Mental Adjustment To Cancer Scale Research Articles

Religious attitude, spirituality and mental adjustment in Turkish geriatric oncology patients.

This study was conducted to determine the relationship between religious attitudes and spirituality levels of geriatric oncology patients and their psychological reactions to cancer. The sample consisted of 261 geriatric oncology patients who were inpatients in oncology and hematology clinics of a university hospital. The research was conducted between 30 July 2020 and 26 January 2022. Data were collected using the Mental Adjustment to Cancer (MAC) scale, the Ok-Religious Attitude (ORA) scale, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale. The effect of the ORA scale and FACIT-SP scale scores on the MAC scale were analyzed using path analysis. A positive relationship was found between Spiritual Well-Being and Fighting (β=0.028, p<0.001) and Anxious Anticipation (β=0.024, p<0.001); a negative relationship was found between Fatalism (β=-0.023, p<0.001), Helplessness/Hopelessness (β=-0.04, p<0.001) and Denial/Avoidance (β=-0.026; p<0.001). A positive relationship was found between Religious Attitude and Fighting Spirit (β=0.154, p=0.009) and Anxious Anticipation (β=0.231, p<0.001), while a negative relationship was found between Religious Attitude and Despair/Hopelessness (β=-0.413, p<0.001). Patients' religious attitudes and spiritual well-being levels affected their psychological reactions to cancer, increased their "fighting spirit" and their "anxious preoccupation" about the disease, and decreased their helplessness/hopelessness, fatalism, denial and avoidance.

Perceived Social Support and its Relation with Mental Adjustment among Women Diagnosed with Breast Cancer

Women with breast cancer experienced many problems in various aspects of their lives, thatthey use active approaches which can result in improving their psychosocial adaptation to thedisease. Social support buffers the harmful impacts of cancer. Aim of the study: was to evaluateperceived social support and its relation with mental adjustment among women diagnosed withbreast cancer Subject: 85 women with breast cancer as a convenient sample from both inpatientand outpatient services of oncology Department of Tanta University Hospital was included.Study design: a descriptive correlation research design was utilized. Tools of the Study: Tool 1:Perceived Social support scale, include 2 parts: Part one: Socio-demographic Characteristicsand Clinical Information. Part two: Perceived Social support scale. Tool 2: Mental Adjustmentto Cancer Scale. Results: majority 74.1% women had moderate social support while one third25.9% of them had high social support. The majority 78.8% of women had adapted in fightingspirit subscale of positive adaptation. But two thirds 68.2% of them had not adapted in anxiouspreoccupation, hopelessness /helplessness, and avoidance subscales of negative adaptationsubscales while 31.8% of them had adapted. Conclusion: perceived social support dimensionswere not statistically significant correlated with mental adjustment to cancer dimensions. Alsoperceived social support dimensions with positive & negative mental adjustment to cancerdimensions. While breast cancer severity & degree was statistically significant related withpositive mental adjustment dimensions. Recommendations: women showing negativepsychological responses to cancer need to psychiatric intervention during cancer treatment.

Psychological Adjustment and Related Factors in Patients with Recurrence/Metastatic Lung Cancer after Curative Surgery

The purpose of study was to clarify the psychological adjustment and related factors in lung cancer patients with recurrence/metastasis after curative surgery. Forty-one with lung cancer who were informed of a recurrence/metastasis after curative surgery completed a questionnaire comprised of the Mental Adjustment to Cancer Scale (MAC), Psychological Adjustment scale for Cancer Survivors (PACS), and information pertaining to demographic variables. When healthcare providers intervene in patients with lung cancer that has recurred/metastasized after curative surgery, it is necessary to assess patients' psychological adjustment based on demographic information, such as age, sex, marital status, and employment status, and to provide effective support promptly. Factors associated with psychological adjustment with recurrent/metastatic lung cancer after curative surgery were 1) female, 2) having a job, 3) over 65 years of age, 4) having a spouse, and 5) advanced-stage cancer. There was no difference in psychological adjustment between treatment and the period from cancer incidence to recurrence/metastatic. J. Med. Invest. 70 : 200-207, February, 2023.

