Michael A Andrykowski

University of Kentucky, Lexington, Kentucky, United States

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Publications (154)555.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.
    Journal of Genetic Counseling 03/2014; · 1.45 Impact Factor
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    ABSTRACT: Healthy People 2020 identifies elimination of health disparities as a key aim. Rural residence is associated with disparities in cancer screening, physical morbidity, and survival. The present study aimed to identify potential disparities in mental health (MH) outcomes (e.g., anxiety and depression symptoms, distress) in lung cancer (LC) survivors associated with ruralness of residence. Lung cancer survivors (LC group; n = 193; mean age = 63.1 years; mean time since diagnosis = 15.6 months) were recruited from the population-based SEER Kentucky Cancer Registry. LC survivors completed a telephone interview and questionnaire assessing MH outcomes. U.S. Department of Agriculture Rural-Urban Continuum Codes were used to identify Rural (n = 117) and Urban (n = 76) LC survivors. A healthy comparison (HC) group was recruited (n = 152) and completed a questionnaire assessing MH outcomes. Across six MH indices, Rural LC survivors reported poorer MH relative to Urban LC survivors with a mean effect size (ES) of 0.43 SD in unadjusted analyses and 0.29 SD in analyses adjusted for education and physical comorbidity. Comparison of the LC and HC groups revealed significant Ruralness × Group interactions for five of six MH indices. The Rural LC group reported poorer MH than the Rural HC group with a mean ES of 0.51 SD. The MH of Urban LC and HC groups did not differ (mean ES = 0.00 SD). Rural residence is a risk factor for poorer MH outcomes for LC survivors. The MH of Rural LC survivors may be more negatively impacted by cancer diagnosis and treatment than the MH of Urban LC survivors. Copyright © 2013 John Wiley & Sons, Ltd.
    Psycho-Oncology 11/2013; · 3.51 Impact Factor
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    ABSTRACT: The course of depressive symptoms during and after breast cancer treatment is not well understood. We identified patient subgroups based on distinct trajectories of depressive symptoms and determined whether subgroups could be distinguished by personal characteristics and coping strategies. Breast cancer patients completed the Center for Epidemiologic Studies-Depression Scale on clinically meaningful occasions and during the posttreatment period. The Illness Management Questionnaire was completed prior to treatment. A three-class mixture model provided the best fit to the data. Subgroup membership was significantly (p < .05) associated with marital status, history of depression, and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (p < .05) predictors of subgroup membership. Distinct trajectories can be identified during and after adjuvant breast cancer therapy. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.
    Annals of Behavioral Medicine 10/2013; · 4.20 Impact Factor
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    ABSTRACT: OBJECTIVE: The goal of this study is to examine the relationship between socioeconomic status (SES) and both positive and negative mental health (MH) outcomes in a population-based sample of colorectal cancer survivors. On the basis of theoretical conceptualizations of trauma and posttraumatic growth, low SES was hypothesized to be positively associated with both greater negative MH outcomes (e.g., distress) and greater positive MH outcomes (e.g., growth). METHODS: Colorectal cancer survivors (n = 1300; 57% male; mean age 69.4 and 4.0 years post-diagnosis) were recruited using a regional, population-based cancer registry in the Netherlands and completed a questionnaire assessing current negative and positive MH outcomes. Low, medium, and high SES respondents were identified using an area-level indicator of SES based on aggregated individual fiscal data on monetary home value and household income. RESULTS: Analysis of covariance and logistic regression analyses indicated that low SES was a risk factor for greater negative MH outcomes. Relative to high SES survivors, low SES survivors reported poorer status on nine indices of MH, and high SES survivors were about 50% less likely to report clinically important levels of anxiety and depression. Results provided partial support for the hypothesis low SES was a 'risk' factor for greater positive MH outcomes. Relative to high SES survivors, low SES survivors reported greater positive MH outcomes on 2 of 5 positive MH indices examined (Positive Self-Evaluation, Meaning of Cancer). CONCLUSIONS: Study findings are the first to suggest that low SES might increase the likelihood of both greater negative as well as positive MH outcomes in cancer survivors. Copyright © 2013 John Wiley & Sons, Ltd.
