To examine the relationship between self-esteem and the psychosocial response to cancer.
Methods
The authors review methodological issues associated with measuring self-esteem inpatients with cancer and examine existing empirical studies in light of these issues.
Results
Self-esteem in cancer has been variously viewed as an outcome variable, a mediator of other psychosocial outcomes, and as a personal resource that facilitates coping. Unidimensional measures of global self-esteem have been most often employed in research studies, despite increasing recognition that self-esteeem is multidimensional. Evaluation of global self-esteem has generally revealed no differences between cancer patients and controls. Aspects of multidimensional self-esteem, particularly body self-esteem, appears to be disturbed in many patients with cancer.
Conclusions
The clinical and theoretical literature have emphasized the importance of self-esteem to the psychosocial response to cancer. Empirical study of self-esteem in cancer has been limited by conceptual and methodological issues. Strategies for future research are discussed.
References
1.
CurbowB., SomerfieldM., LegroM.Self-concept and cancer in adults: theoretical and methodological issues.Soc Sci Med1990; 31: 115–128.
2.
MoosR.H., TsuV.D.The crisis of physical illness. In: MoosR., editor. Coping with physical illness.New York NY: Plenum Press;1977.
3.
TurkD.C.Factors influencing the adaptive process with chronic illness. In: SarasonI.G., SpielbergerD., editors. Stress and anxiety.Washington DC: Hemisphere;1979.
4.
WylieR.The self-concept: Vol 1. Lincoln NE: University of Nebraska Press;1974. Rev.ed.
5.
SchainW.S.Sexual functioning, self-esteem and cancer care. In: VaethJ., editor. Body image, self-esteem, and sexuality in cancer patients.San Francisco CA: Karger;1986.
6.
FoltzA.T.The influence of cancer on self-concept and life quality.Semin Oncol Nurs1987; 3: 303–312.
7.
McCraeR., CostaP.Age, personality and the spontaneous self-concept.J Gerontol Soc Sci1988; 43: 177–185.
RobsonP.J.Self-esteem - a psychiatric view.Br J Psychiatry153: 6–15.
10.
CrandallR.The measurement of self-esteem and related constructs. In: RobinsonJ.P., ShaverP.R., editors. Measures of social psychological attitudes.Ann Arbor MI: Institute for Social Research;1973.
11.
RosenbergM.Society and the adolescent self-image.Princeton NJ: Princeton University Press;1965.
12.
CoopersmithS.The antecedents of self-esteem.San Francisco CA: Freeman; 1967.
13.
JamesW.Principles of psychology.Cambridge MA: Harvard University Press;1981 (original work published 1890).
14.
WylieR.The self concept: Vol 2Lincoln NE: University of Nebraska Press; 1979. Rev.ed.
15.
WylieR.Measures of self-concept.Lincoln NE: University of Nebraska Press;1989.
16.
CurbowB., SomerfieldM.Use of the Rosenberg self-esteem scale with adult cancer patients.J Psychosoc Oncol1991; 9: 113–131.
17.
WellsL., MarwellG.Self-esteem: its conceptualization and measurement.Beverly Hills CA: Sage Publications; 1976.
18.
HatterS.Competence as a dimension of self-evaluation. In: LeahyR., editor. The development of the self.New York NY: Academic Press;1985.
19.
MarshH.W., ShavelsonR.J.Self-concept: its multi-faceted, hierarchial structure.Educ Psychologist1985; 20: 107–125.
20.
BowlbyJ.Loss sadness and depression.London UK: Hogarth Press;1980.
21.
KohutH.The restoration of the self.New York NY: International Universities Press; 1977.
22.
FreudS.The ego and the id. Standard edition XIX.London UK: Hogarth Press;1923.
23.
GreenacreP.Early physical determinants in the development of the sense of identity.J Am Psychoanal Assoc1958; 30: 827–848.
24.
SchilderP.The image and appearance of the human body.New York NY: International University Press; 1950.
25.
RosenbergM.Conceiving the self.New York NY: Basic Books; 1986.
26.
BibringE.The mechanism of depression. In: GreenacreP., editor. Affective disorders.New York NY: International University Press;1953.
27.
GergenK.The concept of self.New York NY: Holt; 1971.
28.
MarkusH., KundaZ.Stability and malleability of the self-concept.J Personal Soc Psychol1986; 51: 858–866.
29.
StolorowR.D., AtwoodG.E., BrandchaftB., editors., The intersubjective perspective.Northvale NJ: Jason Aronson Inc;1994.
30.
HayakawaS.Symbol status and personality.New York NY: Brace and World; 1963.
31.
EpsteinS.The self-concept, the traumatic neurosis, and the structure of personality. In: OzerD., HealyJ.M., StaratA.J., editors. Perspectives in personality.London UK: Jessica Kingsley;1991.
