Comparing the meanings of living with advanced breast cancer between women resilient to distress and women with persistent distress: a qualitative study

Abstract

Background: Most women with advanced breast cancer (ABC) show little distress, but about one in ten show persistent distress over time. It remains unclear if meanings ascribed by patients to ABC differentiate these distress trajectories.Study aims: This qualitative study (a) compared illness meanings of ABC between women with persistent psychological distress and those with low/transient distress, and (b) examined how illness meanings might influence coping strategies.Methods: The sample was drawn from a prior quantitative study exploring psychological distress trajectories following ABC diagnosis. Overall, 42 Cantonese-or Mandarin-speaking Chinese women diagnosed with locally advanced or metastatic ABC were recruited based on their distress trajectory status (low-stable, transient, or persistent distress). Interviews were recorded, transcribed, and analyzed following grounded theory approach using simultaneous analysis.Results: Women with persistent distress viewed their diagnosis as another blow in life, the illness was global, permeating every aspect of their life. Maladaptive rumination and thought suppression were common responses to illness demands. These women had poor social support. A sense of demoralization stood out in their narratives. In contrast, women with transient/low-stable distress encapsulated the illness, with minimum impacts of their life. They did not evidence dysfunctional repetitive thoughts. Living in a supportive environment, they were able to accept and/or live in the present-moment.Conclusions: Rumination, thought suppression, social constraints, and pre-existing exposure to life stress may be potential risks for chronic distress in response to advanced breast cancer. Persistent and transient distress responses to cancer may have different underpinnings.

Developing a preventive psycho‐oncology for a global context. The International Psycho‐Oncology Society 2018 Sutherland Award Lecture

“…Disease diagnosis and stage are poor predictors of distress, 22,24,26,27 and acute distress episodes do not strongly predict prolonged distress difficulties. 22,24,26,27 Screening must therefore go beyond simple distress presence.…”

“…Disease diagnosis and stage are poor predictors of distress, 22,24,26,27 and acute distress episodes do not strongly predict prolonged distress difficulties. 22,24,26,27 Screening must therefore go beyond simple distress presence. Screening for common residual symptoms or late effects, an assessment of early adversity, 28 previous coping patterns, 34 and present social networks, particularly quality of primary relationships, 27 is needed as a minimum.…”

“…Identifying and intervening for patients at highest risk of prolonged and deteriorating distress should be a priority for psycho‐oncology. Disease diagnosis and stage are poor predictors of distress, and acute distress episodes do not strongly predict prolonged distress difficulties . Screening must therefore go beyond simple distress presence.…”

“…22,24,26,27 Screening must therefore go beyond simple distress presence. Screening for common residual symptoms or late effects, an assessment of early adversity, 28 previous coping patterns, 34 and present social networks, particularly quality of primary relationships, 27 is needed as a minimum. To do this, we urgently need to identify reliable methods to differentiate markers of self-limiting distress that can be managed by the patient and family with the knowledge that there is help available if needed.…”

“…Living in a supportive environment, they were able to accept and/or live in the present-moment." 27 Recent work indicates that events substantially predating cancer, for example, childhood adversity, can predispose to subsequent distress and symptoms seen in cancer, such as fatigue. 28 So here we have two indications that vulnerabilities to cancer-related distress predate cancer detection.…”