Journal of Loss and Trauma, 16:229242, 2011

Copyright # Taylor & Francis Group, LLC

ISSN: 1532-5024 print=1532-5032 online
DOI: 10.1080/15325024.2010.519292

Cancer Diagnostic Group Differences in

Posttraumatic Growth: Accounting for
Age, Gender, Trauma Severity, and
Distress

BRONWYN A. MORRIS
National Human Genome Research Institute, National Institutes of Health,
Bethesda, Maryland, USA

JANE SHAKESPEARE-FINCH
School of Psychology and Counselling, Queensland University of Technology,
Kelvin Grove, Queensland, Australia

The type of cancer diagnosed can have a differential impact

on postdiagnosis adjustment (e.g., coping strategies, likelihood to
complete treatment). Investigations examining cancer diagnostic
differences in posttraumatic growth (PTG) are yet to be published.
The current study examined 235 participants who had been
treated at a regional hospital for all forms of cancer. Group differ-
ences in PTG were assessed through a cross-sectional design
between breast, prostate, hematological, and colorectal cancer sur-
vivors. Results demonstrated that breast cancer survivors reported
significantly higher levels of PTG than those diagnosed with colo-
rectal and hematological malignancies, but not significantly dif-
ferent from prostate cancer survivors. While cancer diagnostic
group differences in PTG were evident, PTG levels were also posi-
tively associated with trauma severity and distress. These results
are discussed in terms of developing a postdiagnosis care model

Received 10 June 2010; accepted 21 July 2010.

This research was conducted in association with the University of Tasmania. The authors
are appreciative to the WP Holman Clinic at the Launceston General Hospital, Tasmania, for
their assistance in this project. They also express gratitude to the participants for their
overwhelming and supportive response.
Address correspondence to Jane Shakespeare-Finch, School of Psychology and Counsel-
ling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia.
E-mail: j.shakespeare-finch@qut.edu.au

229
230 B. A. Morris and J. Shakespeare-Finch

that can be utilized across all cancer type diagnoses in order to

assist adaptation during this challenging time.

A diagnosis of cancer is increasingly common in developed nations and is a

leading cause of death (Australian Institute of Health and Welfare [AIHW],
2007). A diagnosis can be a highly stressful situation for all involved as not
only is it a potentially life-threatening situation, but it is also often associated
with aggressive medical treatments (Andrykowski, Cordova, Studts, & Miller,
1998). Although incidence levels of cancer diagnoses are increasing, mor-
tality rates are decreasing (AIHW, 2007). Accordingly, a wealth of research
has been directed toward identifying the impact that a diagnosis of cancer
and subsequent treatments can have on an individual. More recently, in
addition to studies of distress (e.g., depression, anxiety, posttraumatic stress
disorder), efforts have been focused on empirical investigations of positive
life changes or posttraumatic growth (PTG) that can occur postdiagnosis
(see Stanton, Bower, & Low, 2006, for a review).
Research examining participants with heterogeneous cancer diagnoses
has revealed the potential for diagnostic group to influence factors in the
cancer experience such as coping strategies (Franks & Roesch, 2006) and
likelihood to complete treatment (Simmons & Lindsay, 2001). Research
has also investigated how the type of cancer diagnosed will impact dis-
tress and associated psychological pathology (Zabora, Brintzenhofeszoc,
Curbow, Hooker, & Piantadosi, 2001). However, no such research has
been published on variance in PTG levels between cancer diagnostic
groups. The current study redresses this gap in the literature by investigating
potential differences between cancer diagnostic groups in levels of reported
positive life change that has occurred since diagnosis as well as symptoms
of ongoing distress. Demographic and cancer-related factors that may
contribute to potential cancer diagnostic group differences in PTG are also
explored.