32.
MarkusH., WurfE.The dynamic self-concept: a social psychological perspective.Ann Rev Psychol1987; 38: 299–337.
33.
TurnerR.J., RoszellP.Psychosocial resources and the stress process. In: AvisonW.R., GotlibI.H., editors. Stress and mental health: contemporary issues and prospects for the future.New York NY: Plenum Press;1994.
34.
Janoff-BulmanR.Assumptive worlds and the stress of traumatic events: applications of the schema construct.Social Cognition1989; 7: 113–136.
35.
PearlinL.I., LiebermanM.A., MenaghanE.G.The stress process.J Health Soc Behav1981; 22: 337–356.
36.
DevinsG.M., BinikY.M., HollombyD.J.Helplessness and depression in end-stage renal disease.J Abnorm Psychol1981; 90: 531–545.
37.
RodinG., CravenJ., LittlefieldC.Depression in the medically ill: an integrated approach.New York NY: Brunner\Mazel; 1991.
38.
EriksonE.Identity and the life cycle.Psychol Issues1959; 1: 1–17.
39.
CaplanG., editor. Prevention of mental disorders in children: initial explorations.New York NY: Basic Books; 1961.
40.
Dreifuss-KattanE.O.Cancer stories: creativity and self repair.Hillsdale NJ: The Analytic Press;1990.
41.
CantorR.Self-esteem, sexuality and cancer-related stress. In: VaethJ., editor. Body image, self-esteem and sexuality in cancer patients.San Francisco CA: Karger;1986.
42.
GreerS., BurgessC.A self-esteem measure for patients with cancer.Psychol Health1987; 1: 327–340.
43.
ValentineA.Caring for the young adult with cancer.Cancer Nurs1978; 1: 385–389.
44.
MagesN., MendelsohnG.Effects of cancer on patients' lives: a personological approach. In: StoneG., editor. Health Psychology.San Francisco CA: Jossey-Bass;1979.
45.
QuigleyK.The adult cancer survivor: psychosocial consequence of cure.Sem Oncol Nurs1989; 5: 63–69.
46.
MuslinH.L.Transformations of the self in cancer.Int J Psychiatry Med1984; 14: 109–121.
47.
WestD.W.Social adaptation patterns among cancer patients with facial disfigurement resulting from surgery.Arch Phys Med Rehabil1977; 58: 473–479.
48.
BreitbartW., HollandJ.Psychosocial aspects of head and neck cancer.Sem Oncol1988; 15: 61–69.
49.
BronheimH., StrainJ.J., BillerH.F.Psychiatric aspects of head and neck surgery, Part II: Body image and psychiatric intervention.Gen Hosp Psychiatry1991; 13: 225–232.
50.
KosterM., BergsmaJ.Problems and coping behaviour of facial cancer patients.Soc Sci Med1990; 30: 569–578.
51.
DropkinM.Coping with disfigurement and dysfunction after head and neck cancer surgery.Sem Oncol Nurs1989; 5: 213–219.
52.
FilippS.Could it be worse? The diagnosis of cancer as a prototype of traumatic life events. In: MontadaL., FilippS.H., LernerM.J., editors. Life crises and experiences of loss in adulthood.Hillsdale NJ: Lawrence Erlbaum Assoc;1992.
53.
DevinsG.M., StamH.J., KoopmansJ.P.Psychological impact of laryngectomy mediated by perceived stigma and illness intrusiveness.Can J Psychiatry1994; 39: 608–616.
54.
GoldbergR., CullenL.Depression in geriatric cancer patients: guide to assessment and treatment.The Hospice Journal1986; 2: 79–98.
55.
WortmanC.B., Dunkel-SchetterC.Interpersonal relationships and cancer: a theoretical analysis.J Soc Issues1979; 35: 120–155.
56.
HollandJ., RowlandJ.Handbook of psychooncology.Don Mills ON: Oxford University Press; 1990.
57.
DerogatisL.R., MorrowG.R., FettingJ.The prevalence of psychiatric disorders among cancer patients.J Am Med Assoc1983; 249: 751–757.
58.
HobfollS.E., WalfischS.Coping with a threat to life: a longitudinal study of self-concept, social support, and psychosocial distress.Am J Community Psychol1984; 12: 87–100.
59.
SomerfieldM., CurbowB.Methodological issues and research strategies in the study of coping with cancer.Soc Sci Med1992; 34: 1203–1216.
60.
EllK.O., MantellJ.E., HamovitchM.B.Social support, sense of control, and coping among patients with breast, lung and colorectal cancer.J Psychosoc Oncol1989; 7: 63–89.
61.
