Post-treatment adjustment and behavior change among women with breast cancer

Anecdotal and qualitative evidence suggests that women may experience disrupted adjustment during the months following the end of adjuvant breast cancer treatment, in part due to the loss of a "safety net" associated with regular treatment coupled with uncertainty regarding cancer status. The present study examined distress and quality of life, as well as behavioral and cognitive predictors of adjustment, during the three months following adjuvant treatment for breast cancer. Participants were 89 women with breast cancer who completed measures of distress, quality of life, health behavior, behavior changes, and common-sense beliefs about cancer at three time points: toward the end of adjuvant treatment, 3 weeks following the end of treatment, and 3 months post-treatment. Findings indicated that breast cancer survivors were remarkably well-adjusted following treatment: participants reported low levels of anxiety and depression and good health-related quality of life. Nonetheless, women acknowledged significant concerns about ongoing physical symptoms, potential recurrence, and the process of returning to or building a "new normal." Results further suggested that behavior changes were quite common after the end of treatment, particularly positive changes in health practices. Although good health practices were associated with better adjustment, making positive changes in the same behaviors often predicted greater distress. Women's common-sense beliefs about breast cancer provided insight into whether women decided to make behavior changes and what behaviors they decided to change. Women who perceived greater control over their cancer, saw their cancer as an acute rather than chronic condition, and attributed cancer to controllable causes or believed that behavioral or psychological factors could prevent recurrence were more likely to make behavior changes and engage in positive health practices. Although it was predicted that beliefs and behavior changes would interact to predict distress, no consistent pattern of interactions was found. In sum, breast cancer patients actively attempt to create a "new normal" following treatment, and changes in health practices appear to be an important part of this process. Assessing women's beliefs about their cancer and providing psychoeducational interventions addressing post-treatment behavior changes may assist in promoting breast cancer survivors' psychological and physical well-being.