CANCER DIAGNOSTIC GROUP DIFFERENCES IN PTG

The development of standardized measures of PTG has allowed for the

advent of systematic investigations of the positive consequences that may
occur after the diagnosis of cancer. Within psycho-oncology, a considerable
proportion of studies measuring PTG with standardized inventories have
been conducted with breast cancer survivors (e.g., Cordova et al., 2007;
Ho, Chan, Yau, & Yeung, in press; Manne et al., 2004) and, to a lesser extent,
those with prostate cancer (e.g., Thornton & Perez, 2006) and hematological
 Cancer Diagnostic Group Differences in PTG 231

malignancies (e.g., Widows, Jacobsen, Booth-Jones, & Fields, 2005). The

Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) has
become the most widely used measure of positive life change after a trau-
matic experience (Linley et al., 2007).
Using standardized measures, such as the PTGI, allows for evaluation of
PTG levels between studies to compare positive life changes reported by dif-
ferent cancer diagnostic groups in these studies. However, it is difficult to
draw conclusions due to methodological variations between studies (Stanton
et al., 2006). While most studies have been conducted with singular cancer
diagnostic groups, a few have used broad samples of cancer survivors to
focus on differences between groups. These studies have not investigated
PTG, but they do highlight variation in postdiagnosis adaptation due to can-
cer site. For example, research has shown that those diagnosed with breast
cancer are more likely to complete treatment (Simmons & Lindsay, 2001)
and use approach coping when appraising their cancer as a challenge or
threat (Franks & Roesch, 2006). Simmons and Lindsay investigated patients
who had been treated with surgery, with the major diagnostic groups being
breast, colorectal, and bladder cancer. Cancer type differences in treatment
adherence were determined to not be merely a function of gender, as differ-
ences remained when comparing only females across a variety of cancer
types. Yet women were more likely to complete treatment only if they were
diagnosed with breast cancer. Franks and Roeschs (2006) meta-analysis
found that the type of cancer diagnosed influenced postdiagnosis appraisal
and coping. Their study showed that women with breast cancer used an
approach style of coping when appraising their cancer more than other diag-
nostic groups. Franks and Roesch propose that women with breast cancer
may be more hopeful that their cancer can be treated and that their chances
of survival are good, thereby buffering potential negative postdiagnosis
effects.
These studies have highlighted differences in postdiagnosis adjust-
ment; however, research investigating potential PTG differences between
cancer diagnostic groups is lacking. To date, the only pertinent research
is a qualitative study of 58 survivors of bladder, breast, colorectal, gyne-
cological, head and neck, and prostate cancer (Foley et al., 2006). Fre-
quencies of reported themes of personal growth were assessed, and
there were no differences in the number of PTG themes reported
between groups. Research investigating treatment adherence, coping style,
and distress indicates that it is a potentially erroneous assumption to
perceive that the postdiagnosis experience is synonymous across all
types of cancer (Franks & Roesch, 2006; Simmons & Lindsay, 2001).
Clearly, further empirical studies are needed to establish whether the
type of cancer diagnosis a person is given will impact that individuals
perceptions of PTG.
232 B. A. Morris and J. Shakespeare-Finch

POTENTIAL FACTORS CONTRIBUTING TO CANCER TYPE

DIFFERENCES IN PTG

Demographic Variables
Psycho-oncology trends reveal either a negative correlation between age and
PTG (e.g., Manne et al., 2004) or no relationship (e.g., T. Weiss, 2004). Stu-
dies showing an inverse relationship between age and PTG suggest that
being confronted with a life-threatening illness at a young age is more threat-
ening than a diagnosis of cancer at an older age, thereby inducing a greater
potential for reappraisal of life and the possibility for PTG to occur (Manne
et al., 2004). In a meta-analysis of the broader literature regarding PTG,
females tended to show greater levels of PTG than males (Helgeson,
Reynolds, & Tomich, 2006); however, this trend is not evident in studies spe-
cific to psycho-oncology, which generally indicate mixed results (Stanton
et al., 2006). There is a paucity of studies that have investigated gender
differences in perceptions of PTG in cancer survivors, as research has predo-
minantly been conducted with specific diagnostic groups such as those with
breast cancer or prostate cancer. Therefore, further studies are needed with a
broader range of participants, such as those diagnosed with colorectal or
hematological malignancies, in order to investigate the impact that gender
may have on postdiagnosis adjustment and PTG within a diagnostic group.

