Turning the tide: Benefit finding after cancer surgery

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Abstract

Post-traumatic growth and benefit finding after adverse life events are emerging topics in stress and coping research. This study examined personal and social resources of cancer patients and their perception of positive life changes as a consequence of illness. In addition, the mediating role of coping strategies (acceptance and social comparison) was investigated. One month after tumor surgery, 105 cancer patients completed measures of social support and self-efficacy. Coping was assessed half a year after surgery, while benefit finding was examined 12 months post-surgery. Correlational and path analyses showed a link between personal resources (self-efficacy) as well as social resources (received social support) and benefit finding. The effect of self-efficacy disappeared when coping was specified as a mediator between the resources and benefit finding. Social support retained a direct effect on benefit finding. The results emphasize the predictive quality of resources for recovery and adjustment after surgery and the mediating role of coping. Findings are discussed with regard to recent developments in the study of post-traumatic growth.

Introduction

Stressful life events, ranging from illness to natural disaster, have been identified as risk factors for the development of anxiety, depression, or diseases. While these negative consequences are well-studied, comparatively little systematic research has been done on the positive outcomes that may occur in the aftermath of crisis (Updegraff & Taylor, 2000).

At first thought, it might seem contradictory to expect any good to result from severely stressful episodes. For example, an illness such as cancer has a substantial physical and psychological impact on patients as well as on their social environment. Possibly more than any other illness, the diagnosis and treatment of cancer immediately elicits a wide range of negative emotions, especially several fears: fear of pain and suffering, fear of disfigurement by the removal of body parts, fear of costs for care, fear of losing work, family and friends, fear of dependency, and fear of death (e.g., Hobfoll & Walfish, 1984). Even successful surgery, vastly improved pharmacological treatment, and a good prognosis will not necessarily relieve patients and their relatives from thoughts of tumor recurrence at the same or different sites.

However, studies on cancer patients indeed report positive changes in various life domains such as richer and closer social relationships with family and friends, new priorities in life, which may translate into changes in daily activities, as well as a greater overall appreciation for life (Antoni et al., 2001; Collins, Taylor, & Skokan, 1990; Klauer & Filipp, 1997). The quality of life experienced by cancer survivors may even exceed that of healthy persons (Danoff, Kramer, Irwin, & Gottlieb, 1983; Tempelaar et al., 1989). Nevertheless, such optimistic findings should not obscure the fact that the consequences of various stressful life events are rather mixed depending on, for example, the type of event, its impact, and individual differences in coping with adverse circumstances.

Section snippets

Theoretical and empirical groundwork

Various theorists have proposed models that help explain the antecedents and outcomes of adaptation processes after crises. For example, according to cognitive adaptation theory (Taylor, 1983), individuals who have been exposed to stressful circumstances actively seek a new balance. In the coping process, people try to establish a psychological equilibrium by restoring their self-esteem and their sense of meaning and mastery (Updegraff & Taylor, 2000). These positive changes result from a

Research design and procedure

The present study is part of the Berlin Longitudinal Study on Quality of Life after Tumor Surgery. In the surgical wards of four collaborating cancer treatment centers in Berlin, Germany, patients with suspected or confirmed diagnosis of malignant tumors of the gastrointestinal tract were approached by trained interviewers shortly before a scheduled surgery. Structured questionnaires were administered five times. For the first two waves, one to three days before and five to seven days after

Results

Dropout analysis: Of the 255 eligible patients at wave 3, 105 (41%) completed questionnaires also at 6 and 12 months after surgery, respectively. Given this considerable decrease in sample size, we tested whether any systematic differences between the two samples existed. First, demographic variables were analyzed for a possible influence. Patients in both samples did not differ regarding age, gender, marital status, or having children. Second, neither the type of treatment nor the experienced

Discussion

Patients in the present sample reported on the experience of benefit finding in the one-year period after tumor surgery. The structural equation model showed that patient resources were positively related to benefit finding. Social support appeared to be the strongest predictor of positive changes in the aftermath of stressful surgery, both directly and indirectly through social comparisons. While social comparison, in line with Taylor's theory, had a mediating role in the benefit-finding

Acknowledgements

The authors would like to thank Ralf Schwarzer and Aleksandra Luszczynska for their valuable comments on an earlier draft of this paper. Further, the authors are thankful to Eric Jandciu for editing the manuscript. We would also like to thank the other members of the tumor project group Sonja Böhmer, Charis Förster, and Steffen Taubert as well as the physicians of the four participating hospitals.

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