Abstract
<p>Breast cancer survivors experience significant symptom burden during active treatment and survivorship. Psychosocial factors, such as coping, may influence the course of treatment-related physical and psychological symptomatology. Disengagement coping in particular, may be relevant to breast cancer survivors’ symptom experience. Yet, classification of individual coping responses to comprise a higher order category of disengagement coping remains ambiguous, and research investigating the role of disengagement coping on the trajectory of physical and psychological symptoms in breast cancer survivors has yielded inconsistent findings. This study aimed to test a mediation model elucidating the longitudinal relationship between a latent construct of disengagement coping at the time of diagnosis and depressive symptoms 5 years later via pain and fatigue interference during the initial 12 month period of primary treatment for breast cancer. Stage 0-III breast cancer patients (N=240) were recruited 4 to 10 weeks post-surgery and completed a baseline (T1) questionnaire measuring coping responses, pain, fatigue, and depressive symptoms. Women were reassessed 6-months (T2) and 12-months (T3) post-study enrollment. A long-term follow-up 5-years post-surgery (T5) was also conducted among available cases to assess depressive symptoms and general health status. A single factor confirmatory factor analysis was conducted to investigate whether behavioral disengagement, denial, self-blame, and venting share a common variance indicative of disengagement coping. Structural equation modeling was used to test the proposed mediation model. After taking into account modification indices recommended by the <em>Mplus</em> program, a measurement model consisting of behavioral disengagement, denial, self-blame, and self-distraction exhibited good model-data correspondence, suggesting that these coping strategies may constitute a higher order category of disengagement coping. Results from structural equation modeling did not reveal direct effects relating a latent construct of disengagement coping at T1 and long-term depressive symptoms at T5 or pain and fatigue interference at T3, nor was there evidence to suggest mediation between T1 disengagement coping and T5 depressive symptoms via T3 pain and fatigue interference. However, more depressive symptoms at T3 (β = .39, SE = .12, z = 3.02, 95% CI [.16, .62], <em>p</em> < .01) and receipt of chemotherapy within three weeks of the T3 assessment (β = .30, SE = .07, z = 4.07, 95% CI [.16, .43], <em>p</em> < .001) were associated with greater depressive symptomatology during survivorship (T5). Findings from the current study expand upon previous coping research exploring classifications of disengagement coping techniques. Moreover, results highlight the relevance of assessing for depressive symptoms and receipt of chemotherapy 12 months post-diagnosis, as these characteristics may relate to worse psychological functioning well into the survivorship phase. Additional research is warranted to clarify the relationship between disengagement coping, physical symptomatology, and long-term psychological functioning of breast cancer survivors.</p>