Agnes Crisostomo - The International Academic Forum

Agnes Crisostomo - The International Academic Forum

Agnes Crisostomo

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanOptimism and Coping among Women Who Survived Breast CancerAgnes CrisostomoBulacan State University, Philippines0318The Asian Conference on Psychology & the Behavioral SciencesOfficial Conference Proceedings 2012317

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanIntroduction“Why Me?” is the initial question asked by many women diagnosed with breast cancer. It is clear that thediagnosis of breast cancer constitutes a serious crisis in women’s lives (Carver, et al: 1993). Hearing theword “cancer” is like hearing an alarm bell or a death knell, because for most women having cancer is thesame as dying (Ayers: 1994). The combination of such a life-threatening disease, the often radical series oftreatments as well as the uncertainty of survival and the lifelong fear of recurrence all contribute to stressthat the breast cancer patients have to cope with.Breast cancer is Filipino women’s number one killer (as cited in Aguilar, 2002). In recent years, cancer hasstruck millions of lives and has always evoked fear and dread among women. Breast cancer is the secondleading site for both sexes combined (13.1%) and ranks first among women (25.6%). From 1983 to 1987,there were 4649 cases of breast cancer and in 1990, this figure rose to 6325. By 1993, 8321 cases werereported by the Philippine Cancer Society (PCS). And in 1998, an estimated 9,325 new cases were seen andan estimated 3,057 deaths have occurred. In 2005, an estimated 14,043 new cases have occurred amongwomen and 6,375 deaths were predicted. The 2005 Philippine Cancer Facts and Estimates also reported thatin the Philippines, median survival among female is 60 months. Survival at the 5 th year is 50.10% and32.38% at the 10 th year. For both sexes, estimated leading cancer site in 2005 had lung cancer as the first(17,238 or 16.1%), while breast cancer placed second (14,043 or 13.3 %.).It is indeed a chronic disease that requires constant attention, one that a patient, even if she has beendeclared a survivor, has to contend with the rest of her life. Indeed among these women, survival may not bethe only important objective, but also the quality of their lives and relationships. For them, coping becomes alifetime task.Disruptions in life fall along a continuum, ranging from minor frustrations to devastating losses. Alldisruptions raise issues that need to be solved by the people involved. The persons’ effort to dissolve theadversity, to dampen its subjective impact or to accommodate to new life situations that the adversity bringswith it, are the very essence of coping (Scheier and Carver:1993). When a woman had cancer fifty yearsago, there was little discussion on how she was coping. The person just dealt with it (Kneier Inthe last 25 years, however, cancer has become a chronic rather than a terminal illness. The notion thatpatients have to continuously cope with their illness has received enormous attention from both health careprofessionals and behavioural scientists as well. Coping with cancer is now viewed as a process that goes onover a period of months or even years. Coping is not a unitary, single event, but rather a series of ongoingresponses to this life-threatening illness. There are coping strategies however that work best for one personbut may not work well for another.The general problem of the study is to identify the relationship of Optimism with the Coping behavioursadopted by the breast cancer survivors.Review of Literature and StudiesOptimismAnother personality variable to be examined is optimism. It is a characteristic people possess to varyingdegrees and researches have shown that it is linked to desirable characteristics such as happiness,perseverance, achievement, health and even long life. Theorists like Scheier and Carver (1985) have definedoptimism as a " generalized expectancy that good, as opposed to bad outcomes will generally occur whenconfronted with problems across important life domains" (Franken, 1994).318

