Academic journal article Journal of Evidence-Based Psychotherapies

Predictors of Quality of Life during Chemotherapy for Breast Cancer. Investigating the Role of Multidimensional Symptoms and Dysfunctional Beliefs

Academic journal article Journal of Evidence-Based Psychotherapies

Predictors of Quality of Life during Chemotherapy for Breast Cancer. Investigating the Role of Multidimensional Symptoms and Dysfunctional Beliefs

Article excerpt

Breast is the leading cancer site in women in Europe, with over 464,000 new cases of breast cancer being diagnosed every year (Bray, Ren, Masuyer, & Ferlay, 2013; Ferlay et al., 2013). The treatment modalities for primary breast cancer include surgery, chemotherapy, radiotherapy and hormonal therapy, all four of which can be used alone or in combination. Chemotherapy is commonly used after surgery in order to inhibit metastasis and enhance long-term survival rates (NCI, 2014). Although breast cancer chemotherapy increases disease-free survival and life expectancy, it bears adverse side-effects. Breast cancer patients undergoing chemotherapy experience multiple physical (e.g., nausea, fatigue) and psychological symptoms (e.g., anxiety, depression) that can impact their quality of life (QoL) (Hall et al., 2014; Lemieux, Goodwin, Bordeleau, Lauzier, & Theberge, 2011; Reid-Arndt, Hsieh, & Perry, 2010; Safaee, Moghimi-Dehkordi, Zeighami, Tabatabaee, & Pourhoseingholi, 2008).

While numerous studies point to the variety of chemotherapy side effects that patients experience, less is known about the multidimensional nature of these symptoms. Symptoms can be conceptualized as multidimensional in nature with components that include prevalence, frequency, severity and distress (Portenoy et al., 1994). Effective symptom management during chemotherapy requires the assessment of multiple symptom dimensions, not merely the presence or absence (Chang, Hwang, Feuerman, Kasimis, & Thaler, 2000; Cheng, Darshini Devi, Wong, & Koh, 2014).

At the same time, while there is evidence that cognitive factors such as dysfunctional beliefs play a significant role in symptom experience and emotional distress during cancer treatments (David, Lynn, & Ellis, 2010), such as radiotherapy (Sucala, Schnur, Brackman, David, & Montgomery, 2013) and chemotherapy (Broeckel, Jacobsen, Horton, Balducci, & Lyman, 1998; Ferguson et al., 2012), less is known about the role of such cognitive factors and their relationship with symptom experience and QoL. More specifically, although according to the cognitive behavioral theory, dysfunctional beliefs mediate the impact of events (e.g., symptom experience) on emotional distress (David et al., 2010; Ellis, 1994), less is known about the potential of dysfunctional beliefs to mediate the impact of symptoms experience on patients' QoL.

The purpose of this study was to investigate: 1) the multidimensional symptom experience (i.e., prevalence, frequency, severity, and burden) in breast cancer patients undergoing chemotherapy; 2) the breast cancer patients' QoL during chemotherapy, exploring not only the general QoL, but also its multidimensional components (physical wellbeing, emotional wellbeing, functional wellbeing and social wellbeing); and, 3) the relationship between symptom experience and dysfunctional beliefs on the QoL of breast cancer patients, particularly exploring dysfunctional beliefs as mediators between symptoms experience and patients' quality of life.

Method

Participants and procedures

One hundred and forty-five female breast cancer chemotherapy patients (mean age=52.15, SD=10.51) took part in the study. 97.2% were Romanian, 2.8% were Hungarian, 77.2% were married or in a relationship, 33.8% had college or post-graduate education. 54.5% had had breast surgery before chemotherapy, of which 41.4% had had a mastectomy and 13.1% a lumpectomy. 7.65% had metastasized.

Patients scheduled for breast cancer chemotherapy were referred by an oncologist. Data were collected from questionnaires administered by a research assistant, on the day of the treatment. Eligibility criteria included: patients undergoing breast cancer chemotherapy, having the ability to speak and read Romanian (as the study forms were in Romanian), being at least 18 years of age, and consenting to be in the study. Patients were ineligible if they had any uncontrolled major psychiatric comorbidities (determined by medical chart reviews). …

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