    Psycho-Oncology 05/2013; · 3.51 Impact Factor
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    ABSTRACT: BACKGROUND: Reports of 'growth' following cancer diagnosis and treatment are common and are considered evidence for the transformative potential of the cancer experience. However, reports of growth are also common in the general population. This study sought to identify the unique, 'value-added' with regard to the nature and magnitude of growth represented by the cancer experience. METHODS: Lung cancer (LC) survivors (n = 190; mean 15 months post-diagnosis) completed the Posttraumatic Growth Inventory (PTGI), reporting changes occurring 'as a result of having cancer'. Community-based, healthy controls (HC) (n = 152) completed the PTGI, reporting changes occurring 'in the past year'. RESULTS: Reports of growth were common in both the LC and HC groups. However, the LC group reported greater total PTGI scores (effect size (ES) = 0.39 SD) and greater growth for 3 of 5 subscales (ESs 0.34-0.48 SD). The LC group was more likely to report any degree of change for 11 of 21 PTGI items (mean odds ratio (OR) across 21 items = 1.92) and were more likely to report 'moderate' to 'very great' change for eight of 21 items (mean OR = 1.75). The LC group was more likely to report growth in the areas of social relationships and appreciation for life. CONCLUSIONS: In sum, the growth evidenced by LC survivors after diagnosis quantitatively and qualitatively differs from growth reported by the general population over a similar period. Estimates of the value-added by the cancer experience suggest a magnitude representing at least the lower range of clinical significance. Copyright © 2013 John Wiley & Sons, Ltd.
    Psycho-Oncology 03/2013; · 3.51 Impact Factor
  • Celeste R Phillips-Salimi, Michael A Andrykowski
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    ABSTRACT: PURPOSE: Each year, nearly 21,000 adolescents and young adults (AYA) ages 15 to 29 years are diagnosed with cancer. Breast and gynecological cancers account for 25 % of the cancers seen in AYA females. The purpose of this study was to compare the current physical and mental health status of female AYA cancer survivors with non-cancer female controls. METHODS: Using data from the population-based 2009 National Health Interview Survey, 100 cases of female AYA survivors of breast and gynecological cancers were identified [female AYA cancer survivor (FCS) group]. FCS cases were matched with 300 female respondents without a history of cancer on age, education, marital status, and minority status [non-cancer control (NCC) group]. The FCS and NCC groups were compared on a range of physical and mental health status indices using analysis of covariance and binary logistic regression. RESULTS: FCS group reported significantly poorer physical and mental health status than the matched controls. Relative to the NCC group, FCS survivors had significantly poorer scores on 7 of 8 mental health outcomes and were more likely to meet criteria for serious psychological distress (odds ratio = 4.23, p ≤ 0.001). FCS group also reported greater lifetime and current prevalence of various medical conditions, more health-related disabilities, and greater functional limitations than the NCC group. CONCLUSION: Diagnosis of breast and gynecological cancer during adolescence and young adulthood is associated with clinically important deficits in physical and mental health status. Given the young age of this cancer survivor cohort, increased attention should be devoted to minimizing these deficits.
    Supportive Care in Cancer 01/2013; · 2.09 Impact Factor
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    ABSTRACT: OBJECTIVE: The health status and psychosocial well-being of multiple primary cancer (MPC) survivors are under-researched. METHODS: In total, 3615 survivors identified from the Eindhoven Cancer Registry between 2008 and 2009 were assessed. About one in six survivors had survived MPC (n = 556). All survivors completed questionnaires on health status (SF-36/European Organization of Research and Treatment of Cancer quality of life module), mental health (Hospital Anxiety and Depression Scale) and impact of cancer (Impact of Cancer). RESULTS: Compared with single primary cancer survivors, MPC survivors reported significantly poorer scores on general health and higher symptom scores on diarrhoea and fatigue. Significantly more MPC survivors met the subclinical cut-off score of ≥8 points on the Hospital Anxiety and Depression Scale depression subscale (27% vs. 19%, p = 0.0001). MPC survivors also reported significantly greater negative impact of cancer (namely body changes and life interferences) and positive impact of health awareness on their lives. All results were adjusted for age at survey, time since last diagnosis, sex, comorbidity, body mass index and marital status. In secondary analyses, MPC survivors with different primary cancer combinations or time interval between primary cancer diagnoses had comparable health status and psychosocial well-being. CONCLUSION: Multiple primary cancer survivors reported a poorer health status and, in general, experienced a greater negative impact of cancer on their psychosocial well-being than single primary cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.
