This longitudinal study examined the role of coping strategies and posttraumatic growth (PTG) on the psychological adjustment to breast cancer trajectory. The participants were 50 women assessed at the time of surgery (T1), during adjuvant treatment (T2) and six months after the end of treatment (T3). Women completed questionnaires assessing coping strategies, PTG and psychological adjustment (psychological quality of life, anxiety and depression). Results showed that the greatest impact of breast cancer on women's adjustment occurred at T1, when patients were significantly more anxious than in the other phases of the disease. The type of surgery and adjuvant treatment did not account for the course of PTG and adjustment. Coping through seeking social support and using cognitive strategies at T1 were linked to psychological quality of life and depression at T3 via PTG dimension of personal resources and skills at T2. Findings emphasise the value of promoting adaptive coping strategies and PTG in order to improve psychological adjustment in breast cancer patients.

Keywords:Body image scale Instrument Body image Cancer Portuguese version EORTC Breast cancer a b s t r a c t Purpose: The aim of this study was to analyse the psychometric properties of the Portuguese version of the body image scale (BIS; Hopwood, P., Fletcher, I., Lee, A., Al Ghazal, S., 2001. A body image scale for use with cancer patients. European Journal of Cancer, 37,[189][190][191][192][193][194][195][196][197]. This is a brief and psychometric robust measure of body image for use with cancer patients, independently of age, cancer type, treatment or stage of the disease and it was developed in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group. Method: The sample is comprised of 173 Portuguese postoperative breast cancer patients that completed a battery of measures that included the BIS and other scales of body image and quality of life, in order to explore its construct validity. Results: The Portuguese version of BIS confirmed the original unidimensional structure and demonstrated adequate internal consistency, both in the global sample (a ¼ .93) as in surgical subgroups (mastectomy ¼ .92 and breast-conserving surgery ¼ .93). Evidence for the construct validity was provided through moderate to largely sized correlations between the BIS and other related measures. In further support of its discriminant validity, significant differences in BIS scores were found between women who underwent mastectomy and those who underwent breast-conserving surgery, with the former presenting higher scores. Age and time since diagnosis were not associated with BIS scores. Conclusions: The Portuguese BIS proved to be a reliable and valid measure of body image concerns in a sample of breast cancer patients, allowing a brief and comprehensive assessment, both on clinical and research settings.

Results provide support for the stress-buffering role of PTG. Finding positive changes in cancer experience seems to protect women from the effects of a negative perception of the impact of BC on adjustment. Psychosocial intervention programs should facilitate PTG in order to promote women's adjustment.

This study provided significant information about the role of appearance investment in the adjustment of breast cancer patients and added empirical support to SES-MS distinction.

In this cross-sectional study we analyzed the links between marital quality and intimacy, body image, and psychological quality of life (PQoL) of breast cancer patients, as well as the moderating role of cancer phase (treatment, survivorship) on the aforementioned links. We also evaluated whether body image mediated the associations between marital relationship variables and PQoL. An analysis of the data from 128 patients (66 undergoing treatment, 62 survivors) indicated that the majority of links between variables were significant only during the treatment phase. Mediating effect of body image on the associations between relationship variables and PQoL was found only at the treatment phase.