Mindfulness for the self-management of negative coping, rumination and fears of compassion in people with cancer: An exploratory study.

Cancer and its treatments have the potential to significantly impact mental health, provoking feelings of anxiety, depression, and distress, which can last long after treatment is over. One of the most rapidly emerging influences in the healthcare field is mindfulness-based interventions (MBIs), which are designed to cultivate present moment awareness, attentional flexibility, compassion and acceptance, to reduce physical and psychological distress. However, there is limited research into the efficacy of MBIs or disease specific MBIs in shifting negative coping, ruminative thinking and fears of compassion as primary outcomes in individuals with cancer. This exploratory study was designed to evaluate inter- and intra-individual change in the management of negative coping, rumination and fears of compassion, following a cancer-specific mindfulness-based intervention. A single group, non-experimental, repeated measures study of 22 participants across six cancer care centres explored the efficacy of an 8-week Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca) course. The Reliable Change Index (RCI) examined reliable clinical improvement, deterioration, or no change in individuals on the Mental Adjustment to Cancer Scale (MACS), the Ruminative Responses Scale (RRS) and the Fears of Compassion Scale (FCS). About 82% of participants (n=18) saw an improvement in at least one measure. A significant decrease in primary outcome scores was observed in negative coping, ruminating and fears of self-compassion. There were significant correlations between the fear of self-compassion and depressive ruminating, fear of accepting compassion from others and showing it to others pre and post intervention. Our findings indicate that the MBCT-Ca programme may significantly reduce negative coping, ruminating and fears of self-compassion improving psychological health and wellbeing in cancer survivors.

Implementation of Mental adjustment to cancer scale in psycho-oncology practice in Bulgaria

Abstract Background Theoretically there are several insufficiently confirmed statements based on evidences that underline the important role of psychological assistance to patients with malignant neoplasms. Since April, 2021, Mental Adjustment to Cancer Scale (MAC) is translated into Bulgarian and it was introduced to psycho-oncologic practice in Bulgaria. Methods The concise variant of MAC - Mini Mental Adjustment to Cancer Scale (Mini-MAC) has been implemented evaluating the degree when the patients perceive their adaptation to the diagnosis and cancer treatment. It comprises 29 items and measures four inner scales: determination, helplessness, anxiety, cognitive negligence and fatalism. It has been applied in compliance with strict confidentiality, voluntary principle and objectivity to 30 patients - 14 male and 16 female. Results MAC scales have good consistency - alpha coefficient from 0.56 to 0.74. The age correlates moderately with disease type (r=.35, p = 0.05). Helplessness is in positive relation to anxiety (r=.63, p = 0.000) and fatalism (r=.30, p = 0.05), and in negative one to determination (r=-.35, p = 0.05). The determination is in statistic positive relation to cognitive negligence (r=.44, p = 0.02). Conclusions The malignant disease type does not influence the scale results. They are influenced by inner factors as morbid experience, sensitivity to the disease, psychological protections that are frequently demonstrated by cognitive negligence and determination. MAC has been successfully implemented in the clinical psychological counseling in Bulgaria. Key messages Mental Adjustment to Cancer Scale identifies patients' adaptation to cancer and is introduced in Bulgaria. The methodology shows the established cognitive mechanisms for personal understanding and behavior in the course of treatment.

Quality of life in patients with soft palate resection: The relationship between reported functional prosthetic outcomes and the patient’s psychological adjustment