    Psycho-Oncology 12/2012; · 3.51 Impact Factor
  • Society of Behavioral Medicine; 04/2012
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    ABSTRACT: OBJECTIVE: Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS: Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables RESULTS: Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01) CONCLUSIONS: The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease. Copyright © 2012 John Wiley & Sons, Ltd.
    Psycho-Oncology 03/2012; · 3.51 Impact Factor
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    ABSTRACT: Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life. The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n = 29) and no history of depression (n = 144). Women with Stages 0-II breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36. Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p ≤ 0.01). Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression.
    Annals of Behavioral Medicine 12/2011; 43(3):402-8. · 4.20 Impact Factor
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    Michael A Andrykowski
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    ABSTRACT: Little research has identified the physical and mental health status of survivors of multiple primary cancer diagnoses. By using data from the population-based 2009 National Health Information Survey, 154 survivors of multiple primary cancer diagnoses, 1427 survivors of a single cancer diagnosis, and 25,004 individuals without a history of cancer diagnosis were identified. The multiple cancer group was compared with the single cancer and no cancer groups with regard to physical and mental health status using analysis of covariance and binary logistic regression. Relative to the no cancer group, the multiple cancer group reported significantly poorer mental health status, greater lifetime, recent, and current prevalence of a variety of medical conditions and comorbidities, and more health-related disability. Although observed group differences between the multiple cancer and single cancer groups were less pronounced than those between the multiple cancer and no cancer groups, a consistent pattern was also evident; the multiple cancer group reported significantly poorer status relative to the single cancer group across a range of mental and physical health and illness-related disability indices. Diagnosis of 2 or more primary cancers (excluding nonmelanoma skin cancers) is associated with increased risk for poorer physical and mental health status over and above that associated with diagnosis of a single primary cancer. Survivors of multiple and single primary cancer diagnoses should be considered as distinct subgroups, and increased attention should be devoted to the unique status and needs of survivors of multiple primary cancer diagnoses.
    Cancer 12/2011; 118(14):3645-53. · 5.20 Impact Factor
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    ABSTRACT: This study examined the influence of prior treatment on the course of cognitive functioning in breast cancer survivors. Changes in cognitive functioning over time were compared in breast cancer survivors treated with chemotherapy plus radiotherapy, breast cancer survivors treated with radiotherapy only, and women with no history of cancer. Stage 0-II breast cancer patients treated with chemotherapy plus radiotherapy (CT group; n = 62) or radiotherapy only (RT group; n = 67) completed neuropsychological assessments 6 months after completing treatment and again 36 months later. Women with no history of cancer (NC group; n = 184) were assessed over a similar interval. A significant group × time effect was found for processing speed (P = .009) that reflected a tendency for the NC group but not the RT and CT groups to improve over time. There was also a significant group effect for executive functioning (P = .006) that reflected the NC group performing better than the CT and RT groups. Additional analyses found the administration of hormonal therapy was not associated with change over time in cognitive performance. Findings provide limited support for the view that changes in cognitive functioning in cancer survivors are attributable to chemotherapy administration and illustrate the importance of including a radiotherapy comparison group. Future research should seek to examine possible mechanisms that could explain the apparent prolonged impact of both chemotherapy and radiotherapy on cognitive functioning in breast cancer survivors.