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanCopingYears ago, most researchers who were interested in stress and coping would probably not have seriouslyquestioned the assumption that coping is an important determinant of people’s emotional well-being duringa stressful transaction. Lately (Scheier et al: 1993), the issue that has been raised is whether coping helps oreven interferes with outcome such as good adjustment. When impediments are encountered (and theexperience of stress commences), what happens next depends on whether the person feels the obstacle canbe overcome, or the problems solved or circumvented. Coping strategies, according to Scheier and Carver(as cited in Tennen and Affleck: 1987) are adopted when people are confronted with life-threatening eventssuch as a serious illness. Some people directly deal with the source of stress and engage in problem-focusedcoping strategies while those who feel relatively invulnerable may adapt poorly to misfortune and employthe emotion-focused coping; a strategy used when they already feel helpless, embracing the fact that nothingcan be done to alleviate the stress and that the situation is one that must be endured.The coping styles that patients generally employ are the common, more frequent and longer-term style ofcoping that an individual tends to use across a variety of life situations and these are often closely related toone’s overall disposition and personality (Folkman and Greer: 2000 as cited in National Cancer Institute).Today, there is every reason to believe that differences in personality and coping play a crucial role in thesuccess with which patients adapt to/cope with the experience (Andersen: 1992).When people confront adversity such as a life-threatening illness, one’s personality plays an important rolein a wide range of behavioural and psychological outcomes that they have to adapt (Carver: 1993). Tennenand Affleck (1987) argued that personality variables such as explanatory style and optimism appear toaccount for significant variance in subsequent health. Therefore, a complete understanding of what appearsto be health-enhancing personality factors may require a thorough investigation.Over the years, a great deal of research and theory has focused on the ways people deal with difficulties theyencounter in their day to day lives. Among women, the diagnosis of breast cancer is threatening on anylevel. Most obvious is the fact that the patient’s life is placed in jeopardy. The medical field has certainlyprogressed in improving the chance of survival among cancer patients, yet a lot of women still die of breastcancer (Gomez:2001). Considering that there is no absolute survivorship of any type of cancer, breast cancerbecomes a chronic disease that requires constant attention, one that a patient, even if she has already beendeclared a survivor, has to cope with the rest of her life.Bergado (1993) hypothesized that some personal factors like age, educational attainment, income andmarital status may be associated with positive coping. Findings showed interesting results such as: a) theolder the patients, the better is their coping ability b) the greater number of children living with the client,the better they cope and c) the less the client is satisfied with the support from significant others, the betterhe or she copes. Apparently, when patients feel that the support they are receiving is lacking, the more theyare motivated to rely on themselves and they resort to more effective coping.Among local studies, there are findings that women’s coping is related to some socio-demographicvariables. One such variable is age. In both Bergado’s (1993) and Caronan’s (2001) studies which both dealtwith adult respondents , findings showed that the older the patients are, the better their coping abilitybecome. This is contrary to a foreign study conducted by Halperin (1999) which revealed that amongadolescent cancer survivors, older adolescents were relatively more distressed than their youngercounterparts. Besides the age, the number of children the women have also determined better coping abilityamong patients (Bergado: 1993); while (Palma: 1997) averred that successful coping also depended on theavailability of over-all support network. Gomez (1999) has identified that one’s family is the main source of319

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, Japanspiritual, financial, physical support needed by women. The personality traits of Filipina women which arenecessary for successful coping were being prayerful and having faith in God; as well as possessingpositive traits of optimism, bravery and hopeful attitude (Bergado, 1993; Palma:1997) and resiliency(Yap:1999).Problem-Focused/Emotion-Focused CopingIn coping with a disease such as cancer, the strategies used by women are vital components in theiradjustment to and management of the disease (Henderson, et al: 2003). Coping is personality in action inthe face of a stressful event (Bolger: 1990). Lazarus argued that stress consists of three processes (Carver etal, 1989). Primary appraisal, the process of perceiving a threat to oneself, secondary appraisal, the processof bringing to mind a potential response to the threat and COPING, the process of executing that response.Lazaruz and Folkman (1985) have defined appraisal as the personal evaluation of particular conditions asstressful (i.e. harmful, threatening or challenging). Appraisal then acts as a mediating variable that ispositioned between influencing factors and coping responses; while stressors are the specificperson/environmental inputs that are evaluated during the appraisal process. Folk man and Lazarus (1988)have classified coping mechanisms as either behavioural (i.e. problem-focused) or emotional (emotionfocused)responses that are enacted to mitigate sources of stress.Optimism and CopingThe main purpose of the present study is to examine individual differences on Optimism and how it relatesto breast cancer survival. Optimism is a characteristic people possess to varying degrees and researches haveshown that if measured, it is linked to desirable characteristics such as happiness, perseverance,achievement, health and even long life. Theorists like Scheier and Carver (1985) have defined optimism "asa generalized expectancy that good, as opposed to bad outcomes will generally occur when confronted withproblems across important life domains" (Franken, 1994). In general, optimism is used to denote a positiveattitude or disposition that good things will happen independent of one's ability.Participants of the StudyParticipants were 47 active members of the Breast Care Center Support Group of the Philippine GeneralHospital at the time of the study. This support-group holds weekly activities and workshops and has about40-50 breast cancer survivors as its regular members. Its regular activity is held every Wednesday at theCancer Institute of the Philippine General Hospital located at Padre Faura, Manila.Setting of the StudyThe Cancer Institute of the UP-PGHCreated by Commonwealth Act 398 in 1938, The Cancer Institute of the University of the Philippines-Philippine General Hospital (UP-PGH) today remains the country’s sole medical establishment whichintegrates the academic, clinical, and multidisciplinary approach to screening, diagnosis, and treatment ofcancer.Instruments1. Optimism-Pessimism. The LOT (Life Orientation Test: Scheier and Carver, 1985320