DirksenS.R.Perceived well-being in malignant melanoma survivors.Oncol Nurs Forum1989; 16: 353–358.
62.
GreenbergV., RyszczynskiJ., SolomonS.The causes and consequences of a need for self-esteem: a terror management theory. In: BaumeisterR.F., editor. Public self and private self.New York NY: Springer-Verlag;1986. p 189–212.
63.
CellaD.F.Cancer survival: psychosocial and public issues.Cancer Invest1987; 5: 59–67.
64.
DaiterS., LarsonR.A., WeddingtonW.W.Psychosocial symptomatology, personal growth and development among young adult patients following the diagnosis of leukemia or lymphoma.J Clin Oncol1988; 6: 613–617.
65.
TaylorS.E., BrownJ.D.Illusion and Wellbeing: a social psychological perspective on mental health.Psychol Bull1988; 103: 193–210.
66.
TaylorS.E., AspinwallL.G.Psychosocial aspects of chronic illness. In: CostaP.T., VandenbosG.R., editors. Psychological aspects of serious illnessWashington DC: American Psychological Association; 1990. p 3–60.
67.
WatsonP.G.The effects of short-term postoperative counselling on cancer/ostomy patients.Cancer Nurs1983; 21–29.
68.
GreerS., MooreyS., BaruchJ.D.Adjuvant psychological therapy for patients with cancer.Br Med J1992; 304: 675–680.
69.
BlaskovitchJ., TomakaJ.Measures of self-esteem. In: Measures of personality and social psychological attitudes.New York NY: Academic Press;1991.
70.
FittsW.Tennessee self-concept scale: manual.Los Angeles CA: Western Psychological Services; 1965.
71.
WrightJ.G., FeinsteinA.R.A comparative contrast of clinimetric and psychometric methods for constucting indexes and rating scales.J Clin Epidemiol1992; 45: 121–128.
72.
RaskinR., NovacekJ., HoganR.Narcissism, self-esteem and defensive self-enhancement.J Pers1991; 59: 19–38.
73.
O'BrienE.J.1985 Global self-esteem scales: unidimensional or multidimensional?.Psychol Rep1985; 57: 383–389.
74.
EaglyA.H.Involvement as determinant of response to favorable and unfavorable information.J Pers Soc Psychol1967; 9: 1–15.
75.
BerkowitzR., MareaA.T., HamiltonN.Psychological and social impact of gestational trophoblastic neoplasia.J Reprod Med1980; 25: 14–16.
76.
NoyesR., KatholR.G., Debelius-EnemarkP.Distress associated with cancer as measured by the illness distress scale.Psychosom1990; 31: 321–330.
77.
HopwoodP.The assessment of body image in cancer patients.Eur J Cancer.1993; 29A: 276–281.
78.
KahaneD.H.The management of the psychosocial impact of breast cancer.Nurse Pract Forum1994; 4: 105–109.
79.
WareJ.E., SherbourneC.D.The mos 36–item short form health survey (SF-36). 1. Conceptual framework and item selection.Med Care1992; 30: 473–481.
80.
PatrickD.L., DeyoR.A.Generic and disease specific measures in assessing health status and quality of life.Med Care1989; 27(Suppl): 217–232.
81.
CellaD.F., TrossS.Psychological adjustment to survival from Hodgkin's disease.J Consult Clin Psychol1986; 54: 616–622.
82.
ZemoreR., ShepelL.F.Effects of breast cancer and mastectomy on emotional support and adjustment.Soc Sci Med1989; 28: 19–27.
83.
LewisM.S., GottesmanD., GutsteinS.The course and duration of crisis.J Consult Clin Psychol1979; 47: 128–134.
84.
GottesmanD., LewisM.S.Differences in crisis reactions among cancer and surgery patients.J Counsel Clin Psychol1982; 50: 381–388.
85.
DoughertyK., TemplerD.I., BrownR.Psychological status in terminal cancer patients as measured over time.J Counsel Psychol1986; 33: 357–359.
86.
VinokurA.D., ThreattB.A., CaplanR.D.Physical and psychosocial functioning and adjustment to breast cancer.Cancer1989; 63: 394–405.
87.
WolcottD.L., WellischD.K., FawzyFlAdaptation of adult bone marrow transplant recipient long-term survivors.Transplantation1986; 41: 478–484.
88.
PenmanD.T., BloomJ.R., FetopoulosS.The impact of mastectomy on self-concept and social function: a combined cross-sectional and longitudinal study with comparison groups.Women Health1987; 11: 101–130.
89.
SmithK., OstroffJ., TanC.Alterations in self-perceptions among adolescent cancer survivors.Cancer Invest1991; 9: 581–588.
90.
MorrisC.Self-concept as altered by the diagnosis of cancer.Nurs Clin North Am1985; 20: 611–630.