    Cancer 12/2011; 118(7):1925-32. · 5.20 Impact Factor
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    ABSTRACT: In this study, the authors examined the influence of prior treatment on the course of fatigue in breast cancer survivors. Patients who received chemotherapy were expected to have greater fatigue than patients who received radiotherapy and noncancer controls 6 months after the completion of treatment, but they were expected to recover to levels similar to those of the other 2 groups 3 years later. Patients with stage 0 through II breast cancer completed the Fatigue Symptom Inventory (FSI) and the Profile of Mood States Fatigue Scale (POMS-FAT) 6 months (T1) and 42 months (T2) after completing chemotherapy with or without radiotherapy (the CT group; n = 103) or radiotherapy only (the RT group; n = 102). An age-matched group of women with no history of cancer (the NC group; n = 193) was assessed over a similar interval. A significant (P = .041) group × time effect for FSI severity scores revealed that fatigue worsened over time in the CT group but remained stable and lower in the RT and NC groups. There also were significant group effects for FSI days (P < .001) and POMS-FAT (P = .010) scores, indicating that fatigue was significantly greater across time in the CT group than in the NC group (POMS-FAT) or the RT and NC groups (FSI days). Contrary to expectations, fatigue did not diminish over time in patients with breast cancer who received chemotherapy. This finding has important implications for patient education and for fatigue monitoring during follow-up. The authors concluded that future research should seek to examine possible mechanisms to explain the apparent prolonged impact of chemotherapy on fatigue in breast cancer survivors.
    Cancer 11/2011; 118(15):3833-41. · 5.20 Impact Factor
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    Celeste R Phillips-Salimi, Karen Lommel, Michael A Andrykowski
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    ABSTRACT: The growing number of childhood cancer survivors makes examination of their current physical and mental health status and health behaviors an important concern. Much of what is known about the long-term outcomes of childhood cancer survivors comes from the Childhood Cancer Cohort Study (CCSS) which uses sibling controls. Using data from the 2009 Behavioral Risk Factor Surveillance System survey, 651 childhood cancer survivors and 142,932 non-cancer peer controls were identified. The two groups were compared on a variety of physical and mental health status and health behavior variables using ANCOVA and binary logistic regression. While controlling for differences in age, sex, and minority status, survivors significantly (P ≤ 0.001) had poorer socioeconomic outcomes, more comorbid conditions, lower life satisfaction, less social and emotional support, poorer general health, and reported more days per month of poor physical and mental health than non-cancer individuals. Survivors were more likely to report being a current smoker [odds ratio (OR) = 2.33; 95% confidence interval (CI), 1.98-2.73; P < 0.001]; tested for human immunodeficiency virus (HIV) (OR = 1.79; 95% CI, 1.52-2.11; P < 0.001); and that at least one HIV situation applied to them (OR = 2.06; 95% CI, 1.55-2.74; P < 0.001). No significant differences were found between groups in regards alcohol use and diet. Results support and extend previous findings reported by the CCSS. New findings regarding survivors' increased likelihood to engage in risky behaviors proposes new directions for future research.
    Pediatric Blood & Cancer 10/2011; 58(6):964-70. · 2.35 Impact Factor
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    Jessica L Burris, Michael A Andrykowski
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    ABSTRACT: Little is known about the unique experience of adults with a history of multiple cancer diagnoses (i.e., survivors of multiple cancers). This research assessed the health status and health behaviors of survivors of multiple cancers. The health status and health behaviors of 8,734 survivors of multiple cancers, 47,562 survivors of a single cancer, and 348,229 non-cancer controls were compared using weighted data from the 2009 Behavioral Risk Factor Surveillance System. Survivors of multiple cancers reported poorer physical and mental health status outcomes (e.g., more mental distress and greater activity limitations) than survivors of a single cancer (all p's < 0.001) who reported poorer outcomes than controls (all p's < 0.001). Survivors of multiple cancers reported unhealthier behaviors than survivors of a single cancer and healthier behaviors than controls on most health behavior outcomes (e.g., alcohol use, tobacco use, and diet) (all p's < 0.001). Data suggest the need for clinical interventions to enhance physical and mental health status and to increase adoption of healthier behaviors in survivors of multiple cancers.
