1. ¹Department of Oncology, Medical School, University of Tampere, FIN-33014 Helsinki, Finland
2. ²Department of Psychology, University of Tampere, FIN-33014 Helsinki, Finland
3. ³Finnish Cancer Registry, Liisankatu 21 B, FIN-00170 Helsinki, Finland
4. ⁴Department of Health and Functional Capacity, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland
5. ⁵Department of Oncology, Tampere University Hospital, FIN-36280 Pikonlinna, Finland

Correspondence: Dr U-S Lehto, Department of Health and Functional Capacity (TTO), National Public Health Institute KTL, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail: ulla-sisko.lehto-jarnstedt@ktl.fi

Received 19 December 2005; Revised 13 March 2006; Accepted 13 March 2006.

Abstract

Despite the large number of studies on the impact of psychosocial factors on breast cancer progression, there is no certainty about the contributing factors or processes involved. We investigated the relative impacts of socioeconomic, psychological, and psychosocial factors on survival in breast cancer. A consecutive sample of 102 patients (participation 82%) under 72 years of age with locoregional breast cancer completed validated questionnaires on coping with cancer, emotional expression (anger), perceived available support, noncancer life stresses, and quality of life 3-4 months after diagnosis. Survival times were measured from the date of diagnosis to the date of relapse and further to the date of death or date of last follow-up. Cumulative Cox regression analyses were carried out. After controlling for biological prognostic factors, age, and baseline treatment, longer survival was predicted by a long education and a minimising-related coping, while shorter survival was predicted by emotional defensiveness (antiemotionality), behavioural-escape coping, and a high level of perceived support. A shorter event-free time was also predicted by unemployment and depressive symptoms. Cancer survival is affected by a complex combination of psychosocial factors, among which minimising predicts a favourable prognosis and anger nonexpression and escape behaviour an unfavourable prognosis. Higher socioeconomic status is associated with longer survival. High scores in well-being scales may reflect emotional nonexpression.