Although the main goals of the BOUNCE project are (a) to explore resilience in breast cancer patients and, (b) to develop a sophisticated prediction tool of resilience and key outcomes (e.g., psychological health and quality of life) that will facilitate health professionals’ and patients’ decision making, there is another parallel goal. Namely, the examination of the role of several important psychological factors with respect to adaptation to breast cancer. The rare occasion of a large longitudinal multi-center study provides the opportunity to study in-depth the relation of factors, including trait resilience, optimism, sense of coherence, family resilience, mindfulness, illness representations, coping behaviors, spirituality, positive and negative emotions, fear of recurrence, etc., to patients’ physical and psychological health and quality of life.
One of the factors that the BOUNCE research team has focused on so far is self-efficacy to cope with cancer or coping self-efficacy. Self-efficacy to cope with cancer refers to patients’ ability to perform those behaviors that may help them deal with the challenges caused by the disease, like diagnosis and treatment (Chirico et al., 2017). There is evidence that coping self-efficacy is related to several indicators of adaptation to breast cancer (e.g., pain management, distress, quality of life). Typically, higher levels of coping self-efficacy are linked to better adaptation to illness and enhanced well-being. Hence, its promotion is a frequent goal of psychological interventions for cancer patients (Merluzzi et al., 2019).
So far, the research team has prepared (or are preparing) three scientific publications that focus on coping self-efficacy. The first one examines the factors that mediate the impact of coping self-efficacy on patients’ psychological health and quality of life. The second one examines the potential interaction between coping self-efficacy and trait resilience. The third publication refers to the interplay between coping self-efficacy and coping with cancer behaviors.
Specifically, the first study (recently published in Psycho-Oncology; Karademas et al., 2021) showed that coping self-efficacy predicted psychological symptoms (i.e., anxiety and depression) and overall quality of life over a period of six months, through multiple cognitive, emotional, and behavioral pathways. Coping self-efficacy predicted positive and negative affect, perceptions about the effectiveness of the medical treatment to treat or control breast cancer, and coping behavior (that is, reacting with great anxiety), which in turn predicted psychological symptoms. Positive affect, perceptions of treatment effectiveness, sense of hopelessness, and the effort to directly confront/cope with illness mediated the impact of coping self-efficacy on the overall quality of life. It should be noted that all statistical analyses were performed after controlling for several medical and sociodemographic variables.
The findings of this study demonstrated that coping self-efficacy lies in the heart of the patient’s efforts to deal with breast cancer. Coping self-efficacy seems to impact patients’ ways of thinking about breast cancer, their emotional state, and their behavioral reactions towards the disease, which in turn impact well-being. The fact that these variables are also linked to several health-related outcomes showcases the central role of coping self-efficacy in achieving a better adaptation to illness and better well-being. Thus, the enhancement of coping self-efficacy should be a central intervention goal for patients with breast cancer.
A second publication, which is currently under revision, refers to the potential interaction between self-efficacy to cope with cancer and trait resilience as far as their impact on a patient’s psychological symptoms and quality of life is concerned. Trait resilience refers to a patient’s general ability to adapt to a difficult situation and maintain good function despite the difficulty (Johnston et al., 2015).
The findings from this study showed that high trait resilience leads to higher levels of coping self-efficacy, which in turn results in better psychological health and quality of life. Moreover, it was found that the combination of higher levels of trait resilience and higher levels of coping self-efficacy predicts better psychological health and quality of life. Surprisingly, none of the examined relationships was affected by the participant’s country of origin (BOUNCE is conducted in four different countries). At the beginning of patients’ experience with illness, it is likely for their reactions to being mostly shaped by personal resources than contextual factors. Contextual factors (e.g., the health care system) may be more important later, as the condition becomes chronic.
The third publication focusing on coping self-efficacy is under preparation. It will be about the mutual determination of coping self-efficacy and cancer-related coping behaviors (e.g., avoidance, helplessness, fighting spirit), over a period of several months. The statistical analyses showed that probably there is no constant pattern regarding the relationships between coping self-efficacy and coping behaviors, as this may depend on the particular behavior and other factors. According to the results, in half of the cases, the initial levels of coping self-efficacy predicted future coping behaviors, which in turn had an impact on subsequent levels of coping self-efficacy. In other cases, however, it was rather the coping behavior that guided coping self-efficacy, at least during the initial phases of illness. Thus, new theoretical models are needed in order to more accurately describe the many aspects of the link between these two major factors. Also, the findings suggest that addressing only coping self-efficacy in psychological interventions for breast cancer patients may not be sufficient in order to modify all dysfunctional coping behaviors. Addressing both coping self-efficacy and coping behaviors may facilitate adaptation to breast cancer more successfully.
Of course, each of these studies has its limitations (e.g., all variables were self-reported). Still, each one shed light on a particular aspect of coping self-efficacy and helped us gain a better understanding of the adaptation to the breast cancer process. Considering that the members of the BOUNCE research group are currently conducting more analyses and are preparing several publications focusing on different key factors (such as family resilience, fear or recurrence, mindfulness, the impact of the SARS-CoV-2 pandemic, illness representations, etc.), we are hopeful that, besides the main goals of the project, we will be able to offer the scientific community, stakeholders, and the patients new valuable knowledge that will bear significant implications for theory and practice.
- Chirico, A., Lucidi, F., Merluzzi, T., Alivernini, F., De Laurentiis, M., Botti, G., & Giordano, A., (2017). A meta-analytic review of the relationship of cancer coping self-efficacy with distress and quality of life. Oncotarget, 8, 36800-36811.
- Johnston, M.C., Porteous, T., Crilly, M.A., Burton, C.D., Elliott, A., Iversen, L., McArdle, K., … & Black, C. (2015). Physical disease and resilient outcomes: A systematic review of resilience definitions and study methods. Psychosomatics, 56,168–180.
- Karademas, E.C., Simos, P., Pat-Horenczyk, R., Roziner, I., Mazzocco, K., Sousa, B., … & Poikonen-Saksela, P., on behalf of BOUNCE consortium (2021, in press). Cognitive, emotional, and behavioral mediators of the impact of coping self-efficacy on adaptation to breast cancer: An international prospective study. Psycho-Oncology. DOI: 1002/pon.5730.
By Evangelos Karademas, PhD, University of Crete and Institute of Computer Science, Foundation for Research and Technology – Hellas (FORTH)