    Annals of Behavioral Medicine 07/2011; 42(3):304-12. · 4.20 Impact Factor
  • Michael A Andrykowski
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    ABSTRACT: Identify the current physical and mental health status and health behaviors of male breast cancer survivors. Using data from the national, population-based, 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey, 66 cases of male breast cancer were identified (mean age = 66.2 years, mean time since diagnosis = 12.0 years). Male breast cancer cases were matched with 198 male BRFSS respondents with no history of cancer (control group) on age, education, and minority status. The male breast cancer and control groups were compared on physical and mental health status and health behaviors, using t-test and logistic regression analyses. The male breast cancer group reported poorer physical and mental health than controls. Male breast cancer survivors were significantly (p < 0.05) more likely to be obese (Odds Ratio = 2.41) and reported more physical comorbidities (Effect Size = 0.45) and activity limitations (Odds Ratio = 3.17), poorer life satisfaction (Effect Size = 0.41) and general health (Effect Size = 0.40), and more days in the past month when mental health (Effect Size = 0.49), and physical health (Effect Size = 0.29) were not good. In contrast, the male breast cancer and control groups were similar with regard to current health behaviors, including tobacco and alcohol use, diet, exercise, and health care. The diagnosis and treatment of male breast cancer may be associated with clinically important and long-term deficits in physical and mental health status, deficits which may exceed those evidenced by long-term female breast cancer survivors. Copyright © 2011 John Wiley & Sons, Ltd.
    Psycho-Oncology 06/2011; 21(9):927-34. · 3.51 Impact Factor
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    ABSTRACT: Recent attention has focused on the negative effects of chemotherapy on the cognitive performance of cancer survivors. The current study examined modification of this risk by catechol-O-methyltransferase (COMT) genotype based on evidence in adult populations that the presence of a Val allele is associated with poorer cognitive performance. Breast cancer survivors treated with radiotherapy (n = 58), and/or chemotherapy (n = 72), and 204 healthy controls (HCs) completed tests of cognitive performance and provided saliva for COMT genotyping. COMT genotype was divided into Val carriers (Val+; Val/Val, Val/Met) or COMT-Met homozygote carriers (Met; Met/Met). COMT-Val+ carriers performed more poorly on tests of attention, verbal fluency, and motor speed relative to COMT-Met homozygotes. Moreover, COMT-Val+ carriers treated with chemotherapy performed more poorly on tests of attention relative to HC group members who were also Val+ carriers. The results suggest that persons treated with chemotherapy for breast cancer who also possess the COMT-Val gene are susceptible to negative effects on their cognitive health. This research is important because it strives to understand the factors that predispose some cancer survivors to more negative quality-of-life outcomes.
    Cancer 04/2011; 117(7):1369-76. · 5.20 Impact Factor
  • Michael A Andrykowski
    Psycho-Oncology 03/2011; 20(3):335-6. · 3.51 Impact Factor
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    Andrea Floyd, Rachel F Steffens, Edward Pavlik, Michael A Andrykowski
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    ABSTRACT: The term "teachable moment" (TM) has been used to describe a life transition or event which motivates an individual to change a behavior or presents an opportunity to intervene to prompt behavior change. We examined whether receipt of a false positive ovarian cancer (OC) screening result may represent a TM. 403 women participating in an OC screening program completed questionnaires assessing demographic, clinical, behavioral, and psychosocial information. The TM was operationalized as expressed interest in receiving health-related information. We hypothesized that among women receiving a false positive screening test result, those women who had experienced greater personal perceived risk for OC as well as distress would be more interested in receiving health-related information than women receiving a normal result. Analyses revealed that women receiving a false positive screening result were less interested in receiving health-related information than women receiving a normal screening result. For women receiving a false positive result, expressed interest in receipt of health-related information was only modestly related to distress and related even less to perceptions of OC risk. Our data do not support viewing a false positive OC screening result as a TM. Potential explanations for the current findings as well as recommendations for future research investigating the TM are discussed.
