Abstract
This study investigated the relation among perceived social support, uncertainty, and quality of life in older survivors with breast cancer. Proposed hypotheses predicted a significant positive correlation between perceived social support and quality of life, and a significant negative correlation between uncertainty and quality of life. It also was hypothesized that perceived social support and uncertainty, considered together, could explain more quality-of-life variance than either variable considered independently. A sample of 103 breast cancer survivors older than 50 years completed the Social Support Questionnaire, the Mishel Uncertainty in Illness Scale - Community Form, and the Ferrans and Powers Quality-of-Life Index - Cancer Version. Data were analyzed using Pearson product-moment correlation, t tests, analysis of variance, and stepwise multiple regression. All the hypotheses were supported. Additional findings showed significant positive correlations between age and uncertainty, and between support network size and social support. Significant negative correlations were found between age and perceived social support, and between age and size of support network. Uncertainty increased in the presence of other diseases, which were associated with poorer quality of life. The study results underscore the importance of social support in reducing illness uncertainty and improving the quality of life for older survivors of breast cancer.
It is well established that breast cancer brings a myriad of challenges, concerns, and anxieties to women of all ages. Some issues and experiences, such as changes in physical appearance and fear of disease progression, are universal to all women with breast cancer. Each woman with breast cancer perceives the experience within the context of personal history, life cycle concerns, and psychosocial life stage. 1 Along with the commonalities shared universally by survivors of breast cancer, each age cohort exhibits the emergence of problems distinctive to their psychosocial life stages. 2 Because quality of life is influenced greatly by an individual's psychosocial stage and place in life, 3 the consequences of breast cancer and the impact they have on quality of life vary depending on the stage of life in which they occur. 4
Various quality-of-life issues emerge that are unique to older women, who often experience a decline in physical functioning and the development of chronic illnesses. Older women frequently lack financial resources and often have lost their spouse or partner through death or divorce. 5 Furthermore, many older women become the unpaid caregivers of ailing spouses/partners or elderly parents. The resulting effect is that many older women have had to relinquish outside employment along with the benefits of health insurance and pension coverage. 5 The demands of breast cancer added to these issues can place older women at risk for poor quality of life.
The incidence and mortality of breast cancer increase with age. Statistics from the American Cancer Society 6 indicate that approximately 77% of newly diagnosed breast cancer and 84% of breast cancer deaths occur among women older than 50 years. Furthermore, research that specifically addresses the quality of life among older survivors of breast cancer is scarce. Nevertheless, the high incidence of breast cancer among older women and its known ability to evoke greater distress than any other disease, regardless of prognosis, 7 emphasizes the need to examine the impact of breast cancer on the quality of life experienced by older women.
Breast cancer is characterized by uncertainty because of its unpredictable disease prognosis, unclear etiology, and threat of disease recurrence. The long-term effects of current treatment regimens are difficult to predict. Awareness of disease progression, suffering, and death is ever present. 8
Women with breast cancer commonly encounter an increased need for social support. Older women often experience less participatory decision making, fewer supportive interactions, and less time spent with physicians, which may place them at higher risk for adverse psychosocial outcomes. 9 They also may experience difficulty communicating their needs to family and health professionals because they perceive a lack of support and feel insecure about their own abilities to communicate effectively. 9 They may encounter multiple losses of loved ones, friends, and pets, which create a shrinking network of support. 1 These factors can be obstacles in the way of obtaining helpful social support. 10
With the occurrence of breast cancer, the demands of illness and a threat to life and functional status 11 are imposed on the unique role demands of older women. Critical breast cancer issues may be encountered that extend well beyond the completion of treatment and into survivorship, such as fear and uncertainty about treatment outcomes, reduced functional status, disease recurrence, future well-being and independence, and reduced social resources. 12,13
The purpose of this study was to investigate the relation among perceived social support, uncertainty, and quality of life in older women with breast cancer. The significance of this study is accented by the impact that breast cancer and its ensuing uncertainty have on the unique quality-of-life needs among older women and the likelihood that older survivors of breast cancer face obstacles that may prevent them from obtaining effective social support. Although the variables of this study have been well described in the literature, no evidence of their relation exists specifically for older survivors of breast cancer. This study may clarify the relations among these variables as influenced by the unique psychosocial stage and quality-of-life issues experienced by older survivors of breast cancer. The need for this study is endorsed by the significance of advancing quality-of-life research, which has shown the influence that psychosocial stage and place in life have on quality of life. 3 The findings of this study may contribute to the planning and implementation of care that can enhance quality of life significantly for older survivors of breast cancer. 1