From December 2009 to August 2011, the KCR was able to contact 1903 (71.3%) of the 2668 women eligible to participate in this study. Forty-two percent (n=1117) of women agreed to be contacted by the SRC. Of these, 85.1% were reached by the SRC (n=951), and approximately 59.6% (n=567) completed the interview; 14 women declined to answer the IPV questions and were excluded from the analysis. Nonrespondents (n=567) did not differ from respondents by age (t test=1.14, p=0.14), yet nonrespondents were more likely to be of nonwhite race (9.3%) (chi-square=6.54, p=0.01) relative to respondents (5.3%), and nonrespondents were less likely to be diagnosed with breast cancer (77.5%) (chi-square=6.04, p=0.05). We had no other demographic or cancer-related attribute with which to compare nonresponders with responders.
In this sample of 553 women with either breast (n=461, 83.3%), colorectal (n=60, 10.9%), or cervical cancer (n=32, 5.8%), the mean age was 57.9 years (SD=11.4). Among women who reported being in a relationship at diagnosis, 10.6% (44 women of 414) disclosed physical, sexual, or psychologic IPV by a current partner or their partner at cancer diagnosis; 1.7% disclosed current physical IPV (n=7); 0.2% reported current sexual IPV (n=1); and 10.1% (n=42) disclosed current psychologic IPV. Lifetime IPV was disclosed by 37.1% (n=205 of 553 women), with 7.1% (n=39) disclosing sexual IPV, 22.8% (n=126) disclosing physical IPV, and 34.5% (n=191) disclosing psychologic abuse. The overwhelming majority (91%) of those disclosing physical or sexual IPV also disclosed psychologic abuse.
Sixty-one percent of women had at least one symptom of depression after diagnosis, and 18% had four or more symptoms. The majority (84.3%) had at least one comorbid condition, and 50% had two or more conditions. Ten percent of women scored as having high stress levels at diagnosis (defined as responding often or very often to all PSS items), and 2% responded as having high stress levels in the past month using this same definition.
shows the associations between lifetime IPV and demographic attributes and other cancer risk factors. Relative to women not disclosing IPV, women disclosing IPV were significantly (p≤0.05) younger, less likely to be married, and more likely to have lower monthly incomes, to smoke cigarettes, to have a history of CSA, to be less satisfied with their relationships with friends, and to have been diagnosed with cervical cancer vs. breast or colorectal cancer.
provides the results of MANCOVA analyses and presents the adjusted means, standard deviation and p values for cancer-related well-being outcomes. The MANCOVA test results for both IPV and CSA were statistically significant (IPV: Wilks's Lambda=0.96, F (6, 527)=3.65, p=0.002; CSA: Wilks's Lambda=0.974, F (6, 527)=2.37, p=0.03), which indicates that the null hypothesis, that IPV and CSA had no overall effect on correlated outcomes indicative of cancer-related well-being, should be rejected. The models included all correlated outcomes presented in with the primary dichotomous independent variables of (1) IPV and (2) CSA. Note that separate models were run for FACT-B and four subscales.
Briefly, when compared with never experiencing IPV, lifetime IPV was significantly associated with lower FACT-B scores (F=7.51, p=0.006), FACT-B subscales of social/family (F=7.22, p=0.007) and emotional (F=7.69, p=0.006), FACIT-Sp scores (F=4.47, p=0.03), and PSS scores immediately after diagnosis (F=7.50, p=0.006), in the past month (F=4.42, p=0.04), and with higher depressive symptom scores after diagnosis (F=20.56, p<0.0001). When compared with never experiencing CSA (n=493) after adjustment for confounders including IPV, CSA (n=60) was associated with lower FACT-B scores (5.39, p=0.02), specifically FACT-physical (F=6.81, p=0.01) and FACT-function subscales (F=6.00, p=0.01), more comorbid physical conditions (F=2.03, p=0.03), and higher PSS scores during the past month (F=4.21, p=0.04).
The statistically significant results of MANCOVA for IPV by timing (Wilks's Lambda=0.95, F (12, 1052)=2.28, p=0.008) and IPV by type (Wilks's Lambda=0.938, F (12, 1052)=2.86, p=0.0007) again indicated that IPV timing and type did have an effect on these correlated outcomes. As presented in , current IPV (n=44) was associated with lower FACT-b social/family (f=13.13, p=0.0003) and emotional subscale scores (F=7.33, p=0.007), higher PSS scores for the past month (F=5.50, p=0.02), and higher depressive symptom scores after diagnosis (F=8.08, p=0.005). Past IPV (excluding current abuse) was associated with lower FACT-emotional subscale scores (F=4.48, p=0.03), higher PSS scores after diagnosis (F=6.61, p=0.01), and higher depressive symptoms scores (F=17.08, p<0.0001). Disclosing either physical or sexual IPV (n=133) was associated with lower FACT-emotional subscale scores (F=5.32, p=0.02), higher PSS scores after diagnosis (F=4.74, p=0.04), and higher depressive symptoms scores (F=18.96, p<0.0001). Disclosing psychologic IPV (excluding physical or sexual IPV) was associated with lower FACT-B scores (F=8.97, p=0.003) and with FACT-B subscales for social/family (F=8.06, p=0.005), emotional (F=6.02, p=0.01), and function (F=7.38, p=0.007), lower FACIT-Sp scores (F=11.13, p=0.0008), higher PSS scores at diagnosis (F=7.64, p=0.006) and in the past month (F=8.65, p=0.003), and higher depression scores at diagnosis (F=9.36, p=0.002).