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Worry and rumination in breast cancer patients: perseveration worsens self-rated health

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Abstract

A number of studies have shown that self-rated health reliably predicts mortality. This study assessed the impact of perseveration on self-rated health, physical functioning, and physical symptoms (pain, fatigue, breast cancer symptoms) among breast cancer patients. We hypothesized that cancer-related distress would serve as an intervening variable between both worry and rumination and self-rated health, physical functioning, and physical symptoms. Women (N = 124) who were approximately 7 weeks post-surgery but pre adjuvant treatment completed the Impact of Events Scale, the Penn State Worry Questionnaire, and the Rumination Scale. They also rated their pain, fatigue, physical functioning, and self-rated health using the RAND-36 and breast cancer symptoms with the Breast Cancer Prevention Trial Symptom Checklist (BCPT). Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. Worry was associated with higher cancer-related distress, which in turn predicted greater pain and breast cancer symptoms, poorer physical functioning, and lower self-rated health. Rumination also predicted greater cancer-related distress, which ultimately contributed to greater pain along with poorer physical functioning and self-rated health. Models with fatigue as an outcome were not significant. These findings suggest that perseveration can heighten cancer-related distress and subsequent perceptions of physical symptoms and health among breast cancer patients prior to adjuvant treatment. Perseveration early in the cancer trajectory can adversely increase the impact of a cancer diagnosis and treatment on functioning and quality of life.

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Funding

This study was funded by NIH grant number R01CA186720 which was awarded to Dr. Kiecolt-Glaser. Dr. Renna is also supported by T32CA229114-01.

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Authors and Affiliations

  1. Comprehensive Cancer Center, The Ohio State University College of Medicine, 460 Medical Center Drive, Columbus, OH, 43210, USA

    Megan E. Renna, Maryam Lustberg, Stephen P. Povoski, Doreen M. Agnese, Raquel E. Reinbolt, Robert Wesolowski, Nicole O. Williams, Bhuvaneswari Ramaswamy, Sagar D. Sardesai, Anne M. Noonan & Jeffrey B. VanDeusen

  2. Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, 460 Medical Center Drive, Columbus, OH, 43210, USA

    Megan E. Renna, M. Rosie Shrout, Annelise A. Madison, William B. Malarkey & Janice K. Kiecolt-Glaser

  3. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Annelise A. Madison

  4. Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA

    Stephen P. Povoski & Doreen M. Agnese

  5. Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    William B. Malarkey

  6. Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA

    Janice K. Kiecolt-Glaser

Authors
  1. Megan E. Renna
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  2. M. Rosie Shrout
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  3. Annelise A. Madison
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  4. Maryam Lustberg
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  7. Raquel E. Reinbolt
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  8. Robert Wesolowski
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  9. Nicole O. Williams
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  10. Bhuvaneswari Ramaswamy
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  11. Sagar D. Sardesai
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  12. Anne M. Noonan
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  14. William B. Malarkey
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  15. Janice K. Kiecolt-Glaser
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Correspondence to Megan E. Renna.

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Human and animal rights and informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Renna, M.E., Rosie Shrout, M., Madison, A.A. et al. Worry and rumination in breast cancer patients: perseveration worsens self-rated health. J Behav Med 44, 253–259 (2021). https://doi.org/10.1007/s10865-020-00192-9

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  • DOI: https://doi.org/10.1007/s10865-020-00192-9

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