Coping and Stress among Breast Cancer Survivors in China

Background: Patient navigation for breast cancer survivors is an emerging practice in China.  US cancer patient navigation models documented program successes in reducing barriers to care, increasing timely care, and improving survivor mental health and 5-year survival.  Replicating these successes in health care systems like China has not been studied.

Methods: In partnership with Nanjing Cancer Survivors Association in China, 150 breast cancer (BC) survivors were recruited to complete a self-assessment as part of a study of patient navigation. Mental health measures included perceived stress and 14 measures of coping. Mean differences on stress and coping scales were analyzed for demographic and breast cancer health variables.

Results: Mean stress levels were highest for those with BC stage 3 and 4 diagnoses (p=0.067).  Overall, coping scores did not vary by demographics and most health factors. BC survivors in their first year of diagnosis were more likely to use active copying (p=0.000), instrumental support (p=0.006), positive reframing (p=0.019), acceptance (p=0.000) and functional social support (p=0.000).  Survivors diagnosed 2-5 years previously were more likely to use distraction (p=0.002) as a form of coping. 

Conclusion: Intensive treatment for BC occurs primarily in the first year after diagnosis explaining the many types of coping mechanisms used by BC survivors. Distraction from thoughts of breast cancer is understandable in the years after treatment completion.  Surprisingly, longer term survivors reported few coping mechanisms. Patient navigation programs need to be prepared to meet the many health and mental health needs of those newly diagnosed.