastic disease patients [ 18 ] , the current findings show that
it is unadvisable to merely disregard differences.
The survey has several restrictions. First of wholly, the
response rate was low and the two patient groups
were instead little, consisted entirely of adult females
with an confidant spouse and may hold existed
from the least hard-pressed adult females, as drop-outs and
non-completers by and large reported more hurt
and less personal control. Despite the restrictions
such a sample evidently has, such as limited
external cogency, one could reason that when
important relationships are found between variables
that are restricted in scope, consequences are even
more robust. Furthermore, the consequences did non depend
on a few influential instances with more utmost tonss.
Second, the survey leaves inquiries about why
personal control is adaptative and how personal
control is maintained unreciprocated. Future surveies
should research the possible behavioral and cognitive
go-betweens of the control-distress relationship,
including battle in intervention determinations or
self-efficacy for get bying with malignant neoplastic disease. Furthermore,
research workers should seek to derive more penetration into the
schemes people use to keep personal control
over life in the face of stressors such as malignant neoplastic disease.
Possibly, patients who maintain control are those
who are able to concentrate attending off from
unmanageable unwellness facets and towards facets
that are still capable to personal control [ 19,20 ] ,
such as roll uping information or cut downing the
impact of the unwellness on day-to-day life. Furthermore, by
merely increasing the valency of life spheres that
are still governable, like intimate relationships or
spiritualty, adult females might keep a general sense
Table 2. Standardized arrested development coefficients ( step 3 ) , unstandardized coefficients ( step 4 ) and per centums of explained discrepancy
per measure
Distress
3 months 9 months 15 months
B ( step 3 ) B ( step 4 ) DR2 B ( step 3 ) B ( step 4 ) DR2 B ( step 3 ) B ( step 4 ) DR2
Cross sectionala
1. Age 0.23** 0.08** 0.06** 0.11 0.03 0.03* 0.19* 0.06* 0.04*
2. Patient non-CT 0.18* 1.21* 0.09** 0.02 0.15 0.04* 0.13 0.80 0.01
Patient CT 0.32** 2.44** 0.13 0.49 0.07 0.55
3. Personal control 0.23** 0.28** 0.05** 0.43** 0.25 0.18** 0.32** 0.16 0.10**
4. Interaction patient non-CT 0.22 0.02 0.02 0.08
Interaction patient CT 0.09 0.35* 0.04* 0.12 0.00
Longitudinal ( patients non-CT ) a
1. Initial degree of hurt ( T1/T2 ) 0.51 0.31** 0.57 0.35**
2. Age 0.10 0.05 0.05 0.00
3. Personal control 0.20 0.04 0.03 0.00
Longitudinal ( patients CT ) a
1. Initial degree of hurt ( T1/T2 ) 0.57 0.43** 0.92** 0.59**
2. Age 0.03 0.00 0.19 0.03
3. Personal control 0.31* 0.09* 0.21 0.02
**p50.01 ; *p50.05.
a Controlled for group differences in age, related to hurt.
Personal control after a chest malignant neoplastic disease diagnosing 107
Copyright # 2008 John Wiley & A ; Sons, Ltd. Psycho-Oncology 18: 104-108 ( 2009 )
Department of the interior: 10.1002/pon
of control over life. Insight into these underlying
mechanisms can supply clinical pattern with
valuable informations to plan intercessions aimed at
perceptual experiences of control in malignant neoplastic disease patients. Distress
after a malignant neoplastic disease diagnosing might be relieved by
assisting patients to reappraise or allow travel of
temporarily unachievable ends and to place the
countries that are still capable to personal control.
Recognitions
This survey was funded by grants from the Dutch Cancer
Society ( NKB RUG 1999-2092 and RUG 2004-2989 ) .
Additionally, the writers wish to show their gratitude to
the Martini Hospital in Groningen, the University Medical
Center Groningen, the Nij Smellinghe Hospital in Drachten,
the Medical Center Leeuwarden and the Wilhelmina
Hospital Assen for their engagement in the information aggregation,
to Eric new wave Sonderen for his methodological advice, and to
all survey participants.