    Journal of Clinical Psychology in Medical Settings 03/2011; 18(1):70-7. · 1.49 Impact Factor
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    ABSTRACT: There is a growing body of evidence suggesting breast cancer (BC) recurrence risk might be linked to behavioral factors. However, little is known about BC survivors' beliefs regarding the link between their behavior and recurrence risk. The objective of this study was to describe BC survivors' beliefs regarding performance of behaviors potentially associated with BC recurrence risk reduction, and to examine the link between these behaviors and BC recurrence risk reduction beliefs, worry, and risk perception. 200 female BC survivors (age, years: mean=57.7, standard deviation=9.2) completed a questionnaire assessing beliefs about the effectiveness of 14 potential BC recurrence risk reduction behaviors, their performance of these potential risk reduction behaviors, recurrence worry, and perception of personal lifetime BC recurrence risk. The behaviors most frequently endorsed as potentially reducing BC recurrence risk included avoiding tobacco use (84%), exercising at least three times per week (74%), eating an average of five servings a day of fruits and vegetables (72%), and limiting food intake to maintain current weight or lose weight (70%). Multivariate logistic regression analyses predicting behavioral performance showed that beliefs were consistently associated with behavior while worry and risk perception were largely unrelated to behavior. BC survivors' beliefs about the effectiveness of potential BC recurrence risk reduction behaviors are largely consistent with empirical findings and relate strongly to actual behavioral performance. Misconceptions about the effects of behavior to reduce BC recurrence risk are important targets for clinical and public health efforts.
    Psycho-Oncology 02/2011; 21(4):427-35. · 3.51 Impact Factor

Publication Stats

5k Citations
555.09 Total Impact Points

Institutions

  • 1986–2014
    • University of Kentucky
      • • Department of Behavioral Science
      • • Department of Psychology
      Lexington, Kentucky, United States
  • 2013
    • Indiana University-Purdue University Indianapolis
      • School of Nursing
      Indianapolis, IN, United States
  • 2005–2013
    • Moffitt Cancer Center
      • • Department of Health Outcomes and Behavior (HOB)
      • • Program in Health Outcomes and Behavior (HOB)
      Tampa, Florida, United States
  • 2011
    • West Virginia University
      • School of Pharmacy
      Morgantown, WV, United States
    • Radboud University Nijmegen
      • Expert Centre Chronic Fatigue
      Nijmegen, Provincie Gelderland, Netherlands
    • East Tennessee State University
      • Department of Psychology
      Johnson City, TN, United States
  • 2007–2011
    • University of South Florida
      • School of Aging Studies
      Tampa, FL, United States
    • Karmanos Cancer Institute
      Detroit, Michigan, United States
    • Lexington College
      Lexington, Kentucky, United States
  • 2007–2009
    • University of Florida
      • Department of Medicine
      Gainesville, FL, United States
    • The Ohio State University
      • Division of Human Genetics
      Columbus, OH, United States
  • 2008
    • Southern Illinois Healthcare
      Illinois, United States
    • American Cancer Society Inc.
      Atlanta, Georgia, United States
  • 1999–2007
    • Vanderbilt University
      • • School of Nursing
      • • Department of Preventive Medicine
      Nashville, Michigan, United States
  • 2006
    • University of Minnesota Twin Cities
      • School of Nursing
      Minneapolis, MN, United States
    • Fox Chase Cancer Center
      Philadelphia, Pennsylvania, United States
  • 1989–2006
    • Memorial Sloan-Kettering Cancer Center
      • Department of Neurology
      New York City, New York, United States
  • 2004
    • University of Louisville
      • Department of Psychological and Brain Sciences
      Louisville, KY, United States
  • 2003
    • VA Palo Alto Health Care System
      Palo Alto, California, United States
  • 1985
    • University of Illinois, Urbana-Champaign
      Urbana, Illinois, United States