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Clusters of Psychological Symptoms in Breast Cancer

Is There a Common Psychological Mechanism?

Guimond, Anne-Josée, MA; Ivers, Hans, PhD; Savard, Josée, PhD

doi: 10.1097/NCC.0000000000000705
Article: PDF Only

Background Breast cancer patients tend to experience numerous concurrent psychological symptoms that form clusters. It has been proposed that a common psychological mechanism may underlie the membership of symptoms in a given cluster, but this hypothesis has never been investigated. Maladaptive emotion regulation (ER) is one possible common mechanism.

Objective This study examined cross-sectional and prospective relationships between subjective (experiential avoidance, expressive suppression, and cognitive reappraisal) and objective (high-frequency heart rate variability) measures of ER and clusters of psychological symptoms among women receiving radiation therapy for breast cancer.

Method A total of 81 women completed a battery of self-report scales before (T1) and after (T2) radiotherapy, including measures of anxiety, depression, fear of cancer recurrence, insomnia, fatigue, pain, and cognitive impairments. Resting high-frequency heart rate variability was measured at T1.

Results Latent profile analyses identified between 2 and 3 clusters of patients with similar levels of symptoms at T1 and T2 and with a similar profile of symptom changes between T1 and T2. Discriminant analyses showed that higher levels of avoidance and suppression predicted membership in symptom clusters that included more severe symptoms cross-sectionally at T1 and at T2 (both P values < .0001). However, ER at T1 did not significantly predict membership in clusters of symptom changes between T1 and T2 (P = .15).

Conclusion Maladaptive ER strategies, more particularly suppression and avoidance, are a possible psychological mechanism underlying clusters of cancer-related psychological symptoms.

Implications for Practice Psychological interventions targeting maladaptive ER strategies have the potential to treat several psychological symptoms simultaneously.

Author Affiliations: School of Psychology, Université Laval; CHU de Québec-Université Laval Research Center; and Université Laval Cancer Research Center, Québec, Canada.

This study was supported by scholarships from the Fonds de recherche du Québec–Santé and from the Psychosocial Oncology Research Training Program (Canadian Institutes of Health Research) held by the first author.

The authors have no conflicts of interest to disclose.

Correspondence: Josée Savard, PhD, CHU de Québec-Université Laval Research Center, 11 Côte du Palais, Québec, Québec, Canada (

Accepted for publication January 1, 2019.

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