Objective
Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient‐caregiver relationships can mitigate this distress during treatment, but this association is unclear pre‐treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity.
Methods
We recruited 55 breast cancer patient‐caregiver dyads to complete a self‐report survey after diagnosis but before treatment. We used a series of Actor‐Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity.
Results
Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient‐reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain.
Conclusions
This study demonstrates that pre‐treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.
PurposeThe study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status.MethodsData was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural–urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression.FindingsResults demonstrated that patients in small rural/isolated areas with low (B = −4.10, SE = 1.93, OR = 0.02, p = 0.03) to average (B = −2.67, SE = 1.32, OR = 0.07, p = 0.04) food insecurity and average (B = −2.67, SE = 1.32, OR = 0.07, p = 0.04) to high (B = −10.62, SE = 4.71, OR = 0.00, p = 0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B = 4.47, SE = 0.49, d = 0.42, p < 0.001) diabetes and low mortality (B = 5.70, SE = 0.58, d = 0.45, p < 0.001) rates have significantly more severe postmastectomy complications.ConclusionThese findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.
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