Unmet Supportive Care Needs Among Women With Breast and Gynecological Cancer: Relevance of Attachment Anxiety and Psychological Distress

Johanna Graf; Florian Junne; Johannes C Ehrenthal; Norbert Schäffeler; Juliane Schwille-Kiuntke; Andreas Stengel; Anja Mehnert-Theuerkauf; Lennart Marwedel; Sara Y Brucker; Stephan Zipfel; Martin Teufel

doi:10.3389/fpsyg.2020.558190

Unmet Supportive Care Needs Among Women With Breast and Gynecological Cancer: Relevance of Attachment Anxiety and Psychological Distress

Front Psychol. 2020 Oct 21:11:558190. doi: 10.3389/fpsyg.2020.558190. eCollection 2020.

Authors

Johanna Graf^{1

2}, Florian Junne¹, Johannes C Ehrenthal³, Norbert Schäffeler^{1

2}, Juliane Schwille-Kiuntke^{1

4}, Andreas Stengel^{1

2

5}, Anja Mehnert-Theuerkauf⁶, Lennart Marwedel¹, Sara Y Brucker⁷, Stephan Zipfel^{1

2}, Martin Teufel⁸

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
² Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany.
³ Institute of Medical Psychology, Heidelberg University, Heidelberg, Germany.
⁴ Institute of Occupational and Social Medicine and Health Services Research, University of Tuebingen, Tuebingen, Germany.
⁵ Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
⁶ Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
⁷ Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany.
⁸ Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital, Essen, University of Duisburg-Essen, Essen, Germany.

Abstract

Objective: Attachment anxiety and avoidance are known risk factors for the development of unmet needs and poor well-being among patients with chronic diseases. Few studies have addressed this in individuals with cancer. We aimed to explore the relationship between supportive care needs, attachment styles and distress in women with breast and gynecological cancer.

Methods: Using a cross-sectional paper-pencil (n = 157) and online survey (n = 614), a total of 771 patients with breast or gynecological cancer completed a set of validated questionnaires. From September 2013 to January 2014, consecutive inpatients and outpatients of the university hospital Tuebingen were included in the study. Further, participants were recruited through social media, patient internet platforms, self-help group leaders and patient networks. We used the Supportive Care Needs Survey (SCNS-SF-34) with the need dimensions: health system, patient care, psychological, physical, and sexual needs, as well as the Experiences in Close Relationships-Revised Questionnaire, and the Distress Thermometer. A multiple linear regression model was used to analyze the influence of attachment styles (anxiety and avoidance) on the SCNS-SF-34 dimensions. A moderation analysis was used to explore the influence of the interaction between attachment anxiety and distress for all SCNS-SF-34 dimensions.

Results: Attachment anxiety was a significant determinant and led to higher unmet supportive care needs in all dimensions, whereas attachment avoidance was not significant. Distress did moderate the relationship between attachment anxiety and psychological and health system needs and led to a higher unmet needs development. For the other SCNS-SF-34 dimensions, distress was not confirmed as a moderator.

Conclusion: Our findings highlight attachment anxiety as a risk factor for the development of unmet supportive care needs and potentially impaired psychological adjustment to cancer. Further studies are needed to elucidate the interactions between attachment styles, distress and supportive care needs among cancer patients.

Keywords: attachment anxiety; attachment styles; distress; psychooncology; supportive care needs; unmet needs.