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, Japan2. Coping. Coping was assessed by COPE (Carver et al., 1985) which was an inventory of copingresponses. In this study, responses were assessed by COPE on five aspects of problem-focused coping (e.g.use of instrumental social support, active coping, restraint, suppression of competing activities andplanning). Emotion- focused coping, on the other hand, included five specific scales (e.g. positivereinterpretation and growth, denial, religious coping, use of emotional support and acceptance). Internalreliability of most COPE scales was adequate ranging from .65 to .90.ResultsProfile of RespondentsOut of the 47 respondents, 13 women were aged 41-50 years old, 22 women were in the range of ages 51-60, six women fell in the range of 61-70 years old and another 6 women aged 71 years and above. On theeducational attainment of the respondents, 24 have only reached elementary and high school. Sixteen hadreached the college level, and at least two respondents had reached graduate school level.Likewise, almost half of the total number of respondents were married while 25.5% were widows and 10.6%were separated. Another 10.6 percent represents other descriptions of civil status such as single, or being in alive-in set up.Regarding their monthly income of the total 47 respondents, 28 of them declared that they are jobless andtherefore they do not have any income. Fifteen had a monthly income of P5000 below. Only one respondenthad an income of P5, 000-P7499, another one P7, 500 to P10, 499 monthly incomes, another one P10, 500-P14, 499 monthly income and only one as P15, 000 and above income. Offhand, it can be deduced that sincethe PGH is a government hospital, most of its patient came from low to no-income groups.When asked on the number of years that they had been survivors, 11 women had been cancer survivors fortwo years now and another 11 women for three years. One of the respondents had been a survivor for 20years now and one only for the past 9 months. It is to be noted that the women count the length of theirsurvival starting from the time their mastectomy or major treatment was done.Level of OptimismOptimism is a personality disposition that is deemed beneficial to health (Scheier and Carver, 1981) becausepeople’s actions were greatly affected by their beliefs about the probable outcomes of these actions. Resultsof Life Orientation Test (LOT) reveal that the highest score (97.9%) registered by the 47 cancer survivors ison item 3 which states “I am always optimistic about my future”. This clearly shows that despite theirpresent negative health conditions, the women still believe that things will work out positively in their lives.Although the diagnosis of cancer is considered a blow in their lives, they still believe that this situation canbe dealt with and that a good outcome awaits them (Carver, et al, 1993). A survivor of 12 years said, “angcancer na ito ay blessing, hindi sumpa, dahil dito sa sakit ko, nakapag inspire ako ng maraming tao at ngmaraming babaeng may sakit na gaya ko” ( my cancer is more of a blessing than a curse, because of this, Iwas able to inspire a lot of people, a lot of women who are sick just like me).Another respondent answered nung nagka-cancer ako, natuto kong magbago ng frame of mind, nagingpositive thinker ako ngayon; saka dati sobrang tipid ko pero ngayon ok lang lalo na sa mga bata, sige enjoyka lang kaysa sa kung patay na ‘ko, paano pa ‘ko mag-eenjoy. Dati pessimistic ako, laging negatibo, perothis time positive na ang pananaw ko kahit saang bagay.” (When I acquired cancer, I’ve learned to shift myframe of mind, I became a positive thinker , before, I was so stingy but not anymore, especially if it is for321

