Thomas Merluzzi - Academia.edu (original) (raw)

Papers by Thomas Merluzzi

Psycho-oncology, May 10, 2012

Purpose-An estimated 30% of cancer patients are expected to experience clinically significant psy... more Purpose-An estimated 30% of cancer patients are expected to experience clinically significant psychological distress during the treatment phase of their disease. Despite significant attention being directed to the mental health needs of individuals undergoing and completing treatment, there is less known about the mental health needs of survivors and the role of potential protective factors in survivorship, such as coping self-efficacy and social support. Method-One hundred and twenty-four post-treatment cancer survivors (mean age = 62.23 years, female = 70%, average 9.3 years post-treatment) were asked to complete measures of physical symptoms, coping self-efficacy, social support, and depression as part of a national convenience sample of cancer patients and survivors. Results-About 20% of participants possessed scores on the CES-D indicative of clinicallyrelevant depression. Coping self-efficacy was not only a significant predictor of depression (43% VAC); it also partially mediated the relationship between symptoms and depression. Social support accounted for limited variance and was not a significant predictor of depression in a model containing both social support and coping self-efficacy as predictors. Conclusion-A substantial minority of post-treatment survivors reported depression symptomatology. Coping self-efficacy may be an important component of patients' adjustment and possible target for intervention. These results highlight the ongoing mental health and support needs of cancer survivors.

Journal of Religion & Health, Feb 6, 2017

The concept of ''letting go'' or relinquishing control has a long intellectual history, including... more The concept of ''letting go'' or relinquishing control has a long intellectual history, including the earliest Taoist writings, long-standing religious traditions, modern conceptualizations of religious coping, and current psychological control theory. This paper briefly traces the ancient roots of ''letting go,'' with an emphasis on Stoic philosophers, and plants it firmly in current control theory and religious coping research, with a focus on its more modern conceptualization, that of secondary control. Presenting the theoretical perspective, which is grounded in religious conceptions of control of outcomes integrated with modern control theory in psychology, is the main goal of this paper. However, the theoretical integration is bolstered by some initial descriptive findings based on cancer patients and survivors. This integration of religious coping and psychological theory has important implications for testing the utility of personal control and Godreferenced control as ways to cope with the uncertainties of a serious illness such as cancer. Finally, the theory and descriptive findings lay the groundwork for future empirical studies and the development of counseling interventions. Keywords Control Á Religion Á Spirituality Á Cancer Á Oncology Á Coping From antiquity (e.g., Taoism, Buddhism, Stoicism), through the Middle Ages (e.g., Meister Eckhart) to modern times (e.g., Heidegger 1996; Reinhold Niebuhr), some form of ''letting go'' has been posited as one approach that may lead to a better life. Modern psychological theory (Morling and Evered 2006; Rothbaum et al. 1982; Skinner 1996) has contributed to this discussion through the examination of primary control (changing the environment so that events or outcomes are in line with our wishes) and secondary control (bringing

Psycho-oncology, Oct 30, 2018

Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors th... more Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE Scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). Method: A mixed diagnosis sample (N=151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. Results: The SRCE Scale is a 10-item, one-factor, internally reliable ( measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. Conclusions: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

PeerJ, Jul 21, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.

Psychology & Health, 2019

Objective: Stressful life events (SLEs) impact the quality of life (QOL) of cancer patients. This... more Objective: Stressful life events (SLEs) impact the quality of life (QOL) of cancer patients. This study investigated the mediation of the relationship between SLEs and QOL

Psycho-Oncology, 2018

Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors th... more Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE Scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). Method: A mixed diagnosis sample (N=151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. Results: The SRCE Scale is a 10-item, one-factor, internally reliable ( measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. Conclusions: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

Anticancer research, Apr 1, 2017

Recent aggressive chemotherapeutic and combined treatments have resulted in increased survivorshi... more Recent aggressive chemotherapeutic and combined treatments have resulted in increased survivorship for advanced stage breast cancer. In some patients, treatment produces an actual abatement of their cancer, while in others treatment mitigates the progression of cancer bringing those patients into palliative care where their chronic disease requires continuous management. There is also evidence that the majority of palliative-care cancer patients have a deteriorating quality of life that only precipitously declines in the final few weeks of life. The new paradigm of patient-centered care for palliative patients is resulting in a new model of treatment in which the self-efficacy seems to play an important role. The present study represents an extension of the role of self-efficacy for coping to palliative care. Using a stress-coping model, the primary aim of this study was to evaluate a process model, in which self-efficacy for coping with cancer is a moderator between stress and the ...