Disease Severity and Distress

Studies with cancer survivors indicate that subjective appraisal of cancer
severity may predict PTG. For example, Cordova et al. (2007) found no
relationship between stage of disease and PTG and a significant positive
relationship between participants subjective rating of severity and PTG.
These results are congruent with the notion that the event has to be perceived
by the individual as one of sufficient magnitude to disrupt fundamental
assumptions (Calhoun & Tedeschi, 2006; Janoff-Bulman, 2006). Studies con-
ducted with cancer survivors have shown mixed results between PTG and
distress, as represented by PTSD symptoms, but the trend appears to be that
there is no relationship between these variables for cancer survivors (e.g.,
Cordova et al., 2007; Thornton & Perez, 2006; Widows et al., 2005). The trend
for no relationship between these variables implies that PTG and distress do
not exist on a continuum and that a positive postdiagnosis outcome is not
merely an absence of psychopathology (Brennan, 2001).

RATIONALE AND AIMS OF THE CURRENT STUDY

The emerging research investigating heterogeneity in postdiagnosis

adjustment suggests that there may be differences in postdiagnosis coping,
 Cancer Diagnostic Group Differences in PTG 233

treatment adherence, and distress between cancer diagnostic groups. As dif-

ferences have been found in PTG and in PTSD symptoms as a function of
trauma type (Shakespeare-Finch & Armstrong, 2010), this study hypothesized
that there would be differences in levels of PTG between different cancer
diagnostic groups. The study explored individual and illness characteristics
that may contribute to any PTG differences between diagnostic groups,
and importantly retained a measure of distress operationalized as PTSD
symptomatology in order to enable comparisons with the broader body of
PTG literature.

METHOD

Participants
Participants were recruited through a regional hospital in Australia. A survey
package was mailed to every person treated at the oncology clinic in 2003
and 2004. Completed surveys were returned by 335 participants (150 male,
185 female), representing a 35% return rate. Participants had a mean age
of 62.99 years (SD 12.23), with ages ranging from 19 to 89 years. The most
frequently occurring diagnoses were breast (35%), prostate (16%), hematolo-
gical (15%), and colorectal (10%) cancers. Other primary diagnoses such
as brain and testicular cancers were also reported on returned surveys;
however, the incidences of these were insufficient to make statistically mean-
ingful comparisons. Participants were predominantly married, Caucasian-
Australian, no longer had cancer, and were no longer receiving treatment
(see Table 1 for frequencies pertaining to demographic and illness-related
factors).

Materials
The survey package consisted of demographic information (age, gender,
relationship status, ethnicity, and education) and cancer characteristics (diag-
nosis, time since diagnosis, current cancer status, whether treatment was
ongoing, and perception of trauma severity). It also included the following
inventories.

POSTTRAUMATIC GROWTH INVENTORY

The PTGI (Tedeschi & Calhoun, 1996) is designed to obtain an overall assess-
ment of positive outcomes that may occur as a result of negotiating the chal-
lenges faced posttrauma. Participants were asked to indicate the degree to
which each statement had occurred in their life as a result of being diagnosed
with cancer. Each of the 21 items required a response on a 6-point Likert
scale ranging from 0 (not at all) to 5 (very great degree). Strong internal
234 B. A. Morris and J. Shakespeare-Finch

TABLE 1 Sample Demographic and Disease-Related Characteristics (N 335), Along With

PTGI Descriptive Statistics and Mean Difference Test Results by Group.