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, Japanmy children. I just enjoy my life now, because when I’m dead, I cannot do it anymore. I was pessimisticbefore, I’m always negative. But this time my perspective is positive in all areas.)Coping BehavioursAmong the Problem-Focused Categories, it was the Planning Scale which received the highest score(97.8%). This was followed by Active Coping which was a close second at 95.8%. On the other hand,Suppression of Competing Activities ranked the lowest with a percentage of 87.3%.On Emotion-Focused Coping. The results display that Religion scored an overwhelming perfect percentageof 100%. A tie follows between the two scales: Emotional Support and Positive Coping which bothregistered a percentage of 97.9%. Consistent with the high score on Acceptance is the lowest score onDenial which is 72.3%. The final scale Turning to Religion only proves that such a coping tactic may reallybe important to many people. Filipinas are known to be religious people and the scores prove it correct.Seeking emotional support is also present among the respondents when they turned to somebody who canbe source of sympathy, moral support and can be used more as an outlet for the ventilation of one’sfeelings.Relationship Between Optimism and Coping BehaviorsThis shows that optimists do not only hope for the better but they work for it too. Indeed, optimists havefavourable expectations of the future, which they associate with active coping efforts and with making thebest of whatever is encountered (Scheier, et al, 1986).The respondents always have pleasant views of the future because they adopt concrete steps and measures tosolve their present problem. Towards the end, the women admitted that they are already used to the situationthey are in, and in fact have already accepted it.This further proves that the women may at times think that things may not turn out the way they want themto, and yet still remain in control by not entertaining thoughts and ideas which might confuse them furtherand lose focus along the way.Lastly, Optimism in congruence with the result of Scheir and Carver’s (1987) assertion that rather thanengaging in denial, optimists tend to accept the problems at hand and see the best in situations they confront.Likewise, Caronan (2001) asserted that among optimistic Filipina cancer patients, acceptance and copingwith illness can easily be achieved while Yap (1999) found that optimism is a very evident factor in theresiliency of Filipina cancer survivors.ConclusionThe findings complement and extend a small literature concerning the impact of personality on copingbehaviours among women who survived breast cancer. Taking into consideration the level of optimismamong the cancer survivors, it is important to note that there is indeed a need for cancer patients to trainthemselves to have a bright and optimistic outlook instead of victimizing themselves. Dr Simonton (inBackus, 1996) asserted that people who change their doom-laden thoughts about cancer recover while thosewho hold to their negative thoughts become worse.322

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanWhat is perhaps most striking is the prominent role played by Turning to Religion which has consistentlyreceived the highest scores. This only shows that among Filipinas, their faith proved to be very important intheir coping regardless of the type of personality that they possess.It is hoped that through the findings of this research, a psycho-social intervention program for the care of thecancer patients (breasts cancer and other cases) can be devised. This will focus on how cancer patients’behaviours and cognition can be modified in order to influence their subsequent coping, to prolong theirsurvival and eventually to promote a higher quality of life.REFERENCESAdler, N. and Matthews, K. (1994). Health Psychology: Why do people get sick and some stay well? AnnualReviews of Psychology. 45:22-259.Aguilar, MV. (2001). Breast cancer: Shattering the Myth. De La Salle University. Dasmarinas.Antaki, C. and Brewin, C. (1982). Attributions and Psychological Change. Academic Press.Ayers, L.K. (1994). The Answer is Within You. Psychology, Women’s Connections and Breast Cancer. TheCrossroad Publishing Company.Ayers, L.K. (1994). The Answer is Within You. Psychology, Women’s Connections and Breast Cancer. TheCrossroad Publishing Company.Bolger, N. (1990). Coping as a Personality Process: A Prospective Study. Journal of Personality and SocialPsychology. Vol. 59, No.3, 525-537.Ben-Zur, H., Gilbar, O. and Lev, S.,(2001). Coping With Breast Cancer . Patient, Spouse, and Dyad Models,Psychosomatic Medicine 63:32-39 (2001)Carver, C., Pozo,C., Harris, S., Victoria, Sheier, M., Robinson, D., Ketcham. A., Moffat, F., and Clark, K.(1993). How Coping Mediates the Effect of Optimism on Distress: A Study of Women with early stageBreast Cancer. Journal of Personality and Social Psychology. Vol.65, 2,375-390.Carver, C. and Scheier, M. (1999). Stress, Coping and Self-Regulatory Processes. Handbook of PersonalityTheory and Research. 2 nd Edition. Edited by Pervin, L. and John, O. The Guilford Press NY.Carver, C. Scheier, M. and Weintraub, J. (1989) Assessing Coping Strategies: A Theoretically BasedApproach. Journal of Personality and Social Psychology. Vol.56. No.2, 267-283.Folkman, S. (1984). Personal Control and Stress and Coping Processes: A Theoretical Analysis. Journal ofPersonality and Social Psychology, 46, 839-852.Folkman, S. and Lazarus, R. (1988). Coping as a Mediator of Emotion. Journal of Personality and SocialPsychology. Vol. 54, No. 3, 466-Halperin, J.C. (1999). The influence of causal attributions on the psychological adjustment of postadolescent cancer survivors. Columbia University.323