Statement of problemTumors of the soft palate and the adjacent tissues often create considerable soft palate defects that are challenging for the maxillofacial prosthodontist. Soft palate obturator prostheses can usually address functional and esthetic concerns; however, the effectiveness of the prosthetic rehabilitation in improving the patient’s well-being and overall quality of life (QOL) has not been extensively researched. PurposeThe purpose of the present research was to evaluate the function of the prosthesis, to review the interrelation between sociodemographic, medical, and treatment (SMT) characteristics, QOL, and prosthesis functioning, and to analyze the role of the prosthesis in how the patient represents the illness and the psychological coping response. Material and methodsThirty-three patients who underwent resection of the soft palate and had been using a technically successful soft palate obturator prosthesis for at least 1 year were interviewed by means of 5 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), Obturator Functioning Scale (OFS), Illness Perceptions Questionnaire (IPQ-R), and Mental Adjustment to Cancer Scale (MAC). Data analysis was performed at α=.01. ResultsThe QOL (r=-0.53, P=.001), personal control (r=-0.53, P=.001), negative adjustment to cancer (r=0.47, P=.005), treatment control (r=-0.55, P=.001), consequences (r=0.62, P<.001), and emotional representations (r=0.30, P=.009) were significantly related to prosthesis functioning. Better QOL was significantly related to prosthesis functioning (P=.006), age (P=.001), sex (P=.011), and type of soft palate defect (P=.009). The most important predictors of favorable soft palate obturator functioning were age (P<.001) and type of soft palate defect (P=.01). ConclusionsA patient-perceived effective soft palate obturator prosthesis was a significant predictor for advanced QOL, better adjustment to illness and illness-related disabilities, as well as the overall coping response to cancer.

Relationship between the religious attitudes of women with gynecologic cancer and mental adjustment to cancer.

This study was conducted to determine the relationship between religious attitudes of Muslim women with gynecologic cancer and mental adjustment to cancer. Designed as a descriptive relational study, this study was conducted with 123 patients with gynecologic cancer. A personal information form, prepared in accordance with the literature, the Religious Attitude Scale (RAS), and the Mental Adjustment to Cancer Scale (MACS) were used as data collection tools. The data were assessed using descriptive statistics, Pearson's correlation analysis, and linear regression analysis. A positive correlation was determined between the RAS score and the fighting spirit subscale of the MACS (r = 0.65, p < 0.001). A negative correlation was found between the helplessness/hopelessness and anxious preoccupation subscales of the MACS and the RAS score (r = -0.40, p < 0.001; r = -0.30, p < 0.001, respectively). The present results are helpful in understanding the influence of religious attitudes on the mental adjustment to gynecologic cancer patients. The results can serve as a reference for nursing education and clinical healthcare practice. Palliative healthcare providers can participate in improved care by recognizing spiritual needs and by advocating for attention to spiritual needs as a routine part of cancer care.

Effect of the childhood trauma on the adjustment to cancer in the patients with breast cancer.

Early identification of patients coping poorly is important for compliance with treatment and control of distress. This study aims to investigate the effect of the childhood trauma experience on the type of reaction and adjustment that the person exhibits to the cancer among the patients with breast cancer. This cross-sectional study enrolled 310 patients with breast cancer. The effect of the childhood trauma and the psychological condition on the adjustment to cancer was investigated by assessing the adjustment to cancer, the experiences of childhood trauma and psychological status of the subjects using mental adjustment to cancer scale (MAC), childhood trauma questionnaire (CTQ28), Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI). Majority of the subjects (77.4%) showed positive adjustment to cancer. Fighting spirit (63.9%) was the most commonly seen mechanism of adjustment to cancer. Of the subjects, 54.5% suffered at least one of the childhood trauma types. Among the patients, 47.1% had depression and 58.4% had anxiety. In the multivariate logistic regression analysis, emotional neglect and depression, respectively, have an effect on both positive and negative adjustment to cancer. Our study demonstrated that childhood trauma, especially emotional neglect, affects coping and adjustment among the patients with breast cancer. It is necessary to determine the childhood experiences to ensure the development of psychosocial interventions that will increase the adjustment and quality of life after the diagnosis of the cancer.

An observational study of a team management approach for first-line XELOX therapy in patients with advanced/recurrent colorectal cancer: The SMILE study (the study of metastatic colorectal cancer to investigate impact of learning effect).

