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Close Relationships and Emotional Processing Predict Decreased Mortality in Women with Breast Cancer: Preliminary Evidence

From the Department of Psychiatry (K.L.W.) and the Arizona Cancer Center, University of Arizona, Tucson, Arizona; Department of Psychiatry and Behavioral Sciences (T.M.E.), The George Washington University, Washington, DC; and the Departments of Epidemiology and Biostatistics (S.J.S.), The George Washington University, Washington, DC.

Address correspondence and reprint requests to Karen L. Weihs, Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724-5002, Phone: (520) 626-8940. E-mail: weihs{at}email.arizona.edu

Objective: To examine close relationships and emotional processing as predictors of breast cancer mortality.

Methods: Ninety women were enrolled at 14 ± 5 months after diagnosis of Stage II/III breast cancer. The Nottingham Prognostic Index (NPI) quantified disease severity. Cox proportional hazards analyses were used to predict mortality using standardized variables.

Results: Twenty-one subjects developed recurrent disease and 16 died during an 8-year follow-up. NPI predicted increased mortality: risk ratio (RR) = 1.60 (CI = 1.05–2.41). Decreased mortality was predicted by confiding marriage (CONF): RR = 0.31 (CI = 0.10–0.99), and number of dependable, nonhousehold supports (SUPP): RR = 0.41 (CI = 0.21–0.80). A composite measure of close relationships (standardized CONF + SUPP = SUPPCONF) had a strong protective effect: RR = 0.30 (CI = 0.13–0.69). Two emotion processing variables, acceptance of emotion and emotional distress (POMS-TOT) were found to be negatively correlated (r = –.49). Acceptance of emotion predicted decreased mortality (RR = 0.46 (CI = 0.24–0.86)) when analyzed together with emotional distress, but not separately. There was a trend for a protective effect of emotional distress: RR = 0.37 (CI = 0.12–1.09) in the same analysis. RRs for mortality in a multivariable analysis were: SUPPCONF: RR = 0.55 (CI = 0.30–1.00); acceptance of emotion: RR = 0.48 (CI = 0.25–0.91); and emotional distress: RR = 0.40 (CI = 0.14–1.19).

Conclusions: Two aspects of close relationships—marital confiding and dependable, nonhousehold supports—were protective against breast cancer progression. Acceptance of emotion, after controlling for emotional distress, also predicted decreased mortality. Analysis of close relationships together with emotion processing variables suggested unique protective effects against mortality, but a larger study is necessary to determine whether this is the case.

Key Words: social support • marital quality • emotion processing • acceptance • breast cancer • survival

Abbreviations: CI = confidence interval; CONF = marital confiding; NPI = Nottingham Prognostic Index; RR = Risk Ratio; POMS-TOT = Total Mood Disturbance Score, Profile of Mood States; SUPP = number of dependable, nonhousehold supports; SUPPCONF = close relationships total.