PS370 Unit 7 Cancer and Coping Paper Example

Ana's Diagnosis, Paul's Recovery: A PS370 Unit 7 Cancer and Coping Paper

[Student Name]

Purdue University Global

PS370: Health Psychology

Unit 7 Cancer and Coping Paper

[Instructor Name]

[Date]

Ana, Paul and their family are composite; the studies and interventions cited are real.

The Diagnosis

Ana Medeiros is 49 and works as a secretary at an elementary school in New Bedford, Massachusetts. Eight months ago a screening mammogram found a 2.4-centimeter tumor in her left breast, and a biopsy confirmed hormone receptor-positive invasive ductal carcinoma with one involved lymph node, stage II. She had a lumpectomy, then four months of chemotherapy, and is now in radiation, with endocrine therapy planned for at least five years.

Her diagnosis came six months after her husband, Paul, a scallop boat captain, had a heart attack at sea. For half a year Ana had managed his medications, called his rehabilitation program when he missed sessions and worried each time he left on a trip. Now she was the patient. Paul canceled two trips during her chemotherapy, which cost the household income they needed, and went back to sea for the rest.

This paper examines how Ana copes, how her coping affects her distress, what psychological interventions could help her and what the evidence can and cannot claim about psychological factors and cancer outcomes.

Optimism and Coping

Carver et al. (1993) followed women with early-stage breast cancer from diagnosis through the first year after surgery. Women who were more optimistic before surgery reported less distress at each point. The researchers found that much of optimism's effect ran through coping: optimistic women were more likely to accept the reality of their situation, to reframe it positively and to use humor, and less likely to deny it or give up trying to deal with it. Acceptance, reframing and humor were associated with lower distress, while denial and behavioral disengagement were associated with higher distress.

Ana's coping fits the pattern Carver described as protective. She talks openly about the cancer with her sister and her coworkers. She jokes about her wigs, naming each after a television detective. She has framed treatment as a job with a schedule, keeping a calendar of appointments on the refrigerator next to Paul's medication chart. When she learned the cancer had reached a lymph node, she cried for a day and then asked her oncologist what it meant for her plan.

Ana's humor and acceptance are not a way of avoiding the cancer; they are how she faces it every day.

Paul's coping is different, and the contrast is instructive. He does not talk about her cancer, changes the subject when she raises it and spends more time on the boat. In Carver's terms, he relies on behavioral disengagement and avoidance. His distress, which he expresses as irritability and smoking more at sea, fits what that coping predicts. A spouse's coping matters for the patient as well; Ana says his silence is harder than the chemotherapy.

Where Ana Struggles

Ana's coping is good, but she is not untroubled. Since chemotherapy ended she has had trouble sleeping and describes a low mood most afternoons. On a depression screening at her oncology clinic she scored in the mild-to-moderate range. She worries about recurrence, especially at night, and about what would happen to her daughter if both parents became seriously ill. Fatigue from radiation has kept her from work for three weeks, and she feels guilty about it.

These problems are common after active treatment ends, when appointments thin out and patients face the fear of recurrence without the structure treatment provided. They are the kind of problems psychological interventions target.

The household adds pressure of its own. With Paul at sea for two weeks at a time, Ana handles her radiation schedule, their daughter's college applications and the boat's insurance paperwork alone. Her sister drives her to appointments, but the evenings are long. Social support research generally finds that emotional support from a partner matters most to women with breast cancer, and that is the support she currently lacks. Any plan for Ana that ignores Paul will miss part of the problem.

Cognitive-Behavioral Stress Management

Antoni et al. (2001) tested a ten-week group cognitive-behavioral stress management program for women recently treated for early-stage breast cancer. Weekly sessions combined relaxation training with cognitive restructuring, coping skills, assertiveness training and anger management. Compared with women who attended a one-day seminar, women in the program showed a reduced prevalence of moderate depression and increased benefit finding and optimism. The effects were strongest among women who began the study with low optimism.

The program fits Ana's needs. Its relaxation component targets her sleep, its cognitive work targets her night-time worry about recurrence and her guilt about missing work, and its group format adds contact with other women at the same stage. Because the benefits were largest for women low in optimism, it might help her less than some others, but her current mood suggests she would benefit. A couples component, or a referral for Paul, could address the silence she finds hardest.

Can Psychological Treatment Extend Survival?

Andersen et al. (2008) randomized 227 women with stage II or III breast cancer to a psychological intervention, including stress reduction, mood improvement, health behavior change and adherence support, or to assessment only. After a median follow-up of about eleven years, the intervention group had a lower risk of recurrence and a lower risk of death from breast cancer.

The finding is important but should not be overstated. Earlier claims that group therapy extended survival have not been consistently replicated, and the mechanisms are not settled. The intervention may have worked partly by improving adherence to medical treatment and health behaviors, rather than through a direct effect of mood on tumors. For Ana, the most defensible claim is that psychological support can reduce distress and help her stay with five years of endocrine therapy, which many women stop early because of side effects. Telling a patient that her attitude will determine whether her cancer returns would be both unsupported and cruel if it did.

Conclusion

Ana's acceptance, humor and openness are the coping strategies that Carver and colleagues found protect against distress, and her husband's avoidance is the kind they found does the opposite. Her remaining struggles, poor sleep, low mood and fear of recurrence, are the problems cognitive-behavioral stress management was designed to address. Evidence that psychological care might extend survival is intriguing but limited, and the strongest case for helping her rests on her quality of life and her ability to complete her treatment.

References

Andersen, B. L., Yang, H.-C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thornton, L. M., Young, D. C., & Carson, W. E., III. (2008). Psychologic intervention improves survival for breast cancer patients: A randomized clinical trial. Cancer, 113(12), 3450-3458. https://doi.org/10.1002/cncr.23969

Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., Yount, S. E., McGregor, B. A., Arena, P. L., Harris, S. D., Price, A. A., & Carver, C. S. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20-32. https://doi.org/10.1037/0278-6133.20.1.20

Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, F. L., Jr., & Clark, K. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2), 375-390. https://doi.org/10.1037/0022-3514.65.2.375