554 Background: Although oral chemotherapies such as XELOX are widely favored for convenience and flexibility, these have several disadvantages such as drug non-compliance and delayed discovery of adverse events. So we designed a multicenter, prospective, observational study to evaluate the efficacy of supportive interventions in first-line XELOX for colorectal cancer (CRC) patients (pts). Methods: CRC pts undergoing first-line XELOX (+Bevacizumab) therapy practicing one or more of supportive interventions as follows: 1) a telephone follow-up (TF), 2) instruction on dosage and administration by a pharmacist, 3) skin care instruction by a nurse, and 4) pts education by a doctor were eligible. The objective was to evaluate the incident rate of grade 2 or worse hand-foot syndrome (HFS), QoL, safety, and efficacy. QoL was assessed at baseline, 2, 4, 5 and 8 cycles after the treatment started, using the Hospital Anxiety and Depression Scale (HADS) and the Mental adjustment to cancer scale (MAC). Results: From April 2011 to September 2012, 80 pts were enrolled from 14 institutes. The characteristics were as follows: male/female: 46/34, age median: 63 (36-75), and supportive intervention 1)/2)/3)/4): 36/68/73/78. The incidence of grade 2 or worse HFS during 6 months were 11.1% (n=4) for those received TF (n=36), and 20.5% (n=9) for those received other intervention except TF (n=44). Relative dose intensity (RDI) was 75.7% (TF+/-: 77.7/74.3%) in oxaliplatin and 77.5% (TF+/-: 80.2/75.3%) in capecitabine, respectively. Although a tendency of the QoL score improvement about anxiety, fighting spirit and helplessness in a TF group was observed during the periods from start of therapy to 4 courses, there were no significant differences compared to other interventions except TF. Conclusions: We confirmed that HFS incidence was mitigated in a TF group. In regard to QoL, although we could not show the statistical differences due to some limitations of this study such as small sample size and non-randomized, it was indicated that TS had the potential to improve several QoL about anxiety, fighting spirit, and helplessness. Clinical trial information: UMIN000007185.

Illness perceptions, adjustment to illness and depression in a palliative care population

ContextRepresentations of illness have been studied in several populations but research is limited in palliative care.ObjectiveTo describe illness representations in a population with advanced disease receiving palliative care; and to...

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients

The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients. Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time. In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test-retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test-retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses. The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross-national usefulness of the MAC scale.

Breaking Bad News: Relationship between the Experience Receiving Breast Cancer Diagnosis and Early Psychological Adjustment.

Abstract Experiences at time of breast cancer (BC) diagnosis are associated with patient psychological health several months to years later; however, little investigation of this relationship during initial period following diagnosis has been undertaken.METHODS:This prospective study was designed to characterize the experience of receiving cancer diagnosis in women initiating treatment for BC (Stage 0 to III) and to identify associations between this experience and early psychological adjustment, hopefulness, and satisfaction with medical care. 121 women who recently received BC diagnosis prompting referral to specialty center responded to questionnaires assessing their experiences and coping styles:1. Experience Receiving Breast Cancer Diagnosis (ERBCD), categorizing patient demographic, medical, and psychosocial factors; context factors (location, privacy); clinician factors and behaviors.2. Cancer Diagnostic Interview Scale (CDIS) for perceived psychotherapeutic techniques used by clinican conveying cancer diagnosis.3. Mental Adjustment to Cancer Scale (MAC) for coping styles of fighting spirit, hopelessness/helplessness, anxious preoccupation, fatalism, and avoidance.Subjects completed the Profile of Mood States (POMS), Spielberger State-Trait Anxiety Inventory (STAI) and ratings of hopefulness and satisfaction. Multivariate regression analysis was employed with scores from POMS, STAI, hopefulness and satisfaction as dependent variables and values from ERBCD, CDIS and MAC as independent variables.RESULTS:Patients received diagnosis from general physicians, surgeons, radiologists, nurses, NP/PAs, gynecologists, breast specialists, family members, and secretaries. BC diagnosis was disclosed by telephone (59%), face-to-face (40%), letter (1%) and spouse (1%). Mean CDIS-Caring score was 3.4 ± 1.1 and CDIS-Competence was 4.0 ± 0.9 of 5.0. Results of multivariate regression analysis are shown:POMS-Total Mood DisturbanceIndependent VariableParameterSEP ValueAge-0.6600.2760.0183MAC-Fighting Spirit-1.1550.4360.0093MAC-Anxious Preoccupation5.2720.780&amp;lt; 0.001 STAI-State AnxietyIndependent VariableParameterSEP ValueRecent Stress Level0.9420.3710.0127MAC-Fighting Spirit-0.3670.1480.0147MAC-Anxious Preoccupation1.9740.271&amp;lt;0.0001MAC-Avoidant4.4671.4950.0036 Satisfaction was predicted by CDIS-Caring, individual conveying diagnosis, type of information helpful, feeling concerns were understood.CONCLUSIONS:Experiences receiving BC diagnosis are variable and associated with hopefulness and satisfaction. Age, recent stress level and predominant coping style appear more predictive of psychological adjustment (POMS, STAI) than experience receiving BC diagnosis. Understanding these relationships provides direction for future research and clinical interventions to identify patients at risk for early mood disturbance and anxiety following BC diagnosis and to modify aspects of conveying BC diagnosis that influence hopefulness and satisfaction with medical care.HopefulnessIndependent VariableParameterSEP ValueCDIS-Caring0.4270.088&amp;lt;0.0001Diagnosis by Telephone0.3810.1770.0338Opportunity to Ask Questions0.4440.2270.0535Recent Stress Level-0.0820.0290.0057MAC-Fighting Spirit0.0430.0120.0005MAC-Anxious Preoccupation-0.0610.0230.0098 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1069.