n % PTGI mean (SD) Mean difference test

Gender t(324)
4.33, p < .001

Male 150 44.8 53.95 (20.86)
Female 185 55.2 64.26 (21.84)
Relationship status t(323) 1.62, p .11
Married=de facto 252 75.2 60.83 (21.30)
Not in relationship 82 24.5 56.27 (23.76)
(single, divorced, separated,
widowed)
Ethnicity t(313)
1.14, p .26
Anglo-Australian 303 90.4 59.50 (22.06)
Other 20 6.0 65.31 (23.03)
Education F(5, 317) .44, p .82
Less than Grade 10 86 25.7 60.98 (20.57)
Grade 10 97 29.0 61.09 (21.16)
Completed secondary school 45 13.4 56.82 (21.22)
Diploma 56 16.7 57.31 (23.60)
Undergraduate university 24 7.2 60.92 (23.21)
Postgraduate university 23 6.9 58.62 (26.99)
Current cancer status F(2, 314) 2.16, p .12
Has cancer 62 18.5 57.87 (22.20)
No longer has cancer 234 69.9 60.89 (22.13)
Doesnt know 30 9.0 52.03 (21.08)
Current treatment status t(317) 1.21, p .23
Still being treated 76 22.7 62.59 (21.49)
No longer being treated 252 75.2 59.07 (21.98)

Note. Percentages do not equal 100% due to missing data. PTGI Posttraumatic Growth Inventory.

consistency has been found for the PTGI total score and subscale scores in
previous research with cancer survivors (e.g., a .95 for PTGI total score
and alphas ranging from .80 to .89 for subscales; T. Weiss, 2004). The current
study found similar internal consistency for the PTGI total scores and sub-
scales, including appreciation of life, relating to others, new possibilities,
personal strength, and spiritual change (see Table 2).

IMPACT OF EVENT SCALEREVISED

The IES-R (D. Weiss & Marmar, 1997) is a 22-item self-report survey designed
to measure the three clusters of PTSD symptoms: avoidance, hyperarousal,
and intrusion. Respondents are required to rate each item on a 5-point Likert
scale ranging from 0 (not at all) to 4 (extremely). In the current study, respon-
dents were instructed to indicate how distressing each item had been in their
life with respect to their diagnosis of cancer. In addition to subscale scores,
studies with cancer survivors have utilized total IES-R scores to indicate part-
icipants overall distress (Koopman et al., 2002). The measure has elicited
robust reliabilities in psycho-oncology (e.g., a > .77 for IES-R subscales;
 Cancer Diagnostic Group Differences in PTG 235

TABLE 2 Cronbach Alpha Coefficients and Descriptive Statistics for Total

Scales and Subscales.

a Range Mean (SD)

PTGI total .94 0105 59.29 (22.36)

Appreciation of life .81 05 3.55 (1.28)a
Relating to others .89 05 3.28 (1.13)a
New possibilities .86 05 3.16 (1.27)a
Personal strength .82 05 2.00 (1.34)a
Spiritual change .84 05 1.70 (1.69)a
IES-R total .94 082 23.80 (17.18)
Intrusion .90 04 1.13 (0.90)a
Avoidance .81 04 1.12 (0.79)a
Hyperarousal .84 04 0.96 (0.93)a

Note. PTGI Posttraumatic Growth Inventory; IES-R Impact of Events ScaleRevised.

a
Subscale item mean.

Thornton & Perez, 2006), with similar alpha coefficients being found in the
current study (see Table 2).

Procedure
The research was conducted in accordance with APA ethical standards, and
ethical clearance was received by the appropriate institution prior to study
commencement. Survey packages were mailed through the oncology clinic
to patients who had been treated for cancer during a 2-year time period.
The package consisted of an information sheet, consent form, survey, and
reply paid envelope. The researchers did not have access to patient records
in order to preserve patient confidentiality, and participants remained anony-
mous to all concerned. All participants provided informed consent.

