Psychological well-being, acceptance and psychological flexibility, in breast cancer patients undergoing mastectomy or lumpectomy

Abstract

Background: Female patients with breast cancer are in a context with a strong emotional impact that requires adaptability and resilience. The psychological well-being and psychological flexibility and the ability of acceptance, may be considered protective factors. The aim of this study is to evaluate the psychological well-being (Ryff, 1989), and the acceptance and psychological flexibility in the ACT model (Hayes, 1999), in patients undergoing mastectomy, or lumpectomy or patients that have not performed interventions. Methods: Patients were asked to complete questionnaires on clinical state (RSCL, GHQ, Distress Thermometer (DT)), eating behaviour (TFE.Q-51), body image acceptance (BIAAQ), psychological flexibility and acceptance (AAQ-2) and psychological well-being (PWBQ). The patients were divided into two groups: 1- patients without surgery and patients with breast-conserving surgery (lumpectomy) and 2- patients with mastectomy. Results: Fifty consecutive patients (mean age = 54 years (SD 9,28)), have completed the questionnaires; t-test showed significant differences in two groups (group 1: M 55,22; SD 9,22; groups 2: M 49,57; SD 7,89). Both groups of patients showed high psychological distress (GHQ - group 1: M 4,08; SD 2,5; BIAAQ- groups 2: M 4,45; SD 3,7); (DT - group 1: M4,87; SD 2,19; DT - groups 2: M 5,15; SD 2,44), and high physical distress (RSCL - group 1: M 17,97; SD 10,54; BIAAQ- groups 2: M 25,32; SD 20,35). The data show a high well-being (PWBQ - group 1: M 75,98; SD 11,07; PWBQgroups 2: M 79,50; SD 11,27) and a high acceptance and psychological flexibility (AAQ-2 - group 1: M 43,54; SD 11,16; AAQ-2 - groups 2: M 46,61; SD 11,01). Conclusion: Our study shows a good level of general well-being for both groups. However, a very interesting aspect is that women without surgery and with breast-conserving surgery (groups 1), have lower levels of acceptance and less psychological flexibility. At the same time, this outcome shows that psychological flexibility is independent from suffering. We believe that this finding is relevant for clinical practice. It suggests that acceptance and then psychological flexibility, are independent factors to be evaluated in the assessment process of cancer patients.