PeerJ, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.

Annals of Behavioral Medicine, 2021

Background Comorbid disease in cancer patients can substantially impact medical care, emotional d... more Background Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. Purpose The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). Methods Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional dist...

Psycho-oncology, 2015

Optimal matching theory posits that the effects of social support are enhanced when its provision... more Optimal matching theory posits that the effects of social support are enhanced when its provision is matched with need for support. We hypothesized that matching received social support with the needs of persons with cancer, and cancer survivors would be related to better psychosocial adjustment than a mismatched condition. In a cross-sectional design, sample 1, consisting of 171 cancer patients, and sample 2, consisting of 118 cancer survivors, completed measures of emotional and instrumental received support, physical debilitation, and psychological distress. The optimal matching theory model was confirmed; those needing support (i.e., greater physical debilitation), who did not receive it, experienced more distress than those who needed support and received it. Patients in treatment benefited from the matching of need and provision for both emotional and instrumental support, whereas survivors only benefited from the matching of emotional support. The results suggest that social ...

PeerJ, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress. Subjects Oncology, Psychiatry and Psychology WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson 3rd WE. 2008. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113(12):Arora NK, Finney Rutten LJ, Gustafson DH, Moser R, Hawkins RP. 2007. Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer. Psycho-Oncology 16(5):474-486 DOI 10.1002/pon.1084. Avci IA. 2008. Factors associated with breast self-examination practices and beliefs in female workers at a Muslim community. AS, Moffat Jr FL, Clark KC. 1993. How coping mediates the effects of optimism on distress: a study of women with early stage breast cancer. . Carver CS, Scheier MF. 2000. Scaling back goals and recalibration of the affect system are processes in normal adaptive self-regulation: understanding 'response shift' phenomena. Social Science and Medicine 50(12):1715-1722 DOI 10.1016/S0277-9536(99)00412-8. Casellas-Grau A, Font A, Vives J. 2014. Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology 23(1):9-19 DOI 10.1002/pon.3353. Chen JY, Diamant AL, Thind A, Maly RC. 2008. Determinants of breast cancer knowledge among newly diagnosed, low-income, medically underserved women with breast cancer. Cancer . Fiszer C, Dolbeault S, Sultan S, Brédart A. 2014. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology 23(4):I, Dulay MF, Liscum KR. 2006. Optimism, social support and psychosocial functioning among women with breast cancer. Psycho-Oncology 15(7):595-560 DOI 10.1002/pon.992. Gallagher J, Parle M, Cairns D. 2002. Appraisal and psychological distress six months after diagnosis of breast cancer. . Henselmans I, Fleer J, de Vries J, Baas PC, Sanderman R, Ranchor AV. 2010. The adaptive effect of personal control when facing breast cancer: cognitive and behavioural mediators. Psychology and Health 25(9):HW, Fielding R. 2007. Treatment decision difficulties and post-operative distress predict persistence of psychological morbidity in Chinese women following breast cancer surgery. Psychooncology 16(10):Maunsell E, Brisson J, Deschi'nes L. 1992. Psychological distress after initial treatment of breast cancer assessment of potential risk factors. Cancer 70(1):120-125 . Mehnert A, Koch U. 2008. Psychological co-morbidity and health-related quality of life and its association with awareness, utilization and need for psychosocial support in a cancer register based sample of long-term breast cancer survivors. Journal of Psychosomatic Research (02)00350-1. Ohaeri BM, Ofi AB, Campbell OB. 2012. Relationship of knowledge of psychosocial issues about cancer with psychic distress and adjustment among breast cancer clinic attendees in a Nigerian teaching hospital. Psycho-Oncology 21(4):419-426 DOI 10.1002/pon.1914. Philip EJ, Merluzzi TV, Zhang Z, Heitzmann CA. 2013. Depression and cancer survivorship: importance of coping self-efficacy in post-treatment survivors. Psycho-Oncology 22:987-994 DOI 10.1002/pon.3088. Preacher KJ, Hayes AF. 2008. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40(3):879-891

