Social Support 65and con“rmatory factor analyzes to examine the psychomet-
ric properties of the Partner Responses to Cancer Inventory
(PRCI). This inventory contained both spouse positive and
negative responses, and behaviors by others that speci“cally
encouraged particular coping efforts. Four factors emerged:
emotional and instrumental support, cognitive information
and guidance, encouraging distancing and self-restraint, and
criticism and withdrawal.
Levels of Support
Bloom and Kessler (1994) compared perceived emotional
support by patients with early stage breast cancer, patients
undergoing surgery for gallbladder disease, biopsy for benign
breast disease, or women who did not undergo surgery. Per-
ceived emotional support was rated at three time points after
surgery. Results indicated that, in contrast to the authors•
hypothesis that breast cancer patients would experience less
emotional support over time than women undergoing other
types of surgery, breast cancer patients perceived more emo-
tional support during the three months after surgery. Neuling
and Wine“eld (1988) followed early stage breast cancer
patients at the time of surgery, one month postsurgery, and
three months postsurgery. Women rated the frequency of, and
satisfaction with, supportive behaviors from family mem-
bers, close friends, and surgeons. Empathic support and reas-
surance from family members and friends decreased over
time, as did empathic support from the surgeon. Informa-
tional and tangible support increased over the “rst month
postsurgery, and then decreased.
Support and Psychological Adaptation
The majority of studies investigating the role of social sup-
port in adaptation to cancer have been cross-sectional, many
studies have had relatively small sample sizes. Perceived so-
cial support has been investigated in several studies, and re-
sults have been inconsistent. Ord-Lawson and Fitch (1997)
investigated the relation between perceived social support, as
measured by the Medical Outcomes Study social support
survey and the Importance of Social Support Questionnaire
(developed by the authors), and mood of 30 men diagnosed
with testicular cancer within the past two months. Results in-
dicated that there was no signi“cant relationship between so-
cial support and mood. Komproe, Rijken, Winnubst, Ros, and
Hart (1997) found that perceived available support, as rated
by women who recently underwent surgery for breast cancer
(84% early stage cancer), was associated with lower levels of
depressive symptoms. Budin (1998) studied unmarried early
stage breast cancer patients using a cross-sectional design,
and found that, after accounting for symptom distress and
treatment (e.g., lumpectomy or radical mastectomy), per-
ceived support accounted for a signi“cant, but small (2%)
variance in distress. Two prospective studies have found post-
surgical perceived support from family members to be related
to less distress at later time points, among women with breast
cancer (Hoskins et al., 1996; Northouse, 1988). However,
neither study adjusted for initial levels of psychological dis-
tress, which would have clari“ed whether or not perceived
support predicted changes in distress. Alferi, Carver, Antoni,
Weiss, and Duran (2000) examined cancer-speci“c distress
(intrusive thoughts and avoidance symptoms) and psycholog-
ical distress among 51 Hispanic women being treated for
early stage breast cancer. Women were evaluated presurgery,
postsurgery, and at 3-, 6-, and 12-month follow-ups. Emo-
tional support from friends and instrumental support from the
spouse at presurgery predicted lower distress postsurgery. No
other prospective bene“ts of perceived support on distress
emerged. This study evaluated the impact of distress on sub-
sequent support from spouse, friends, and family. Distress at
several time points predicted erosion of instrumental support
from women in the family. Similar “ndings were reported by
Bolger, Foster, Vinokur, and Ng (1996) in a sample of breast
cancer patients followed up to 10 months postdiagnosis.
Several studies have evaluated the associations between
received or enacted support and psychological adaptation
among cancer patients. De Ruiter, de Haes, and Tempelaar
(1993) examined the relationship between the number of pos-
itive social interactions and psychological distress among a
group of cancer patients who were either in treatment or
completed treatment. In this cross-sectional study, positive
support was associated with distress only among patients who
had completed treatment. A second cross-sectional study
by Manne and colleagues (Manne, Taylor, Dougherty, &
Kemeny, 1997) investigated the potential moderating role of
functional impairment and gender on the relationship between
spouse support and psychological distress. Spouse support
was associated with lower levels of distress and higher levels
of well-being for female patients, but was not associated with
distress or well-being among male patients. Spouse support
was associated with lower psychological distress among pa-
tients with low levels of functional impairment, whereas
spouse support was not signi“cantly associated with distress
among patients with high levels of functional impairment.
Similar associations were reported by Dunkel-Schetter
(1984). These results suggest that the reason that the associa-
tion between support and distress has not consistently been
found is because support•s impact may depend on contextual
or demographic variables such as gender and physical dis-
ability. One of the few studies focusing on patients with late