Centrality of event and cancer-related post-traumatic stress symptoms: an explorative analysis in Danish and Palestinian breast cancer patients (#288)
Background: Cancer diagnosis has been associated with post-traumatic stress (PTS). Several risk factors may influence the development of PTS-symptoms, including the degree to which the cancer diagnosis is construed as a central reference point for the patients’ personal identities.
Aim: To investigate the association between centrality of the cancer diagnosis and PTS-symptoms and explore possible differences between two culturally distinct samples.
Methods: As part of two larger studies, 489 of 643 Palestinian women (mean age: 47.6 yrs) and 683 of 992 Danish women (mean age: 58.1 yrs) treated for breast cancer completed cancer-related versions of the Centrality of Event Scale (CES) and the Impact of Event Scale-Revised (IES-R).
Results: Palestinian women had considerably higher IES-scores (M=39.85; SD=13.7) than Danish women (M=15.68; SD=21.73) (p>0.001). In contrast, Danish women showed higher CES-scores (M=22.25, SD=6.57) than Palestinian women (M=19.48, SD=6.58) (p>0.001). When adjusting for demographic and clinical variables in multiple regressions, adding CES-scores to the model yielded a slightly higher increase in R2 in the Danish (∆R2=0.29) than in the Palestinian (∆R2=0.23) sample. In the Palestinian sample, IES-scores were associated with higher CES-scores (β=0.52, p<0.001; CI:0.91-1.24), not receiving radiotherapy (β=0.24, p<0.001; CI:-9.90 to -4.97), higher educational level (β=0.11, p<0.01; CI:1.01-5.98), and number of children (β=0.12, p<0.01; CI:0.22-1.41). In the Danish sample, CES-scores (β=0.57, p<0.001; CI:1.44-1.82), older age (β=0.10, p<0.05; CI:0.04-0.39), and lower educational level (β=0.13, p<0.001; CI:-11.49 to -3.84) predicted IES-scores.
Conclusions: The degree to which the cancer diagnosis is perceived as central to identity may increase PTS-symptomatology. Although Palestinian women, compared to Danish women, experienced more PTS-symptoms and perceived the diagnosis as less central to their identity, the centrality of the cancer remained a significant predictor in Palestinian women. Furthermore, different demographic and clinical factors appeared to predict PTS-symptoms in the two culturally distinct samples. Further exploration of cultural differences is needed.