The mental adjustment to cancer scale: a psychometric analysis in Spanish cancer patients

The Mental Adjustment to Cancer (MAC) scale was used to assess the cognitive responses to a cancer diagnosis. The aim of this study was to replicate the factorial structure of the Spanish version of the scale and ascertain the correlations between dimensions of the MAC and socio-demographic characteristics or medical variables. The sample included 693 cancer outpatients. In order to validate the MAC questionnaire was applied a principal component analysis. The dimensions of the questionnaire were compared and correlated with socio-demographic characteristics (age and gender), medical variables (cancer site, time since diagnosis) and distress. After the MAC factorial analysis, 28 items were included in five factors: Hopeless, Anxiety, Resignation/Fatalism, Illness Acceptance and Self-Safety Behaviour. In relation to the variables, the women cope with cancer with more Illness Acceptance and Resignation subscales than men. More mature ages were related with Hopeless, Resignation and Self-Safety Behaviour, also correlated negatively with Anxiety. The cancer site showed significant differences on the Hopeless and a tendency on Resignation subscale. Time since diagnosis did not correlate significantly with any subscales in the Spanish version of the MAC. Distress was reflected in the Anxiety and Hopeless subscales, and moreover it was related negatively with Self-Safety Behaviour. The MAC scale was a valid and acceptable tool for Spanish cancer patients, however, these findings provide a factorial structure different from the original MAC scale.

A randomized study assessing the efficacy of communication skill training on patients' psychologic distress and coping

Although studies have shown the usefulness of improving health professionals' communication skills by training, to the authors' knowledge none have demonstrated the efficacy of communication skill training (CST) for health professionals in terms of improving patient outcomes. This study aimed to assess the efficacy of CST for nurses in improving psychologic distress and coping among patients after being informed of a cancer diagnosis. Nurses who mainly provide patients with psychologic and informational support after being informed of their cancer diagnosis by physicians at a cancer screening center were randomly assigned to either an experimental or a control group; patients were supported by either group of nurses. Patient selection criteria were: age >18 years with gastric, colorectal, or breast cancer that was not in advanced stage. Intervention consisted of 3 1-on-1 nurses' interviews (on the day of, 1 week after, and 1 month after diagnosis). Efficacy was assessed through patients' psychologic distress and coping by administering the Hospital Anxiety and Depression Scale (HADS) and Mental Adjustment to Cancer scale (MAC), at 3 time points (1 week, 1 month, and 3 months after diagnosis). Eighty-nine patients participated. Repeated measures analysis of variance demonstrated a significant group-by-time decrease in patients' psychologic distress on HADS (P = .03), and significant group-by-time increase in fighting spirit and decrease of fatalism (P = .01 and P = .04, respectively), in addition to significant between-group difference of anxious preoccupation on the MAC (P = .003). Support by nurses who completed the CST program was found to reduce psychologic distress and improved coping long term among patients informed of their cancer diagnosis.

