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

Fear of recurrence and psychological wellbeing 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. Participants 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 of 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.

Sex differences in the relationship between socio-cultural norms and sun exposure behaviours

The tripartite influence model (Thompson et al. 1999) theorises that internalised appearance ideals mediate between socio-cultural norms and sun exposure. This study examined the extent to which socio-cultural norms lead to an idealisation of a toned physique and darker skin, which, in turn predicts sun exposure.

Adult males (N = 124) and females (N = 175) completed an online questionnaire measuring socio-cultural norms endorsing a tanned appearance, internalisation of mesomorphic and tanned ideals, and sun exposure. The internalisation of mesomorphic and tanned ideals mediated between norms and sun exposure in both sexes. A greater internalisation of a tanned ideal was associated with increased sun exposure in both sexes whereas, in males, a greater internalisation of a mesomorphic ideal was associated with increased sun exposure.

Evidently, people who internalise a tanned ideal based on the perceived attitudes of others are more likely to sun expose. Skin cancer prevention should aim to target the perceived norms of others, with possible education about the often unrealistic portrayal of appearance ideals in media. Furthermore, when creating an intervention to reduce risky sun exposure in males, some males may be better targeted through an internalised mesomorphic ideal. Targeting males with a high internalisation of the mesomorphic ideal could indirectly reduce risky sun exposure by challenging the ideal through addressing the bronzed, highly muscular males in media. Such an approach could be beneficial to males who may find interventions based specifically around a tanned ideal to be more feminine or not relatable to them, as they do not deliberately sun expose to the same extent as females. Overall, the results of this study support the need to address the perceived benefits of tanned skin in order to reduce skin cancer prevalence.

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