Data Analyses
Analyses were conducted using the Statistical Package for the Social Sciences
(SPSS; version 14). Minimum breaches in assumptions were revealed in
examinations of frequencies, normal probability plots, scatterplots, and
Mahalanobis distance, with the exception that the IES-R total score was nega-
tively skewed. Analyses were conducted prior to and after a logarithm 10
transformation on this variable to show that the significance of p values
remained on all analyses. Results were subsequently reported using the
untransformed variable as it is recommended to preserve comparability
when interpreting the data (Hair, Anderson, Tatham, & Black, 1998). An
analysis of the relationship between PTGI and IES-R scores and inspection
of the scatterplot demonstrated that there was no evidence of a curvilinear
relationship. Mean difference tests were initially conducted on demographic
and illness-related variables to determine effects on PTG levels. To achieve
236 B. A. Morris and J. Shakespeare-Finch

adequate power, an analysis of variance (ANOVA) was conducted with the

four main diagnostic groups of breast, prostate, colorectal, and hematological
cancers (n 235) to determine PTG differences. This was followed by an
analysis of covariance to explore potential demographic or illness-related
covariates that might contribute to PTG differences.

RESULTS

Descriptive Statistics
Descriptive statistics pertaining to the inventories used in the study are out-
lined in Table 2, and descriptive statistics calculated for demographic and dis-
ease characteristic groups and results of mean difference tests are provided in
Table 1. Results showed that PTGI scores did not differ as a result of relation-
ship status, ethnicity, education, whether or not the participants currently
had cancer or were currently receiving treatment, or time since diagnosis.
A small significant correlation was found between age and PTG (r
.14,
p < .05), and females had a significantly higher PTGI mean than males (see
Table 1). An ANOVA showed significant differences in levels of PTG due
to perception of trauma severity, F(3, 321) 6.36, p < .01. Tukey post hoc
analyses showed that participants who perceived their diagnosis as not trau-
matic (M 50.38, SD 21.89) and mildly traumatic (M 55.04, SD 23.99)
had significantly lower PTG scores than participants who perceived their
diagnosis as moderately traumatic (M 64.55, SD 21.23) or very traumatic
(M 62.48, SD 18.50). However, there were no differences in PTG levels
between participants who perceived their diagnosis as not traumatic or
mildly traumatic, nor did participants who perceived their diagnosis as
moderately traumatic or very traumatic significantly differ from each other.
A significant positive correlation was found between PTG and distress
(r .30, p < .001).

Heterogeneity of PTG Between Cancer Diagnostic Groups

As a result of the size of the study sample, comparisons of PTG levels were
possible between four major diagnostic groups comprising breast, prostate,
colorectal, and hematological cancer survivors. An ANOVA revealed signifi-
cant differences in PTG levels between these cancer diagnostic groups,
F(3, 227) 4.72, p < .01. Tukey post hoc analyses showed that breast cancer
survivors had a significantly higher PTGI mean than hematological and colo-
rectal cancer diagnostic groups. Prostate cancer survivors did not significantly
differ from any other diagnostic group (see Table 3 for PTGI means).
Initial analyses revealed age, gender, perception of trauma severity, and
distress to influence levels of reported PTG. An analysis of covariance was
conducted to determine whether these variables accounted for the
 Cancer Diagnostic Group Differences in PTG 237

TABLE 3 Major Cancer Diagnostic Groups and PTGI Descriptive

Statistics.

n PTGI mean (SD)

Breast 113 64.47 (22.19)

Prostate 50 58.86 (20.14)
Hematological 43 52.22 (24.45)
Colorectal=rectal 29 51.44 (22.45)

Note. Breast cancer survivors were females only. PTGI Posttraumatic

Growth Inventory.

differences in PTG between the four cancer diagnostic groups. Results

showed that age, F(1, 182) 1.67, p .20, and gender, F(1, 182) 4.55,
p .06, were not significant covariates, whereas perception of trauma sever-
ity, F(1, 182) 6.62, p < .05, and distress, F(1, 182) 7.76, p < .01, were sig-
nificant covariates. PTGI mean differences between types of cancer remained
significant, F(3, 182) 2.97, p < .05.