Psycho-oncology, May 10, 2012

Purpose-An estimated 30% of cancer patients are expected to experience clinically significant psy... more Purpose-An estimated 30% of cancer patients are expected to experience clinically significant psychological distress during the treatment phase of their disease. Despite significant attention being directed to the mental health needs of individuals undergoing and completing treatment, there is less known about the mental health needs of survivors and the role of potential protective factors in survivorship, such as coping self-efficacy and social support. Method-One hundred and twenty-four post-treatment cancer survivors (mean age = 62.23 years, female = 70%, average 9.3 years post-treatment) were asked to complete measures of physical symptoms, coping self-efficacy, social support, and depression as part of a national convenience sample of cancer patients and survivors. Results-About 20% of participants possessed scores on the CES-D indicative of clinicallyrelevant depression. Coping self-efficacy was not only a significant predictor of depression (43% VAC); it also partially mediated the relationship between symptoms and depression. Social support accounted for limited variance and was not a significant predictor of depression in a model containing both social support and coping self-efficacy as predictors. Conclusion-A substantial minority of post-treatment survivors reported depression symptomatology. Coping self-efficacy may be an important component of patients' adjustment and possible target for intervention. These results highlight the ongoing mental health and support needs of cancer survivors.

Journal of Religion & Health, Feb 6, 2017

The concept of ''letting go'' or relinquishing control has a long intellectual history, including... more The concept of ''letting go'' or relinquishing control has a long intellectual history, including the earliest Taoist writings, long-standing religious traditions, modern conceptualizations of religious coping, and current psychological control theory. This paper briefly traces the ancient roots of ''letting go,'' with an emphasis on Stoic philosophers, and plants it firmly in current control theory and religious coping research, with a focus on its more modern conceptualization, that of secondary control. Presenting the theoretical perspective, which is grounded in religious conceptions of control of outcomes integrated with modern control theory in psychology, is the main goal of this paper. However, the theoretical integration is bolstered by some initial descriptive findings based on cancer patients and survivors. This integration of religious coping and psychological theory has important implications for testing the utility of personal control and Godreferenced control as ways to cope with the uncertainties of a serious illness such as cancer. Finally, the theory and descriptive findings lay the groundwork for future empirical studies and the development of counseling interventions. Keywords Control Á Religion Á Spirituality Á Cancer Á Oncology Á Coping From antiquity (e.g., Taoism, Buddhism, Stoicism), through the Middle Ages (e.g., Meister Eckhart) to modern times (e.g., Heidegger 1996; Reinhold Niebuhr), some form of ''letting go'' has been posited as one approach that may lead to a better life. Modern psychological theory (Morling and Evered 2006; Rothbaum et al. 1982; Skinner 1996) has contributed to this discussion through the examination of primary control (changing the environment so that events or outcomes are in line with our wishes) and secondary control (bringing

Psycho-oncology, Oct 30, 2018

Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors th... more Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE Scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). Method: A mixed diagnosis sample (N=151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. Results: The SRCE Scale is a 10-item, one-factor, internally reliable ( measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. Conclusions: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

PeerJ, Jul 21, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.

Psychology & Health, 2019

Objective: Stressful life events (SLEs) impact the quality of life (QOL) of cancer patients. This... more Objective: Stressful life events (SLEs) impact the quality of life (QOL) of cancer patients. This study investigated the mediation of the relationship between SLEs and QOL

Psycho-Oncology, 2018

Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors th... more Objective: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE Scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). Method: A mixed diagnosis sample (N=151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. Results: The SRCE Scale is a 10-item, one-factor, internally reliable ( measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. Conclusions: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

Anticancer research, Apr 1, 2017

Recent aggressive chemotherapeutic and combined treatments have resulted in increased survivorshi... more Recent aggressive chemotherapeutic and combined treatments have resulted in increased survivorship for advanced stage breast cancer. In some patients, treatment produces an actual abatement of their cancer, while in others treatment mitigates the progression of cancer bringing those patients into palliative care where their chronic disease requires continuous management. There is also evidence that the majority of palliative-care cancer patients have a deteriorating quality of life that only precipitously declines in the final few weeks of life. The new paradigm of patient-centered care for palliative patients is resulting in a new model of treatment in which the self-efficacy seems to play an important role. The present study represents an extension of the role of self-efficacy for coping to palliative care. Using a stress-coping model, the primary aim of this study was to evaluate a process model, in which self-efficacy for coping with cancer is a moderator between stress and the ...

