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"Cancer Much Before I Expected’’: The Influence of Life Script Expectations on Post Traumatic Stress Symptoms and Religious Coping in Breast Cancer Patients
Mimi Mehlsen, Bashir AlHajjar, Annette Bohn, Heidi Frolund, Maja O’Connor, Robert Zacharia
In: Abstracts of the 13th World Congress of Psycho-Oncology: Integrating the Psycho-social Domain into Routine Cancer Care: Bridging Continents and Cultures for Global Cancer Support; 16 Oct 2011-20 Oct 2011; Kremlin Palace, Antalya, Turkey. Psycho-Oncology, 20, 2011 (Suppl. 2) ; 2011. p. 45-46.
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Abstract
BACKGROUND: Life scripts refer to culturally normative expectations to the sequence and timing of events in a life course. Cancer risk increases with age and cancer is often considered a disease of old age. We examine whether: 1) cancer is expected to occur in a certain period of life, 2) expected time when developing cancer depends on own age at cancer diagnosis, and 3) discrepancy between age at diagnosis and expected cancer-time is associated with distress. METHOD: Participants were 489 women (Age: 18–68 yrs; response rate: 76%) attending treatment or control visits for breast cancer during a 3-month period at the two main departments responsible for treating cancer patients in the Gaza Strip. Assessments included: Demographic, disease- and treatment-related factors including age at diagnosis, post-traumatic stress symptoms (IES-R subscales: avoidance, intrusion, hyperarousal), religious coping (Brief-Cope subscales: positive and negative). Expected cancer-time was measured by the question: How old would an ordinary woman be when she gets cancer? RESULTS: Cancer was most frequently expected between 40–60 yrs (69%). Average cancer-time was 54.7 yrs (SD58.7), and did not differ between younger, middle-aged or older women (F(2,383)51.155, p50.316). Expected cancer-time did not correlate with age at diagnosis (r5_0.011, p50.805). At diagnosis, 73% weremore than 5 years younger than expected cancer time, 18 % were within 5 years of expected cancer time, and only 9% were more than 5 years older than expected cancer-time. Women who were younger at diagnosis than expected cancer-time showed more avoidance and hyperarousal and used more negative and less positive religious coping when adjusting for age (F:3.934–13.0,po0.05). CONCLUSIONS: In this sample of Palestinian women with breast cancer, cancer was mainly expected to occur in midlife, and no one suggested cancer to occur after 70 in an ordinarywoman’s life. The perception of what is the ‘‘normal’’ cancer-time were neither dependent on present age nor the time of own cancer diagnosis. Age at diagnosis differed for most women from their expectations to an ordinary woman’s life. When they had breast cancer, the majority were younger than their expectation to ‘‘normal’’ cancer-age. These women showed higher levels of post traumatic stress symptoms and used religious coping in a non-adaptive way. RESEARCHIMPLICATIONS: This study is the first to show an effect of life script expectations on psychological adaptation in cancer patients. It suggests that age is important when investigating the psychology of cancer. Cancer is usually assumed to be considered a disease of old age, but the Palestinian women considered it a disease of (late) midlife. Since life scripts are culturally specific, it should be tested if this finding can be replicated in other populations. CLINICAL IMPLICATIONS: Discrepancies between expectations and experiences generally lead to dissatisfaction. When a person experiences cancer much earlier than she or he expects of an ordinary life, it may cause feelings of injustice or being abandoned or punished by God (negativereligious coping). The experienced discrepancy between ‘‘myself’’ and ‘‘normal life’’ can be associated with fear (hyperarousal) and make it more difficult to integrate the event in daily life (avoidance).