rence of breast cancer, psychological well-being is often maintained (Bull et al., 1999; Frost et al., 2000; Ganz et al., 2002). For a minority of women however, a diagnosis of breast cancer contributes to significant psychosocial distress that can interfere with functioning and well-being. Assessing the factors that contribute to resilience, effective coping with cancer, and positive psychological outcomes associated with the cancer experience is of increasing interest to researchers (Brennan, 2001; Cordova et al., 2001; Justice, 1999; Petrie et al., 1999; Tomich and Helgeson, 2002), and some of these studies show reductions in the need for medical visits with benefit finding (Stanton et al., 2002) (see section on Measuring Psychosocial Distress). This chapter reviews some of the psychosocial concerns that have been described among women at various points along the disease continuum.1 Estimates of the prevalence of psychosocial distress are then presented. The chapter concludes with a discussion of risk factors associated with psychosocial distress and methods that are available to identify women who are distressed and who may benefit from intervention.
Some of the most common psychosocial concerns reported by women with breast cancer include:
Fear of recurrence,
Physical symptoms such as fatigue, trouble sleeping, or pain,
Body image disruption,
Intrusive thoughts about illness/persistent anxiety,
Feelings of vulnerability, and
Existential concerns2 regarding mortality.
To some degree, these concerns are expected and are experienced by all women at some point after their diagnosis and treatment for breast cancer. There is variation, however, in the extent to which women accept these concerns, cope with them, and adapt to living with a degree of uncertainty about the future. Some women live in a state of persistent rumination about the illness and are overwhelmed with concerns about the inability to control what