Prospective longitudinal health-related quality of life (QOL) data from 161 women newly diagnosed with breast cancer were compared to age-adjusted mean QOL scores from a general female population (n=949). In addition, multiple factors (demographic, personality trait, participation in treatment decision-making, information satisfaction, and medical data), which previous research has indicated affect the QOL of breast cancer patients, were simultaneously investigated in a multivariate model, in order to determine which of these variables have the strongest influence on QOL one year after surgery. QOL was evaluated with the EORTC QLQ-C30 at time of diagnosis, three- and 12-months postoperatively. Women with breast cancer scored significantly lower on emotional, cognitive, and social functioning (p < 0.01) at time of diagnosis compared to the general female population, and continued to score lower on cognitive (p=0.008) and social (p=0.009) functioning one-year after surgery. In addition to the initial QOL, breast conservation surgery was predictive of better physical functioning (p=0.01) and body image (p < 0.0001), while chemotherapy was predictive for poorer role functioning (p=0.01) one year after surgery. Dispositional optimism was predictive for better emotional (p=0.003) and social functioning (p=0.01) one year after surgery. At time of diagnosis and throughout the post-diagnosis period, dispositional optimism was associated with better QOL and fewer symptoms.

The prevalence of and predictive factors for emotional morbidity (measured by the Hospital Anxiety and Depression Scale (HAD)) one year following surgery, with special focus on dispositional optimism/pessimism (measured by the Life Orientation Test (LOT-R), was examined in 165 women, newly diagnosed with breast cancer. Patients characteristics, appraisal of cancer diagnosis, beliefs about treatment efficacy, treatment decision-making participation, coping and emotional morbidity was assessed by self-rating questionnaires. Prevalence of anxiety and depression cases at time of diagnosis was 34 and 12%, respectively, and 26 and 9% after one year. Prevalence of emotional morbidity was significantly enlarged among pessimists at all assessments. Pessimism was the strongest predictor for anxiety (OR: 0.86 C.I. 95% 0.77 - 0.95) and depression (OR: 0.83, C.I. 95% 0.73 - 0.95) one year following breast cancer surgery. Optimists and pessimists differed not only in regard to coping styles, but also in regards to predictors of emotional morbidity. Optimists experiencing anxiety at time of breast cancer diagnosis had about six times higher risk of experiencing anxiety after one year, compared to optimists without preoperative anxiety. For pessimists, the more pessimistic one was about one's overall future the higher risk for developing anxiety following one year of breast cancer surgery. Pessimists, who endorse helpless/hopeless coping style when receiving a diagnosis of breast cancer, had three times greater risk for experiencing depression one year after breast cancer surgery, than pessimists who did not. Health care professionals should therefore provide intervention for pessimists, as well as for patients with high anxiety scores at time of diagnosis.

Longitudinal data from 165 women diagnosed and treated for breast cancer were used to investigate if the relationship between optimism-pessimism and quality of life (QOL) is attributed to the appraisal and coping strategies. The women completed the Life Orientation Test-Revised (LOT-R), as a measurement of optimism-pessimism, the Mental Adjustment to Cancer (MAC) Scale, as a measure for coping, a VAS for appraisal and the EORTC QLQ-C30, as a measure for QOL at two time points: at diagnosis and 12-months after breast cancer surgery. Optimism-pessimism had both a direct and indirect influence on QOL. Two coping strategies were particularly strong mediators for the indirect influence: fighting spirit and hopeless/helpless. Optimists responded with fighting spirit, which had a positive effect on their QOL. On the other hand, pessimists responded with hopeless/helplessness, which had a negative effect on their QOL. The relationship between pessimism and QOL at time of diagnosis was also mediated by appraisal, such as threat. The two coping strategies remained fairly stable over the 12 months within the optimists and pessimists.The results suggest that the influence of optimism and pessimism on QOL appears to be mediated by coping both before and after treatment for breast cancer. Fighting spirit and hopeless/helplessness appear to reflect the characteristic coping strategies for optimists and pessimists.

In this study, we investigated the stability of optimism-pessimism in relation to receiving bad news (i.e., positive lymph nodes, more advanced cancer stage) after breast cancer surgery and in comparison to the stability of anxiety and depression level. The women (n = 165) completed the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) at time of diagnosis, 3 months, and 12 months after surgery. Overall, women's optimism-pessimism levels remained stable over the follow-up period whether they received bad news or not. In contrast, women's anxiety and depression level decreased significantly over the same time period with 1 exception. Women's level of depression remained fairly stable among those who received bad news. Optimism-pessimism appears to remain stable over situations as well as time and regardless of negative affects.

Women who participated in the hospital psychosocial support groups following breast cancer surgery were compared with non-participants. The Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire were used to measure emotional distress and quality of life at the time of diagnosis and after 12 months. The General Life Orientation Test-Revised was used to measure dispositional optimism. Of 165 women, 87% reported that they had been invited to participate, and 66% participated. The salient predictor for participating in support group was optimism (OR 0.89 CI: 95% 0.83-0.98, p=0.01). No significant difference was found between the prevalence of anxiety and depression caseness at the time of diagnosis, but after 12 months, the prevalence of anxiety caseness was significantly lower among the participants than that among the non-participants (19% vs 34%, p=0.04). In conclusion, psychosocial intervention as a component of routine breast cancer care appears to have a long-term clinical beneficial effect on anxiety. For depression and quality of life, the study is inconclusive. Self-selection may prevent patients at risk of adverse outcome to participate in support groups.

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