Department of Psychology, UCLA, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
School of Psychological Sciences, Monash University, Melbourne, Australia.
J Behav Med. 2017 Dec;40(6):875-885. doi: 10.1007/s10865-017-9855-x. Epub 2017 May 20.
Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women's physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women's lives.
乳腺癌患者通常会经历医疗治疗带来的不良身体副作用。根据癌症应激和疾病的生物行为模型，诊断和治疗期间的生活压力可能会对女性对乳腺癌的身体健康相关调整轨迹产生负面影响。这项纵向研究考察了慢性和偶发性压力作为乳腺癌诊断后一年中恼人身体症状的预测因素。在研究开始时和 9 个月后，最近 4 个月内被诊断患有乳腺癌的女性（N=460）完成了一项生活压力访谈，以评估慢性和偶发性压力严重程度的背景情况。在研究开始时、6 周后至 6 个月、9 个月和 12 个月时测量身体症状困扰（例如疼痛、疲劳）。在多层次结构方程模型（MSEM）分析中，诊断后不久发生的慢性压力和偶发性压力都预测了研究期间更大的身体症状困扰。在 MSEM 分析中，在诊断前发生的偶发性压力并未预测症状困扰，慢性压力和偶发性压力对症状困扰的相互作用并不显著。结果表明，乳腺癌诊断后不久发生的持续慢性压力和偶发性压力是癌症治疗期间和之后恼人症状的重要预测因素。在诊断后几个月内对慢性压力和近期生活应激事件进行筛查，可能有助于识别有持续和恼人身体症状风险的乳腺癌患者。预防或改善治疗相关身体症状的干预措施可能会通过解决女性生活中的非癌症相关压力而带来额外的益处。
