Use of coping strategies and breast cancer survival: Results from the black/white cancer survival study

This analysis was designed to evaluate the association between coping strat egies and breast cancer survival among Black and White women in a large pop ulation-based study. A total of 442 Black and 405 White US women diagnosed with invasive breast cancer during 1985-1986 and actively followed for surv ival through 1994 were administered a modified Folkman and Lazarus Ways of Coping questionnaire. Coping strategies were characterized via factor analy ses of the responses. Hazard ratios associated with coping strategies were estimated using Cox proportional hazards models, with adjustment for age, r ace, tumor stage, study location, tumor hormone responsiveness, comorbidity , health insurance status, smoking, relative body weight, and alcohol consu mption. Emotion-focused coping strategies were significantly associated wit h survival. Expression of emotion was associated with better survival (haza rd ratio = 0.6; 95% confidence interval: 0.4, 0.9). When it was considered jointly with the presence or absence of perceived emotional support, women reporting low levels of both emotional expression and perceived emotional s upport experienced poorer survival than women reporting high levels of both (hazard ratio = 2.5; 95% confidence interval: 1.7, 3.7). Similar risk rela tions were evident for Blacks and Whites and for patients with early and la te stage disease. These results suggest that the opportunity for emotional expression may help improve survival among patients with invasive breast ca ncer.