Living Well With Advanced Breast Cancer: A Predictive Model

Institution: University of California, Los Angeles
Investigator(s): Annette  Stanton , Ph.D. -
Award Cycle: 2004 (Cycle 10) Grant #: 10IB-0079 Award: $99,982
Award Type: IDEA
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2004)
Most women diagnosed with breast cancer can expect to enjoy a long life, but only 23% of women diagnosed with Stage IV disease (cancer spread to the bone, brain, soft tissues) are expected to live for at least 5 years. Women with advanced disease face not only the likelihood of an uncertain future, but also the prospect of undergoing nearly continuous medical treatments and cancer-related problems in emotional and physical domains. The body of research on quality of life and health in women with advanced disease is very small. In particular, no good measures are available to detail the specific concerns of women with advanced breast cancer, and no models have been tested to identify psychosocial factors that help and hinder women as they live with advanced disease across time. The proposed research in women with Stage IV breast cancer is designed to address these limitations.

What are the central concerns of women living with Stage IV breast cancer? We will develop a measure of these concerns. What factors aid and hinder women as they live with advanced disease? We hypothesize that psychological factors reflecting active engagement in pursuing cherished life goals will contribute to positive outcomes over a three-month period. These factors include hope (goal-directed determination and perceived pathways toward goals), approach-oriented coping (e.g., seeking social support, problem solving, finding benefit), and involvement in goal-related activities. Outcomes include mood, quality of life, and a biological marker, cortisol, which is important in regulating stress responses and may be significant to the health of women with advanced disease.

We will recruit 140 women with Stage IV breast cancer to participate in a study of living with advanced disease. We will conduct two assessment points over a three-month period, using established questionnaires, an interview with each woman, and cortisol assessment through saliva collection.

Women with advanced breast cancer have been relatively neglected in research to understand central concerns surrounding the experience of cancer and the factors that aid and hinder women as they live with the disease. Although a few sound evaluations of psychological interventions for women with metastatic breast cancer exist, ours will be among the first longitudinal research (i.e., conducted over time) to investigate central concerns of and contributors to quality of life in women with advanced disease. This research will pave the way for a deeper understanding of the lives of women with advanced disease, as well as development of interventions to bolster well-being and health in women with Stage IV breast cancer.


Final Report (2008)
Most women diagnosed with breast cancer can expect to enjoy a long life, but the prognosis for women diagnosed with Stage IV disease (cancer spread to the bone, brain, soft tissues) is much poorer. Women with advanced disease face not only the likelihood of an uncertain future, but also the prospect of undergoing nearly continuous medical treatments and cancer-related problems in emotional and physical domains. Very few studies have detailed the specific concerns of women with advanced breast cancer or have tested theoretical models to identify psychosocial factors that help and hinder women as they live with advanced disease across time. The two primary aims of this research, which were addressed successfully, were to identify the central concerns of women living with metastatic breast cancer and to specify factors that aid and hinder women as they live with advanced disease. With regard to barriers to the research itself, study accrual was lower than anticipated, primarily owing to relocation of referring oncologists and women reporting that they were too ill or too busy to participate. This necessitated extension of the accrual period.

Three major findings of the research, in which 105 women with metastatic disease were followed over three months, are: (1) central concerns of women with metastatic disease involve restriction of activities, social withdrawal by others, concerns regarding the medical team, and concerns about mortality; (2) as hypothesized, high goal-directed determination and perceived pathways to reach goals, as well as low concern about social withdrawal by others, were the most consistent psychological predictors of favorable adjustment (e.g., high life satisfaction, high quality of life related to mental health) at three months; (3) contrary to hypothesis, engagement in fewer behaviors to pursue important goals was associated with improved adjustment and a steeper diurnal cortisol slope over time, perhaps suggesting that women who do not attempt to maintain goal-directed activity at their pre-illness levels have more favorable adjustment than those who forcefully engage in goal-directed behaviors in the context of the many demands of metastatic disease.

Plans for future research include continued refinement of the measure of central concerns for women with metastatic disease and of the predictive model for risk and protective factors for living well with metastatic disease. Development of an intervention targeting these central concerns and promoting the identified protective factors is also a future step.

Activity Disruption and Depressive Symptoms in Women Living With Metastatic Breast Cancer.
Periodical:Health Psychology
Index Medicus: Health Psychol
Authors: Low, Carissa A.; Stanton, Annette L.
Yr: 2014 Vol: DOI Nbr: Abs: Pg: