Comparison of four common stressors across the breast cancer trajectory.

OBJECTIVE: Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory.

METHODS: Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer.

RESULTS: Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends.

CONCLUSION: Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.