Psychosocial Adaptation in Breast Cancer Patients: A Mixed-Methods sequential Explanatory Study

Qing Li,1,* Juan Song,2,* YuQin Chen,3 XueQin Jin2 1Operating Theatre, Kunshan Fourth People’s Hospital, Kunshan, Jiangsu, People’s Republic of China; 2Oncology Ward, Kunshan First People’s Hospital, Kunshan, Jiangsu, People’s Republic of China; 3Thyroid and Breast Surgical Ward, Kunshan Second People’s Hospital, Kunshan, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing Li, Operating theatre, Kunshan Fourth People’s Hospital, Kunshan, Jiangsu, People’s Republic of China, Email [email protected]: Breast cancer is the leading cause of death among women. Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis through treatment. However, knowledge of the levels of heterogeneity in psychosocial adaptation and its influencing factors in breast cancer patients is limited.Objective: To examine the psychosocial adaptation trajectories of breast cancer patients from diagnosis to the chemotherapy phase and to explore the facilitators and barriers influencing their psychosocial adaptation.Methods: Latent class growth modeling was used to analyze the latent classes of psychosocial adaptation trajectories. Colaizzi’s seven-step method was used to analyze the qualitative data.Results: Three distinct psychosocial adaptation trajectories were identified in breast cancer patients: high-stable, moderate-declining, and low-increasing adaptation groups.The individuals within the three psychosocial adaptation categories share identical growth trajectories but exhibit different growth patterns. Category 1, the “High-stable adaptation group”, comprised 51 individuals (30.9% of the total sample), with an average intercept of 176.85 (P< 0.001) and a slope of − 0.032 (P=0.977). Category 2, the “Moderate-declining adaptation group”, included 54 individuals (32.7% of the total sample), with an average intercept of 142.77 (P< 0.001) and a slope of − 1.78 (P=0.381). Category 3, the “Low-increasing adaptation group” consisted of 60 individuals (36.4% of the total sample), with an average intercept of 105.04 (P< 0.001) and a slope of 13.13 (P< 0.001). Predictive factors for different trajectory groups included monthly income, type of surgery, and pathological stage. Through semi-structured interviews, three themes were identified for facilitators and barriers. Facilitators included personal resources, social resources, and family resources, while barriers included complications and adverse drug reactions, heavy economic burden, and cognitive changes.Conclusion: Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis to chemotherapy. The trajectory predictors and barriers identified in this study can assist healthcare providers in offering personalized, targeted interventions and plans to promote psychosocial adaptation in breast cancer patients.Keywords: breast cancer, psychosocial adaptation, ABC-X model of stress, latent class growth model