Mental Adjustment to Cancer Scale©: psychometric properties in a large cancer cohort

The Mental Adjustment to Cancer (MAC) Scale is widely used to assess psychological response to cancer. There have been several attempts to replicate independently the original factor structure of the MAC. Evidence from these replication studies is reviewed. A re-analysis of the MAC Scale was conducted on a substantial new cohort in order to clarify the factor structure. 1255 patients with various cancer diagnoses completed the MAC Scale. Two results emerged: first, that the original MAC dimension of Helplessness/Hopelessness is extremely stable and robust; second, that the original factors can be subsumed within two overarching (first order) factors relating to positive and negative adjustment scores. The original MAC Scale remains a satisfactory measure of psychological outcome. Two-higher order factors representing global adjustment are now available to provide an overall summary measure alongside the original specific sub-scales.

Comparison of a questionnaire commonly used for measuring coping with a daily-basis prospective coping measure

Background Much research have investigated the relation between stress and health, with focus on the role of coping as a moderator. The use of the concept of coping is in need of more stringency since it is often used in a more or less careless manner. A contributory cause of the confusion within the research field is the often-negligent interpretation of results from the Mental Adjustment to Cancer (MAC) Scale (i.e., results are discussed in terms of coping strategies instead of mental adjustment). Furthermore, checklists are often used in research but seldom specify the stressor that patients are attempting to cope with. Methods Consecutive patients newly diagnosed with gastrointestinal (GI) cancer were included in this study. Of 151 eligible patients, 95 (63%) participated. As soon as their physical condition so permitted, patients were asked to assess their coping by way of two methods: an instrument commonly used for measuring coping (MAC Scale) and a daily-basis prospective coping measure [Daily Coping Assessment (DCA)]. The study investigated the relations between these two methods, which are used to evaluate different ways of coping with cancer, and related these to specified stressful events and psychologic distress outcomes [Hospital Anxiety and Depression Scale (HADS)]. Results Among patients with GI cancers, a comparison of the DCA with the MAC Scale renders important differences regarding the use of coping strategies. Furthermore, coping as measured by the DCA is more clearly separated from both stressors such as psychologic aspects and psychologic distress outcomes as measured by the HADS. Discussion A comparison between the two measures renders differences regarding the use of coping strategies among patients with GI cancers. The daily-basis prospective coping measure seems to be better separated from both stressful events and psychologic distress outcomes. The DCA offers a promising alternative to the use of coping checklists. The difference between the measures is in accordance with the original intention that the MAC Scale be used to measure mental adjustment rather than coping (i.e., the results do not support the use of the MAC Scale as a coping measure).

Japanese cancer patients' communication style preferences when receiving bad news

This study describes the communication style preferences of Japanese patients when receiving bad news, examines the factor structure of the measure for patients' preferences (MPP) in a Japanese population, and explores variables that may be associated with patients' communication style preferences. Five hundred twenty-nine cancer outpatients completed several psychosocial measures including the Japanese version of the MPP (MPP-J), the Mental Adjustment to Cancer Scale (MAC), and the Hospital Anxiety and Depression Scale (HADS). The patients desired detailed information and a supportive environment when receiving bad news. The MPP-J demonstrated a 5-factor structure: support, facilitation, medical information, clear explanation, and encouraging question-asking. Regression analyses indicated that a female gender, the fighting spirit and anxious preoccupation dimensions of the MAC were positively associated with all 5 MPP-J factors. In conclusion, Japanese cancer patients' preferences for communication when receiving bad news differ somewhat from those of American patients. Japanese physicians should encourage patients to ask questions and should consider the demographic (e.g. gender), medical (disease status) and psychosocial characteristics (fighting spirit and anxious preoccupation) of patients when delivering bad news.

