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Cancer Attributions, Distress, and Health Practices Among Gynecologic Cancer Survivors

From the University of Iowa, Iowa City, Iowa (E.S.C., S.K.L., S.L.B.); and the University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.L.R., B.A.).

Address correspondence and reprint requests to Susan K. Lutgendorf, PhD, Department of Psychology, E11 Seashore Hall, University of Iowa, Iowa City, IA 52242. E-mail: susan-lutgendorf{at}uiowa.edu

Objective: Personal beliefs about one’s medical condition have been related to health behaviors and psychological distress among individuals with serious illness. We examined whether beliefs about cause of cancer and prevention of recurrence were associated with health practices and distress in 134 long-term endometrial and cervical cancer survivors.

Methods: Participants completed questionnaires assessing depressive symptoms, anxiety, health behavior, and beliefs about factors that may have caused their cancer and prevented recurrence.

Results: Genetics/heredity was rated as the most important cancer cause, followed by stress, God’s will, hormones, and environmental factors. Medical screening was rated as most important in preventing recurrence, followed by positive attitude and prayer. Stronger causal attributions were generally associated with elevated depressive symptomatology and anxiety, but women citing potentially controllable causes were more likely to be practicing healthy behaviors. Similarly, women citing health behaviors as important in preventing recurrence reported greater anxiety but were more likely to practice positive health behaviors. Health behavior and lifestyle attributions interacted with health practices in predicting distress. For example, among women who had not made positive dietary changes, rating lifestyle as important in preventing recurrence was associated with greater distress, whereas among women who had made a positive change in diet, this belief was associated with less distress.

Conclusions: Results suggest that stronger attributions are associated with greater distress, but engaging in behavior believed to be important in preventing cancer or recurrence may ameliorate this distress.

Key Words: endometrial cancer • cervical cancer • cancer survivors • distress • attributions • health practices

Abbreviations: CAM = complementary and alternative medicine; FACT = Functional Assessment of Cancer Therapy; CES-D = Center for Epidemiological Studies Depression Scale; IES = Impact of Events Scale; CARS = Concerns About Recurrence Scale; ANOVA = analysis of variance; ANCOVA = analysis of covariance.

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