DISCUSSION

PTG was explored with four major cancer diagnostic groups: breast, prostate,
colorectal, and hematological malignancies. Results showed that breast
cancer survivors reported a higher level of PTG than those diagnosed with
colorectal and hematological malignancies. Prostate cancer survivors had
the second highest PTG mean; however, their level of postdiagnosis growth
was not significantly different from any other cancer group. Variables that
were initially shown to influence PTG included age, gender, perception of
trauma severity, and distress. After taking potential demographic variables
and covariates into account, trauma severity and distress remained as having
a significant impact on PTG. Participants who perceived their diagnosis as
more traumatic and had higher levels of distress reported higher levels of
PTG, and cancer type differences in PTG remained after taking these covari-
ates into account.
Intuitively, the higher PTGI means reported by breast cancer survivors
could be attributable to the tendency for women to report higher levels of
PTG (Helgeson et al., 2006). However, the differences in PTG as a result
of cancer diagnosis remained after taking gender into account. Therefore,
while females reported higher levels of PTG, this effect shown by cancer
diagnosis on PTG cannot solely be attributed to gender. This result is consist-
ent with Franks and Roeschs (2006) assertion that differences in postdiagno-
sis pathology are also beyond the simple delineation of gender. Qualitative
evidence suggests that breast cancer survivors may have access to more sup-
port during their treatment and postdiagnosis care compared to people diag-
nosed with other types of cancer, and this may be a reason for breast cancer
238 B. A. Morris and J. Shakespeare-Finch

survivors reporting higher levels of PTG than other cancer survivor groups
(Morris & Shakespeare-Finch, 2006). A pertinent example of this was
expressed by a 54-year-old female participant who had been diagnosed with
lymphoma: Just because I didnt have breast cancer meant I couldnt access
the same types of services after I was diagnosed. Being told I had the wrong
type of cancer was devastating (Morris & Shakespeare-Finch, 2006).
Breast cancer awareness has increased dramatically over the last few
years through media attention and fundraising activities (Kedrowski &
Sarow, 2007). A recent study examining Australian television news coverage
of cancer found that breast cancer received 13 times the number of reports
compared to colorectal cancer, which does not reflect incidence or mortality
rates of these cancers (MacKenzie, Chapman, McGeechan, & Holding,
2010). MacKenzie et al. also found that compared to other cancer groups,
there was a distinct lack of high-profile cases of bowel cancer in the media,
whereas celebrities diagnosed with breast cancer attracted large amounts of
news coverage. Such news coverage may provide women diagnosed with
breast cancer the opportunity to openly discuss their own experiences, thus
allowing for modeled behavior from others who may have perceived positive
life change and promoting the potential for their own personal growth
(T. Weiss, 2004).
The results from the current study indicate that breast cancer survivors
are more likely to record higher levels of growth after diagnosis than other
diagnostic groups, but this is also dependent on having a greater perception
of trauma severity and higher levels of distress. It may be that the advocacy
and level of awareness surrounding women diagnosed with breast cancer
provide a unique experience and an environment conducive to both greater
distress and PTG. In their recent book, Kedrowski and Sarow (2007)
explored the differences that exist in cancer advocacy, awareness, and infor-
mation on public policy available for women diagnosed with breast cancer in
the U.S. and other cancer diagnosis groups such as prostate cancer.
Kedrowski and Sarow stated that the breast cancer movement has evolved
and has shaped media coverage, public awareness, and government policy
aimed at improving the well-being of women diagnosed with this cancer.
Perhaps the breast cancer movement can be used as a model of intervention
and support for other cancer diagnostic groups, thereby promoting dis-
cussion and support through modeling behaviors related to survival and
fulfillment.

