PURPOSE: The aim of this study was to investigate the psychological impact of
diagnosis and surgery in the treatment of eariy stage breast cancer. It was predicted
that diagnosis of breast cancer would be associated with an acute stress reaction.
Better psychological adjustment one month after surgery was predicted for women who
had undergone breast-conserving surgery in comparison to patients who had received
a mastectomy. Suppression of negative emotion in response to breast cancer diagnosis
was predicted to be related to poorer short-term psychological adjustment.
Method: Twenty-nine women completed baseline psychological measures one week
after receiving a breast cancer diagnosis. Follow-up measures completed one month
after surgery were obtained in twenty five cases. Evidence of acute stress response
was measured using scores for intrusive distress and avoidance on the revised Impact
of Events Scale (IES, Horowitz, 1979). Psychological adjustment was assessed based
on several key factors described in the literature concerning the psychosocial outcome
of breast cancer: levels of psychological distress (anxiety and depression), measured
using the Hospital Anxiety and Depression Scale (HAD, Zigmond & Snaith, 1983);
coping responses obtained on the Mental Adjustment to Cancer Scale (MAC, Watson,
Greer, Young et al, 1988b), and body image satisfaction, assessed using the recently
developed Body Image Scale (BIS, Hopwood, Fletcher, Lee & Al Ghazal, 2001).
Suppression of negative emotion was indicated by scores for control of negative
emotion on an adapted version of the Basic Emotion Scale (Power, 2001).
DATA ANALYSIS: Patient scores on psychological measures obtained one week after
diagnosis and at follow up one month post-surgery were compared using a within and
between subjects repeated measures ANOVA. Patient age at diagnosis, and whether or
not they were referred through screening, were then re-entered as covariates within the
repeated measures design in post-hoc analyses. Backward multiple linear regression
was carried out to examine emotional suppression as a predictor of adjustment
assessed using the psychological measures completed at follow up post surgery.
RESULTS: Evidence of acute stress response, indicated by clinical 'caseness' for
intrusion and avoidance on the IES, was found in 28% of the sample assessed soon
after diagnosis, with a proportion of patients (almost 20%) continuing to report high
levels of intrusive distress and avoidance at follow up one month after surgery. As
predicted, IES scores for intrusion and avoidance were significantly lower between
assessment soon after diagnosis and at follow up after surgery (F 1,23 = 13.37,
p<0.05). Consistent with previous reports in the literature, no effect was found for type
of surgery on any of the measures used. Women who were younger at the time of
diagnosis were, however, likely to be more anxious (F 1,23 = 4.48 p<0.05) and to
experience greater levels of intrusive distress ( F 1,23 = 4.86, p<0.05). Suppression of
negative in response to diagnosis predicted higher levels of intrusive distress and
avoidance at one month (F2,22 =6.24, POD.05, R2 =.36), and greater levels of
dissatisfaction with body image (F 1,22 = 7.74, p<0.05, R2 = 32). Results are discussed
in relation to the previous literature, and in terms of implications for aspects of
psychosocial care for breast cancer patients.