Effects of Stress and Support on Delay in Cancer Treatment

Institution: Stanford University
Investigator(s): Karyn Angell, Ph.D. -
Award Cycle: 1995 (Cycle I) Grant #: 1FB-0490 Award: $76,087
Award Type: Postdoctoral Fellowship
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (1995)
This project is a direct attempt to identify behavioral and social barriers to the early detection of breast cancer. Women recently diagnosed with primary breast cancer will be interviewed in an effort to understand the roles of both life stress and social support on their initial cancer treatment-seeking decisions. While it is fairly clear why women with more financial resources may take advantage of medical intervention sooner than women who live in poverty, it is less clear how a woman who is juggling a shaky marriage, caring for an ailing parent, or worrying about a teenager on drugs may be influenced by these factors when making decisions about her own medical care. A woman's social network may also influence how she chooses medical care upon discovery of potential cancer symptoms. Sixty women with biopsy-confirmed breast carcinoma without distant metastases (i.e., Stage I-III breast cancer) will be recruited within six months of their diagnoses through their oncology clinics. The women will be interviewed in their homes by trained clinical interviewers about the year preceding their cancer diagnosis. The interview is designed to tap 10 major areas of life experiences. The interview forms the basis for standardized ratings on a social stress rating system which provides an assessment of the degree of stress arising from different life circumstances. The women will also be asked to complete questionnaires assessing the presence and effectiveness of any social support network they identify. The onset of any symptom or health change preceding the breast cancer diagnosis will be carefully documented during the interview, and actual dates of initial treatment will be confirmed through a chart review.

We hypothesize that the time between the onset of first cancer symptoms and the date of first cancer care will be affected by the experience of severe life events and the type of social support available during the year prior to diagnosis. We anticipate a buffering effect of social support on stress such that women who experience severe stress but who also report strong supportive networks will be less affected than women whose severe stress occurs in the absence of social support or in the context of a social network which is critical in nature.

Knowledge about the influences of stress and social support on careseeking behavior will provide important information for interventions aimed at getting women into treatment sooner, possibly leading to better prognoses and potentially lowering breast cancer mortality rates.

Final Report (1999)
The goals of this study were to investigate whether social stress and social support influenced a woman's delay in seeking treatment for symptoms of breast cancer. Thirty-four women recently diagnosed with primary breast cancer were interviewed using a semi-structured clinical interview designed to tap most major areas of life experiences. These interviews were then rated on over 15 dimensions of stress and social support using a standardized stress rating scale. Interview data were supplemented by questionnaires. Dates of contact with medical providers were collected from patients' records. I hypothesized that the time between the onset of first breast cancer symptoms and the date of first oncologic care would be affected by the experience of severe life events and the quality of social support during the year prior to diagnosis.

Results revealed that women who experienced the death of a parent or close family member during the year before diagnosis were over 7 times more likely to delay treatment for breast cancer (OR=7.50, CI=(1.28-44.08)). Women with severe chronic stressors of two or more years duration were 4 times more likely to delay treatment (OR=4.02, CI=(1.22-13.27)). The presence of close friends or relatives in whom a woman could confide did not predict less delay in seeking treatment. However, women whose social network included people who were critical or demanding were two and a half times more likely to delay treatment for their breast cancer (OR=2.45, CI=(1.01-5.93)). These results suggest that even though a woman may know about symptoms of breast cancer and have access to medical care, her decision to seek medical care for herself is strongly influenced by the social and emotional demands of close friends and family members.

This is a small pilot study and these results should be replicated with more diverse groups of women with breast cancer. However, these data point to the importance of a woman's social environment in affecting the way she takes care of herself. At the age when the risk of breast cancer is rising, women are taking care of, and often losing to death or separation, people close to them. If we are to lower the social and economic costs of breast cancer in California, these results suggest we cannot ignore the role of a woman's social network in our treatment and prevention efforts.