Centrality of event and cancer-related posttraumatic symptoms: An explorative analysis in Danish and Palestinian breast cancer patients

Background: Cancer diagnosis has been associated with post-traumaticstress (PTS). Several risk factors may influence the development of PTS symptoms, including the degree to which the cancer diagnosis is construedas a central reference point for the patients’ personal identities.Aim: To investigate the association between centrality of the cancer diagnosisand PTS-symptoms and explore possible differences between twoculturally distinct samples.Methods: As part of two larger studies, 489 of 643 Palestinian women(mean age: 47.6 yrs) and 683 of 992 Danish women (mean age: 58.1 yrs)treated for breast cancer completed cancer-related versions of the Centralityof Event Scale (CES) and the Impact of Event Scale-Revised (IES-R).Results: Palestinian women had considerably higher IES-scores (M = 39.85;SD = 13.7) than Danish women (M = 15.68; SD = 21.73) (p > 0.001). Incontrast, Danish women showed higher CES-scores (M = 22.25, SD = 6.57)than Palestinian women (M = 19.48, SD = 6.58) (p > 0.001). When adjustingfor demographic and clinical variables in multiple regressions, addingCES-scores to the model yielded a slightly higher increase in R2 in the Danish(ΔR2 = 0.29) than in the Palestinian (ΔR2 = 0.23) sample. In the Palestiniansample, IES-scores were associated with higher CES-scores (β = 0.52,p <0.001; CI: 0.91–1.24), not receiving radiotherapy (β = 0.24, p <0.001;CI: −9.90 to −4.97), higher educational level (β = 0.11, p <0.01; CI: 1.01–5.98), and number of children (β = 0.12, p <0.01; CI: 0.22–1.41). In theDanish sample, CES-scores (β = 0.57, p <0.001; CI: 1.44–1.82), older age(β = 0.10, p <0.05; CI: 0.04–0.39), and lower educational level (β = 0.13,p <0.001; CI: −11.49 to −3.84) predicted IES-scores.Conclusions: The degree to which the cancer diagnosis is perceived ascentral to identity may increase PTS symptomatology. Although Palestinianwomen, compared to Danish women, experienced more PTS symptoms andperceived the diagnosis as less central to their identity, the centrality of thecancer remained a significant predictor in Palestinian women. Furthermore,different demographic and clinical factors appeared to predict PTS symptomsin the two culturally distinct samples. Further exploration of cultural differences is needed.