Coping Strategies Used by Dying Cancer Patients Affect QOL

Roxanne Nelson, BSN, RN

July 25, 2016

Patients use a variety of coping strategies after receiving a diagnosis of incurable cancer, but although some strategies may improve quality of life (QOL), others may have a detrimental   effect, according to findings of a new study.

The study examined associations between coping strategies, QOL, and mood in 350 patients who were part of a randomized trial of palliative care. Assessments were made within 8 weeks of   receiving a diagnosis of incurable lung or gastrointestinal cancer.

Most patients reported using emotional support and acceptance coping strategies; these correlated with better QOL and mood, but a "concerning proportion" reported high utilization of denial and   self-blame, which correlated with worse QOL and mood.

The use of acceptance coping strategies correlated with lower anxiety and depression scores, whereas denial and self-blame coping strategies were associated with higher anxiety and depression   scores.

The study is published in the July issue of Cancer.

"The main finding of this study is that patients with newly diagnosed, incurable cancer utilize a variety of unique coping strategies," commented lead author Ryan Nipp, MD, of Massachusetts   General Hospital, Boston.

"Notably, we found that patients' use of certain coping strategies was associated with their quality of life and mood," he told Medscape Medical News. "These findings underscore the   importance of addressing patients' coping behaviors, as these behaviors can affect other key patient-reported outcomes."

The findings also support the need for ongoing research to better understand how certain coping strategies influence patient outcomes. "Currently, our findings suggest that simply evaluating   and addressing patients' use of specific coping strategies may be a good first step," said Dr Nipp.

Understanding the coping strategies patients use will in turn allow clinicians to be better prepared to support patients throughout their treatment course.

"Specifically, clinicians may offer certain psychological and supportive care services to help meet the unique needs of their patients," he explained. "Moreover, we need additional research to   help determine the supportive care services that most effectively encourage patients to utilize more adaptive coping mechanisms while also preventing the perpetuation of maladaptive   strategies."

Variety of Strategies Used

For their study, Dr Nipp and colleagues used the Functional Assessment of Cancer Therapy–General to measure QOL, the Hospital Anxiety and Depression Scale to assess mood, and the Brief COPE   tool to measure coping strategies.

Over half the trial participants were men (54.0%) who had been diagnosed with lung cancer (54.6%); the mean age was 65 years; more than two thirds were married (70%).

The majority of patients reported high use of emotional support coping strategies (77.0%). Many also reported that they used acceptance (44.8%), self-blame (37.9%), and denial (28.2%) to cope   with their cancer diagnosis.

The Brief COPE is a validated instrument that was used to assess the patients' coping mechanisms, explained Dr. Nipp. It is a 28-item questionnaire that assesses 14 coping methods using two   items for each method.

To minimize questionnaire burden for participants, the authors limited the assessment to the following seven coping strategies, which were felt to be most appropriate for the study population:   emotional support, positive reframing, active, acceptance, self-blame, denial, and behavioral disengagement.

Scores on each scale range from 2 to 8, with higher scores indicating greater use of that particular coping strategy. "In order to determine the strategies used most frequently in our sample,   we calculated the median scores on each item of the Brief COPE and then described the proportion of patients with a score greater than the median," said Dr Nipp. "We designated patients with   scores above the median as 'high' utilizers of that particular coping strategy."

As an example, with respect to self-blame, the following two items were presented:

  • I've been criticizing myself.

  • I've been blaming myself for things that happened.

The patients then could choose from the following responses:

  • 1 = I haven't been doing this at all.

  • 2 = I've been doing this a little bit.

  • 3 = I've been doing this a medium amount.

  • 4 = I've been doing this a lot.

Differences Across Demographics

The proportions of patients who reported high utilization of each coping strategy were compared with respect to age (<65 years vs >65 years), sex, marital status, cancer type, religion,   and smoking history.

The analysis showed that a higher proportion of younger patients (58.6% vs 39.9%, P = .001), those who were not Catholic (55.9% vs 44.4%, P = .038), and those with a smoking   history of less than 10 pack-years (56.2% vs 42.9%, P =.017) reported high use of positive reframing.

The authors also found that a larger percentage of younger patients (43.9% vs 32.0%, P = .027), those with lung cancer (43.1% vs 31.6%, P = .034), and patients with a smoking   history of 10 pack-years or more (44.6% vs 30.2%, P = .008) reported high utilization of self-blame.

There was no difference in the use of active, denial, emotional support, behavioral disengagement, and acceptance coping strategies across these specific demographics.

"In this study, we found that emotional support was the most frequently utilized coping strategy in patients with newly diagnosed, incurable cancer," said Dr Nipp. "Importantly, use of both   emotional support and acceptance coping strategies correlated with better quality of life and mood in this population."

These findings suggest that certain coping behaviors may be more adaptive than others, and these adaptive coping behaviors can be further nurtured to improve patients' outcomes, he noted.

Importantly, these data will inform future studies to determine whether behavioral interventions can encourage patients to utilize these more adaptive coping mechanisms and to discourage the   use of strategies that are maladaptive with respect to QOL and mood in this vulnerable population, Dr Nipp added.

This study was funded by the National Institute of Nursing Research and the National Cancer. The authors have disclosed no relevant financial relationships.

Cancer. 2016;122:2110-2116. Abstract


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