Coping, Quality of Life, Depression, and Hopelessness in Cancer Patients in a Curative and Palliative, End-of-Life Care Setting

Hanneke W. M. van Laarhoven, MA, MD, PhD; Johannes Schilderman, PhD; Gijs Bleijenberg, PhD; Rogier Donders, PhD; Kris C. Vissers, MD, PhD; Constans A. H. H. V. M. Verhagen, MD, PhD; Judith B. Prins, PhD

Disclosures

Cancer Nurs. 2011;34(4):302-314. 

In This Article

Abstract and Introduction

Abstract

Background: Coping strategies may be important factors influencing quality of life (QOL), depression, and hopelessness. However, most studies on this issue were performed in patients still undergoing anticancer treatment. Unknown is which coping strategies are of importance for palliative-cancer patients who no longer receive treatment.
Objective: The objectives of this study were to assess coping strategies in curatively treated and palliative-cancer patients no longer receiving anticancer treatment and to examine the relation of these coping strategies with QOL, depression, and hopelessness.
Methods: A descriptive research design was used. Ninety-two curative and 59 palliative patients filled out the COPE-Easy abbreviated version, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck Depression Inventory for Primary Care, and Beck Hopelessness Scale.
Results: In both curative and palliative patients, active coping strategies and acceptance were beneficial in terms of QOL, depression, and hopelessness, unlike avoidant coping strategies and venting of emotions. Palliative patients scored higher on the coping strategy, seeking moral support. For the outcome variable, emotional functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, seeking moral support. For the outcome variable, role functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, waiting.
Conclusions: Coping strategies were significantly correlated to QOL, depression, and hopelessness. However, this correlation differed in the curative and palliative, end-of-life care setting.
Implications for Practice: The observed relations between coping strategies, QOL, depression, and hopelessness give room to cognitive-behavioral nursing interventions. Specific attention is needed for differences in coping strategies between curative and palliative patients.

Introduction

In the Netherlands, 86 200 new cases of cancer were diagnosed in 2007, and the incidence of cancer is still increasing (www.ikcnet.nl). Chances of survival largely depend on the type of cancer and the stage when it is diagnosed. Roughly about half of the cancer patients can be cured. Even when a patient is cured, he/she has to deal with long-term adverse effects of the cancer treatment.[1] In everyday language, cancer is associated with terms such as battle and war, struggle, and suffering. This suggests that coping with cancerVthe symptoms, diagnosis, and treatmentVis a major challenge. Coping with the fact that cancer cannot be cured may be an even greater challenge.

From several studies in cancer patients, it is known that the coping strategies that patients use may be important factors influencing quality of life (QOL), depression, and hopelessness.[2–4] However, most studies on this issue have been performed in patients who were treated with a curative intent. Even studies performed with so-called palliative patientsVthat is, patients who cannot be curedVincluded patients who were still undergoing anticancer treatment by means of palliative chemotherapy or radiation therapy. However, it cannot be assumed that the relationship between coping and QOL, depression, or hopelessness, which is observed in patients undergoing anticancer therapy, can be extrapolated to patients for whom all therapies have been terminated and who are facing death.

Therefore, in this study, we compare the coping strategies of cancer patients in the curative and the palliative, end-of-life care setting and examine the relation of these coping strategies with QOL, depression, and hopelessness.

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