Fighting spirit expressed by women with breast cancer in professional-and peer-led online support groups: effects on outcomes

Objective: Does fighting spirit reduce depression in women with breast cancer (BC)? Methods: Unlike previous studies using questionnaires, we assessed fighting spirit by analyzing interaction in BC support groups. Three online groups were studied: synchronous professionally led groups (Life Beyond Cancer), asynchronous professionallyled groups (Bosom Buddies) and asynchronous peer-led bulletin board groups (Peer Bulletin Boards). The samples were predominantly Caucasian, married, highly educated, and had early stage cancer. We used a content analysis program, DTSearch, to measure fighting words expressed in the groups. Linear regression was used to examine the relation between fighting words and follow-up depression, controlling for baseline depression and total word count. We also compared samples on the number of fight words expressed. Results: We found that viewing their cancer as a fight or battle would result in lowered depression was disconfirmed in all samples. The peer groups had twice as many fight words compared to professionally led groups. Conclusion: Previous studies as well as the current one strongly support the null hypothesis. Our finding based on a behavioral measure of fighting spirit does add to previous studies results. Unfortunately the common lay perspective for cancer sufferers is that not having fighting spirit would mean a psychological incapacity. The message is that "brave and good people defeat cancer and that cowardly and undeserving people allow it to kill them". This view can create guilt, self flagellation and stress in woman already facing a difficult disease.