PeerJ, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.

Annals of Behavioral Medicine, 2021

Background Comorbid disease in cancer patients can substantially impact medical care, emotional d... more Background Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. Purpose The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). Methods Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional dist...

Psycho-oncology, 2015

Optimal matching theory posits that the effects of social support are enhanced when its provision... more Optimal matching theory posits that the effects of social support are enhanced when its provision is matched with need for support. We hypothesized that matching received social support with the needs of persons with cancer, and cancer survivors would be related to better psychosocial adjustment than a mismatched condition. In a cross-sectional design, sample 1, consisting of 171 cancer patients, and sample 2, consisting of 118 cancer survivors, completed measures of emotional and instrumental received support, physical debilitation, and psychological distress. The optimal matching theory model was confirmed; those needing support (i.e., greater physical debilitation), who did not receive it, experienced more distress than those who needed support and received it. Patients in treatment benefited from the matching of need and provision for both emotional and instrumental support, whereas survivors only benefited from the matching of emotional support. The results suggest that social ...

PeerJ, 2015

Background. The diagnosis, treatment, and long-term management of cancer can present individuals ... more Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress. Subjects Oncology, Psychiatry and Psychology WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson 3rd WE. 2008. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113(12):Arora NK, Finney Rutten LJ, Gustafson DH, Moser R, Hawkins RP. 2007. Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer. Psycho-Oncology 16(5):474-486 DOI 10.1002/pon.1084. Avci IA. 2008. Factors associated with breast self-examination practices and beliefs in female workers at a Muslim community. AS, Moffat Jr FL, Clark KC. 1993. How coping mediates the effects of optimism on distress: a study of women with early stage breast cancer. . Carver CS, Scheier MF. 2000. Scaling back goals and recalibration of the affect system are processes in normal adaptive self-regulation: understanding 'response shift' phenomena. Social Science and Medicine 50(12):1715-1722 DOI 10.1016/S0277-9536(99)00412-8. Casellas-Grau A, Font A, Vives J. 2014. Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology 23(1):9-19 DOI 10.1002/pon.3353. Chen JY, Diamant AL, Thind A, Maly RC. 2008. Determinants of breast cancer knowledge among newly diagnosed, low-income, medically underserved women with breast cancer. Cancer . Fiszer C, Dolbeault S, Sultan S, Brédart A. 2014. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology 23(4):I, Dulay MF, Liscum KR. 2006. Optimism, social support and psychosocial functioning among women with breast cancer. Psycho-Oncology 15(7):595-560 DOI 10.1002/pon.992. Gallagher J, Parle M, Cairns D. 2002. Appraisal and psychological distress six months after diagnosis of breast cancer. . Henselmans I, Fleer J, de Vries J, Baas PC, Sanderman R, Ranchor AV. 2010. The adaptive effect of personal control when facing breast cancer: cognitive and behavioural mediators. Psychology and Health 25(9):HW, Fielding R. 2007. Treatment decision difficulties and post-operative distress predict persistence of psychological morbidity in Chinese women following breast cancer surgery. Psychooncology 16(10):Maunsell E, Brisson J, Deschi'nes L. 1992. Psychological distress after initial treatment of breast cancer assessment of potential risk factors. Cancer 70(1):120-125 . Mehnert A, Koch U. 2008. Psychological co-morbidity and health-related quality of life and its association with awareness, utilization and need for psychosocial support in a cancer register based sample of long-term breast cancer survivors. Journal of Psychosomatic Research (02)00350-1. Ohaeri BM, Ofi AB, Campbell OB. 2012. Relationship of knowledge of psychosocial issues about cancer with psychic distress and adjustment among breast cancer clinic attendees in a Nigerian teaching hospital. Psycho-Oncology 21(4):419-426 DOI 10.1002/pon.1914. Philip EJ, Merluzzi TV, Zhang Z, Heitzmann CA. 2013. Depression and cancer survivorship: importance of coping self-efficacy in post-treatment survivors. Psycho-Oncology 22:987-994 DOI 10.1002/pon.3088. Preacher KJ, Hayes AF. 2008. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40(3):879-891