Strengths, Limitations, and Future Directions

The current study used a broad sample of diagnostic groups to allow
for direct comparability of postdiagnosis psychological trajectories, thus
facilitating the control of methodological confounds that may result when
comparing samples across different studies. The results address a unique
 Cancer Diagnostic Group Differences in PTG 239

question, and the knowledge gained regarding posttraumatic growth after a

diagnosis of cancer provides new information for this burgeoning area of
investigation. The variation in postdiagnosis experience highlights the het-
erogeneous nature of adjustment, growth, and distress reported by different
cancer diagnostic groups.
Although gender differences in reported positive life change have been
indicated in previous PTG research (Helgeson et al., 2006), a majority of this
research is conducted with breast and prostate cancer survivors. Further
research could focus on obtaining larger samples of participants who have
been diagnosed with cancers such as hematological or colorectal cancers.
This would enable a direct comparison of males and females within diagnos-
tic groups. A gender difference was found in the current study when simply
looking at gender as an independent variable; however, when it was
included in the analysis as a covariate between type of cancer and postdiag-
nostic psychological outcomes, its influence was no longer evident. Clearly,
more research needs to be done to expand this area of investigation.
The members of the present sample predominantly identified them-
selves as Anglo-Australians and were married or in long-term relationships.
Therefore, it is important to consider the current studys results in the context
that they were investigated in and to apply caution when interpreting these
findings in other countries, cultural environments, or with minority groups
(in Australia and elsewhere). Although previous research has indicated that
subjective measures of disease severity are more influential on PTG levels
than medical variables, the sole reliance on subjective measures in the
current study could be enhanced in future research. Results showed that cur-
rently receiving treatment was not related to PTG; however, factors such as
type of treatment may influence the perception of positive life change and
can be explored by obtaining medical records. Also, the retrospective and
cross-sectional nature of this study could have resulted in memory bias,
potentially compromising the recall of the cancer experience. Longitudinal
research in this area would be beneficial in investigating different points of
postdiagnosis adaptation and examining the ebbs and flows of the process
of adjusting to life after a cancer diagnosis and treatment.

Conclusion
The results of the current study support the notion that positive life change
can occur after a cancer diagnosis. A quantitative assessment of differences
in PTG due to type of cancer diagnosed has been provided, showing that dif-
ferences exist in postdiagnosis adaptation. Breast cancer survivors reported
higher levels of positive life change compared to colorectal and hematologi-
cal cancer survivors, and these differences could not solely be explained by
demographic or disease-related variables. Higher levels of PTG were related
to perception of disease severity and distress. The results, in combination
240 B. A. Morris and J. Shakespeare-Finch

with previous research showing that breast cancer survivors are more likely
to complete treatment (Simmons & Lindsay, 2001) and use approach coping
when appraising their cancer as a challenge or threat (Franks & Roesch,
2006), highlight heterogeneity in the postdiagnosis experience. It may be that
interventions and postdiagnosis supportive care need to be tailored to
address the unique experience associated with each diagnostic group.
The efforts dedicated to raising breast cancer awareness and the
increased advocacy for women with this disease potentially provide a model
of postdiagnosis care that can be adapted to other cancer groups. Future
research could be directed toward identifying elements of the breast cancer
postdiagnosis care model and the broader awareness campaign that can be
utilized to enhance the support of all cancer patients. This model of postdiag-
nosis care, advocacy, and community awareness can be applied to other
prevalent cancer diagnostic groups to meet the psychosocial needs of people
diagnosed with cancer and promote posttraumatic growth in cancer
survivors.

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242 B. A. Morris and J. Shakespeare-Finch

Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001).
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Bronwyn A. Morris is a Postdoctoral Fellow at the National Genome Research Insti-

tute, National Institutes of Health. Her current research interests include the identifi-
cation of factors that reduce postdiagnosis distress and promote posttraumatic growth.

Jane Shakespeare-Finch is a senior lecturer in the School of Psychology and Coun-

selling, Queensland University of Technology, Australia. Posttraumatic growth is Janes
primary area of research, and she has studied PTG phenomena in a wide variety of
populations ranging from emergency service personnel to refugees and adult survivors
of childhood sexual assault.
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