The Moderating Role of Dyadic Coping in the Relationship between Distress and Health-Related Quality of Life Among Young Women with Breast Cancer: A Cross-Sectional Study

Background and Purpose. Breast cancer (BC) is the most commonly occurring malignancy among U.S. women. Despite significant advances in BC screening, treatments, and care delivery, recent data have highlighted concerning age-specific trends. Cancer-incidence rates are 80% higher in females, ages 20-49 years, and BC represents the leading cause of cancer-related death in this group. Young women with BC report greater psychological distress and physical morbidity than older women and healthy peers, including significant impairment in body image, sexual and reproductive health, and health-related quality of life (HRQOL). Partners contribute to young women’s wellbeing by providing practical and emotional support. However, little is known about interpersonal processes and how within-dyad coordinated coping behaviors contribute to better patient-reported outcomes. This study adds to a nascent evidence base assessing the role of interpersonal processes by investigating the moderating role of dyadic coping on the relationship between distress and HRQOL.

Methods: A sample of 83 BC survivors, ages 18-45 years, receiving care at an NCI-designated comprehensive cancer center completed a cross-sectional survey. Validated questionnaires of psychological distress (PHQ-9; GAD-7), health-related quality of life (EORTC-QLQ C30), and dyadic coping (Dyadic Coping Inventory) were administered. Descriptive statistics were used to describe the sample; multiple regression analyses were conducted to examine predictors of HRQOL. Additionally, the moderating role of dyadic coping (DC) in the relationship between distress and HRQOL was assessed using the PROCESS macro. SPSS version 28 was utilized for data management and analysis, with significance set at p<0.05.

Results: Participants were in their late thirties (mean: 38.8 (SD=4.7), range: 27-45 years) and mostly non-Hispanic white (74.3%), college educated (45.1%), and diagnosed with early-stage breast cancer (stage II, 34%). Approximately 34% scored above the cut-off for clinically significant depression and 14.1% for anxiety. Among HRQOL domains appraised, emotional, social and role functioning were particularly affected by the cancer diagnosis. Delegated DC moderated the relationship between depression and emotional functioning (p<0.05), with greater wellbeing reported by women who perceived their partners willing to assume care responsibilities. Stress communication (p< .01), supportive (p< .01) and delegated DC by the partner (p<.01) moderated the relationship between patient’s anxiety and emotional functioning. Additionally, the relationship between patient’s anxiety and social functioning was moderated by negative DC of the partner (p<0.01), suggesting worse patient outcomes when partners’ coping responses included hostile, ambivalent, or superficial behaviors. Conversely, better social functioning was reported by young patients who rated highly the ability of the couple to develop coordinated coping strategies (p<.05).

Conclusions and Implications: The present work confirms that young BC patients are susceptible to elevated psychological distress and impaired HRQOL. Additionally, findings emphasize the importance of incorporating a dyadic perspective in cancer care and highlight the potential benefits of involving partners. Yet, current psychosocial oncology programs may not include these critical interpersonal sources of support as clinical intervention targets. Interventions aimed at promoting positive DC behaviors and reducing ambivalent or hostile interactions between young women and their partners should be integrated into routine psychosocial care delivery.