Coping Strategies and Anxiety in Young Breast Cancer Survivors

Abstract

Objectives: To understand the types of coping strategies reported by young women with breast cancer in the first 2 years following diagnosis and to evaluate the relationship between coping strategies and anxiety in early survivorship. Background: Young women with breast cancer are thought to be vulnerable to age- specific stressors, and this group’s use of coping strategies has not been clearly defined in the literature. A better understanding of coping strategies used by this group and the relationship between specific coping strategies and anxiety could help to inform the development of effective interventions to promote healthy coping, with the goal of improving quality of life in this population. Methods: Helping Ourselves, Helping Others: The Young Women’s Breast Cancer Study (YWS) is a multi-center, prospective cohort that enrolled 1297 women with newly diagnosed breast cancer at age < 40 years between 2006 and 2016. YWS participants complete serial surveys that include information on demographics (baseline), coping strategies (6 months and 18 months), and anxiety and depression (baseline, 2 years). We performed descriptive statistics, tabulated hospital anxiety and depression (HADS) scores at baseline and 2 years, tabulated coping strategies used at 6 and 18 months. We used univariable and multivariable logistic regression models to examine the relationship between specific coping strategies used at 18 months and anxiety at 24 months. We also performed an exploratory analysis of utilization of coping strategies among those participants with anxiety at 24 months. Results: After excluding women who had not completed the 6 month and/or 18 month surveys and those with metastatic disease at diagnosis, 833 women remained in the analytic sample. The median age at diagnosis was 37 (range: 17-40) years. The cohort was 87% white non-Hispanic, 86% college-educated, 80% married or living as married, and 81% able to pay bills without cutting back. 86% were diagnosed with stage 0, I, or II disease, and over 70% received a bilateral (46%) or unilateral (25%) mastectomy. Social supports were the most commonly reported coping strategies at both 6 and 18 months, with greater than 80% reporting at least moderate use of support from partner, parents, family, and friends. Greater than 40% of women reported partner support as the most helpful coping strategy. The reported use of alcohol/drugs, exercise, and diet changes to cope increased from 6 to 18 months. In multivariable logistic regression, those with moderate or greater reliance on family support and moderate or greater use of exercise for coping at 18 months were less likely to have anxiety at 24 months, while those with moderate or greater reliance on alcohol/drug use as well as reporting taking care of others to cope were more likely to have anxiety. Conclusion: Young breast cancer survivors rely heavily on social supports from family and friends, and they employ more health-related coping strategies during survivorship compared to early after diagnosis. There is a relationship between specific coping strategies (less social support, less exercise, more alcohol/drug use, more taking care of others) and moderate or greater anxiety in early survivorship. Our findings may help inform the development of psychosocial interventions for young breast cancer survivors and their caregivers.