Coping and survival in breast cancer patients evaluated in a 5-year follow-up

18624 Background: A notable amount of studies investigated possible relations between the kind of coping with the disease and the survival in cancer patients. There is some evidence that distress is a predictor of shortened survival and that active coping is related to better chances. Nevertheless many of those studies were limited by small sample sizes or a retrospective design and the published data are inconsistent. Methods: This investigation of 212 breast cancer patients (stage I and II) in an adjuvant, disease free situation started 5 years ago about 3 years after the initial diagnoses and was carried out at three different measuring times (5 and 4 years ago and at present). It was an attempt to explore whether the preferred coping styles implicate survival. Results: At present 3.8% (N = 8) of the patients have died because of their cancer and 10.8% (N = 23) are suffering from a relapse. Significant relations between recurrence and avoidance (F1;178 = 3.973; p = 0.048) measured with the IES (Impact of Event Scale) five years ago and between recurrence and avoidance (F1;164 = 6.788; p = 0.010) and aggression (F1;164 = 3.277; p = 0.038) measured with the BSI (Brief Symptom Inventory) four years ago were found with MANOVAs. Patients, who stated a higher level of avoidance and aggression, were at higher risk to become a relapse or metastases. Patients having a progressive course of disease tended to be younger (57.2 years) than patients being free of disease (61.3 years, F1;179 = 3.294; p = 0.070). Regarding the 8 year survival those patients, who had died, stated a higher level of anxious preoccupation measured with the MAC (Mental Adjustment to Cancer Scale) 5 years ago (M-W-U = 397.5; p = 0.48). Conclusions: The results of this study provide an essential aspect for psychological support and of the necessity to include psychooncological elements in physician-patient-communication. No significant financial relationships to disclose.

A 1-year prospective study of individual variation in distress, and illness perceptions, after treatment for breast cancer

Objective The primary objective was to conduct a detailed analysis of individual variation in psychological morbidity in the year following surgery for breast cancer. The salience of the patients' “illness perceptions” to morbidity was examined as a secondary objective. Methods Psychological morbidity was assessed with the General Health Questionnaire (GHQ-28) in a prospective study of 371 women having surgery for primary breast cancer. Patients also completed the Illness Perception Questionnaire (IPQ), Mental Adjustment to Cancer Scale (MAC) and the Eysenck Personality Scales (EPS). Assessments were made postoperatively and at 3, 6 and 12 months after surgery. Results Whilst descriptive statistics indicated a general reduction in mean distress over the 12-month follow-up, close analysis showed that a quarter of all patients maintained clinically significant levels of distress throughout the period. Patients with chronically elevated distress were characterised by higher levels of neuroticism, greater symptom awareness, more pain and poorer self-rated general health. In the regression analysis, psychological morbidity across the 1-year follow-up was predicted principally by the immediate postoperative state of distress, IPQ symptom awareness and the perceived time line of the illness, general health and, to a more minor extent, by neuroticism. Conclusion There is marked individual variation in psychological morbidity in the year following breast cancer surgery, which is reliably predicted by the patient's immediate postoperative state of distress, her perception of the impact of the symptoms and the time line of the disease. Subgroups of patients with chronically high distress are characterised by factors including personality and negative perceptions and beliefs about their illness.

Psychological characteristics of cancer patients who use complementary therapies.

There has been considerable research on the prevalence and demographic profile of cancer patients who opt to supplement conventional therapies with the use of complementary therapy. There is rather less information on the personality and adjustment variables associated with the decision to use complementary therapy. The aim of the present study is to investigate the relationship between the use of complementary therapies by cancer patients and their mental adjustment to cancer, recovery locus of control, life orientation and psychopathology. Two groups were drawn from a regional centre which provides both conventional and complementary cancer treatments. Participants in Group 1 (n = 61) opted for complementary therapies in addition to conventional treatments for cancer, while participants in Group 2 (n = 56), chose conventional treatment only. All participants completed the Mental Adjustment to Cancer Scale (MAC), the Recovery Locus of Control Scale (RLOC), the life orientation test (LOT), and the Hospital Anxiety and Depression Scale (HADS). Information regarding demographic details and patients' motivation for the use of complementary therapy was also collected. Those people who chose complementary therapy demonstrated a mental adjustment to cancer which is characterised by significantly higher levels of fighting spirit and anxious preoccupation. This group had also a higher internal recovery locus of control than those receiving conventional treatment alone. There were no significant differences between the groups on life orientation or psychopathology. The findings of this study do not support the argument that the use of complementary therapy is associated with higher levels of psychopathology and distress. However, the data do indicate that for some patients the use of complementary therapy fulfils an important psychological need. The finding that psychosocial variables like fighting spirit and locus of control may impact on an individual's therapeutic choice can assist clinicians in tailoring interventions to personality and adjustment characteristics.