Behavioural Research and Evaluation Unit (BREU), Cancer Council SA

Fear of cancer recurrence and psychological well-being in women with breast cancer: the role of causal cancer attributions and optimism

Causal attributions or beliefs that people hold with regards to the cause of their own illness are associated with affective responses to cancer and subsequent choice of coping mechanisms. This study investigated the association between causal cancer attributions, fear of cancer recurrence (FCR) and psychological wellbeing, and the possible moderating effect of optimism among women with a previous diagnosis of breast cancer.

A total of 314 breast cancer survivors (mean age = 55.22, SD = 9.33), who were diagnosed within the last five years (mean time since diagnosis = 2.89 years, SD = 1.26), completed an online self-report assessment of causal attributions for their own breast cancer, FCR, psychological wellbeing and optimism. Simultaneous multiple regression analyses were conducted to explore the overall contribution of causal attributions to FCR and psychological wellbeing separately. Hierarchical multiple regression analyses were also utilised to examine the potential moderating influence of dispositional optimism on the relationship between causal attributions and FCR and psychological wellbeing.

Results indicated that causal attributions of environmental exposures, family history and stress were significantly associated with higher FCR. The attribution of stress was also significantly associated with lower psychological wellbeing. Causal attributions of lifestyle risks and chance were not associated with psychological outcomes measured. Optimism did not moderate the relationship between causal attributions and FCR or wellbeing.

The observed relationships between causal attributions for breast cancer with FCR and psychological wellbeing among women highlight the need to improve awareness of evidence-based risk factors for breast cancer. Furthermore, health professionals may need to provide greater psychological support to women who attribute their cancer to non-modifiable causes and are less optimistic. Women who attributed the cause of their cancer to stress may be at most risk of experiencing greater distress. As beliefs about lifestyle were not associated with poorer psychological outcomes, cancer prevention messages that are intended to help women meet necessary lifestyle recommendations may help improve their cancer-related self-efficacy as opposed to exacerbating negative affective responses.

Perceptions of the solarium ban in Australia

The causal link between ultraviolet radiation from solarium use and skin cancer is well established. In 2009, the International Agency for Research on Cancer classified UV-emitting tanning devices (sunbeds) as ‘carcinogenic to humans’. Research suggests that the eradication of sunbeds from Australia would result in significant reductions in skin cancer incidence. In 2012 and 2013, state governments across Australia announced plans to ban commercial solarium use from 31 December 2014.

In 2013 and 2014 researchers from Flinders University, Cancer Councils SA and Victoria, and the University of Tasmania examined the responses of solarium users and non-users to the intended ban of commercial solariums in Australia. Participants (n = 488; 388 females, 100 males; mean age = 26.02, s.d. = 9.95) completed an online questionnaire during the summer prior to the ban relating to solarium usage and their opinions about the ban.

Results showed that 17% (n = 83) had used a solarium at some point in their life and 49% (n = 237) of participants were aware of the impending ban. The response to the solarium ban was generally positive; however, some current solarium users intended to use privately owned sunbeds post-ban or spend a greater amount of time sun-tanning.

These findings indicate a high level of public support for the solarium ban, which has removed a risky source of ultraviolet radiation in Australia. Further steps are now needed to monitor the tanning behaviours of previous solarium users post-ban and their access to private sunbed use and other potentially dangerous methods of tanning (e.g. tanning injections). More generally, application and evaluation of strategies identified in other successful public health campaign strategies (e.g. tobacco control) are required in order to ‘de-normalise’ tanning and consequently reduce UV exposure.

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