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanHenderson, P., Fogel, J., and Edwards, Q. (2003). Coping Strategies Among African American Women withBreast Cancer. Southern Online Journal of Nursing Research. Issue 3, Vol. 4.Kneier, A.(2002). The Psychological Challenges Facing Melanoma Patients. UCSF Melanoma CenterMcConnel, H. (2000). Dealing with False Optimism in Terminal Cancer. DG Review. 321,1376-1381.Nezu, A., Nezu, C. and Lombardo, E. (2001). Managing Stress through Problem-Solving. Stress News. Vol.13, N0. 3.Pervin. L. and John, O. (1997). Personality Theory and Research,. 7 th Edition. John Wiley and Sons, Inc.Petticrew, M. Bell, R and D. Hunter. (2002). Influence of Psychological Coping on survival and recurrenceof cancer: Systematic view. BMJ. Vol, 325, (7372).Scheier, M., Weintraub, J.K. and Carver, C. (1986). Coping With Stress. Divergent Strategies of Optimistsand Pessimists. Journal of Personality and Social Psychology. Vol. 51, No. 6, 1257-1264.Scheier ,M. and Carver, C. (1992). Effects of Optimism on psychological and well-being: TheoreticalOverview and Empirical Update. Cognitive Therapy and Research. 16, 201-208.Scheier, M. and Carver, C. (1987). Dispositional Optimism and Physical Well-being: The Influence ofGeneralized Outcome Expectancies on Health. Journal of Personality and Social Psychology. Vol. 55, No.2169-209.Stanton, A., Danoff-Burg, S., Cameron, C., Bishop, M, Collins, C., Kirk, S. and Sworowski, L. (2000).Emotionally Expressive Coping Predicts Psychological and Physical Adjustment to Breast Cancer. Journalof Consulting and Clinical Psychology. Vol. 68. No. 5., 875-882.Taylor, Lichtman and Wood (1984) . Attributions, Beliefs About Control, and Adjustment to Breast Cancer.Journal of Personality and Social Psychology Vol. 46, No. 3, pp. 489-502Tennen, H. and Affleck, G. (1987). The Costs and Benefits of Optimistic Explanations and DispositionalOptimism. Journal of Personality. 55:2. Duke University Press.Unpublished Theses/Dissertations:Bergado, F. (1996). Coping Strategies of Filipina Women with Breast Cancer. UP College of Nursing. MAThesis.Caronan, M. (2001). The Filipino Cancer Patients’ Grief Responses. UP College of Nursing. Ma Thesis.Gomez, M.V. (1999). Life after Diagnosis social support among women with breast cancer. MA Thesis. DeLa Salle University.Palma, E. (1997). Factors Influencing the Coping behaviour of Terminally-ill women with Cancer ofReproductive Organs. Master Thesis. De La Salle University.324

The Asian Conference on Psychology & the Behavioral Sciences 2012Official Conference ProceedingsOsaka, JapanPastor-Ugto, C (1998). Perceived Ability to Cope of CAPD and Haemodialysis Patients. UP College ofNursing. MA Thesis.Yap, T.L. (1999). “Resiliency among Filipino Cancer Survivors”. Unpublished Thesis. Ateneo de manilaUniversity.Electronic Materials:Virginia Anderson International Nursing Library. (2004). Illness Attribution in Midwestern Women withBreast Cancer.ALL RIGHTS RESERVED325

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