91.
BakerF., CurbowB., WingardJ.R.Development of the satisfaction with life domains scale for cancer.J Psychosoc Oncol1992; 10: 75–90.
92.
StraussR.Psychosocial responses to oral and maxillofacial surgery for head and neck cancer.J Oral Maxillofac Surg1989; 47: 343–348.
93.
NeulingS., WisefieldH.Social support and recovery after surgery for breast cancer.Soc Sci Med1988; 27: 385–392.
94.
VinokurA., ThreattB.A., Vinokur-KaplanD.The process of recovery from breast cancer for younger and older patients.Cancer1990; 65: 1242–1254.
95.
BloomJ., RossR.Measurement of the psychosocial aspects of cancer. In: CohenJ., editor. Psychosocial aspects of cancer.New York NY: Raven Press;1982.
96.
RevensonT.A., WollmanC.A., FeltonB.J.Social supports as stress buffers for adult cancer patients.Psychosom Med1983; 45: 321–331.
97.
FeatherB., WainstockJ.Perceptions of postmastectomy patients. Part 2.Cancer Nurs1989; 12: 301–309.
98.
LasryJ., MargoleseR.G., PoissonR.O.Depression and body image following mastectomy and lumpectomy.J Chron Dis1987; 40: 529–534.
99.
SchainW., WellischD.K., PasnauR.O.The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction.Am J Psychiatry1985; 142: 40–46.
100.
KemenyM.M., WellischD.K., SchainW.S.Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer.Cancer1988; 62: 1231–1237.
101.
SteinbergM.D., JulianoM.A., WiseL.Psychological outcome of lumpectomy vs mastectomy in the treatment of breast cancer.Am J Psychiatry1985; 142: 34–39.
102.
FallowfieldL.Psychosocial adjustment after treatment for early breast cancer.Oncology1990; 4: 89–97.
103.
MockV.Body image in women treated for breast cancer.Nurs Res1993; 42: 153–157.
104.
GambaA., RomanoM., GrossoI.M.Psychosocial adjustment of patients surgically treated for head and neck cancer.Head Neck1992; 14: 218–223.
105.
FreedlanderE., EspieC.A., CampsicL.M.Functional implications of major surgery for intraoral cancer.Br J Plastic Surgery1989; 42: 266–269.
106.
MacDonaldL., AndersonH.Stigma in patients with rectal cancer: a community study.J Epidemiol Community Health1984; 38: 284–290.
107.
KrouseJ.H., KrouseH.J., FabianR.L.Adaptation to surgery for head and neck cancer.Laryngoscope1989; 99: 789–794.
108.
CurbowB., SomerfieldM., BakerF.Personal changes, dispositional optimism and psychological adjustment to bone marrow transplantation.J Behav Med. Forthcoming.
109.
YoussefF.A.Crisis intervention: a group-therapy approach for hospitalized breast cancer patients.J Adv Nurs1984; 9: 307–313.
110.
TempelaarR., DehaesJ.C., DeRuiterJ.H.The social experiences of cancer patients under treatment: a comparative study.Soc Sci Med1989; 29: 635–642.
111.
ItanoJ., TanabeP., LumJ.L.Compliance of cancer patients to therapy.Wes J Nurs Res1983; 5: 5–16.
112.
HislopT.G., WaxlerN.E., GoldmanA.J.The prognostic significance of psychosocial factors in women with breast cancer.J Chron Dis1987; 40: 729–735.
113.
JamisonR.N., BurishT.G., WallstonK.A.Psychogenic factors in predicting survival of breast cancer patients.J Clin Oncol1987; 5: 768–772.
114.
FerlicM., GoldmanA., KennedyB.J.Group counselling in a adult patients with advanced cancer.Cancer1979; 43: 760–766.
115.
LinnM.W., LinnB.S., HarrisR.Effects of counselling for late stage cancer patients.Cancer1982; 49: 1048–1055.
116.
WordenJ., WeismanA.Preventive psychosocial intervention with newly diagnosed cancer patients.Gen Hosp Psychiatry1984; 6: 243–249.
117.
ChristensenD.N.Post mastectomy couple counselling: an outcome study of a structured treatment protocol.J Sex Mark Ther1983; 9: 266–274.
118.
SpeigelD., BloomJ.R., YalomL.Group support for patients with metastatic cancer.Arch Gen Psychiatry1981; 38: 527–533.
119.
MooreyS., GreerS.Psychological therapy for patients with cancer: anew approach.Washington DC: American Psychiatric Press;1989.
120.
GoldenW.L., GershW.D., RobbinsD.M.Psychological treatment of cancer patients: a cognitive-behavioral approach.Boston MA: Allyn and Bacon;1992.
