The complex role of personality in cancer treatment: impact of dependency-detachment on health status, distress, and physician-patient relationship.

Although medical factors such as type of cancer and the extensiveness of surgery and follow-up intervention (e.g., chemotherapy) help determine patients’ adjustment during and after treatment, evidence suggests that psychosocial variables such as coping style, stress management skill, and social support also play a significant role (Orom et al., 2009; Penedo et al., 2013). As the importance of psychosocial processes in cancer treatment has become established, researchers have begun to examine the impact of personality on patients’ response to cancer diagnosis. Among the personality factors associated with more positive adjustment are optimism and internal health locus of control; low self-efficacy (both global and health related) and alexithymia are linked with more negative outcomes (Carver et al., 2005; Orom et al., 2009). Given the feelings of helplessness, fear, and vulnerability that often follow a cancer diagnosis, it is not surprising that researchers have examined links between patient dependency and adjustment in cancer patients. Evidence from a study of 101 older adults (Mean age = 73.90, Range = 68-83) newly diagnosed with cancer suggested that patients’ degree of physical (or functional) dependency on caregivers was negatively associated with their overall quality of life assessed by questionnaire and open-ended interview (Esbensen et al., 2011). These results echo findings from studies of functional dependency and quality of life in adults receiving care for other types of illnesses and injuries (e.g., loss of mobility, dementia; see Baltes, 1996; Bornstein, 2005). No studies have assessed the impact of personality based interpersonal dependency (sometimes called trait dependency) on adjustment in cancer patients, but a plethora of studies have documented the impact of interpersonal dependency on health related attitudes and behaviors in other domains. For example, dependent psychotherapy and medical patients tend to overuse health and mental health services, incurring higher costs than nondependent patients with similar demographic and diagnostic profiles; these patterns hold in both outpatient and inpatient treatment settings (Bornstein, 1993, 1998; O’Neill and Bornstein, 2001; Porcerelli et al., 2009). Along somewhat different lines, O’Neill and Bornstein (2006) found that dependent patients undergoing inpatient treatment for an array of physical illnesses reported higher levels of satisfaction than did nondependent patients with similar diagnoses. These findings are consistent with the longstanding observation that dependent adults tend to be more comfortable than nondependent adults in situations where they are cared for by a figure of authority (e.g., physician, psychologist, professor; see Bornstein, 2011, 2012). Although the converse of interpersonal dependency—detachment—has received only modest attention from researchers, preliminary evidence suggests that detachment may also moderate patient adjustment during treatment for physical and psychological illness. For example, Bornstein et al. (2009) found that high levels of dysfunctional detachment as assessed by the Relationship Profile Test (RPT; Bornstein and Languirand, 2003) were associated with increased depression and anxiety in a sample of female primary care patients undergoing outpatient treatment in an urban health center. Porcerelli et al. (2009) found that high levels of detachment in primary care patients from the same sample were associated with higher average healthcare costs per office visit. High levels of detachment are associated with a maladaptive defense style in patients undergoing outpatient substance abuse treatment (Bornstein et al., 2010), and with elevated levels of distress and poorer treatment response in patients undergoing inpatient treatment for substance abuse (Haggerty et al., 2010). Given that interpersonal dependency and detachment moderate patient adjustment for an array of illnesses, it is likely that these variables play a particularly important role in moderating patient adjustment following cancer diagnosis. After all, cancer diagnosis is a highly stressful event that typically evokes a strong emotional response in patients, and as noted, such a diagnosis typically evokes feelings of helplessness, fear, and vulnerability, especially in patients predisposed toward interpersonal dependency. The physician—who plays an important symbolic role as protector and caregiver even for individuals undergoing treatment for less serious illnesses—becomes a crucial figure in the patient’s life following cancer diagnosis. This study examined the impact of interpersonal dependency and detachment on health status, distress, and the physician-patient relationship in a mixed-sex sample of adults undergoing outpatient treatment for cancer. Dependency and detachment were assessed via the RPT (Bornstein and Languirand, 2003), a widely-used self-report measure which yields separate scores for Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD). We hypothesized that high scores on the RPT DO and DD scales would be associated with higher levels of distress, and lower health related quality of life. High DO scores should be associated with a more positive physician-patient relationship, whereas high DD scores should be associated with a comparatively negative physician-patient relationship. High scores on the RPT HD scale should be associated with lower levels of distress, higher health related quality of life, and a more positive physician-patient relationship.