Mental Adjustment To Cancer Research Articles

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.

A randomized controlled trial of the effect of intercessory prayer on the spiritual wellbeing and quality of life of patients with cancer

e20708 Background: A number of scientific trials assessing the positive impact of intercessory prayer attest to centuries of anecdotal evidence, despite debate of its mechanism. However, little attention has been afforded to patients with cancer and the effect such intervention has on quality of life, including spiritual wellbeing. This study aimed to assess the effect of remote, Christian intercessory prayer on cancer patients’ quality of life, specifically their spiritual wellbeing, including their search for meaning, peace, and faith. Methods: New, consecutive patients with cancer attending an Australian cancer centre, aged 18 years or above, able to read English, and give consent were recruited. With Ethics Committee approval, this prospective, double blinded randomized controlled trial only partially divulged the nature of the study to patients who were informed of the measurements but not the inclusion of randomization to an intervention. Specifically, patients were blindly, randomly allocated to receive distant, intercessory prayer from an established Christian prayer chain (intervention) or not to receive prayer (control). All patients completed the Mental Adjustment to Cancer (MAC) scale and the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (FACIT-Sp) at baseline. The FACIT-Sp was re-administered six months later to assess the primary endpoint, a change in spiritual wellbeing. It was anticipated that 1000 patients were needed (allowing for 20% drop out) to achieve 80% power to detect hypothesized small differences (Cohen's d .20-.50) between groups (alpha = .05). Results: A total of 1003 eligible, consenting patients were accrued between June 2003 and May 2008. Intervention (n = 509) and control (n = 494) groups will be compared across baseline characteristics to identify any pre-existing differences. Between-within subject analyses of covariance (ANCOVAs) will be used to assess whether any differences were evident between groups across measures of spiritual wellbeing and other facets of quality of life. Conclusions: The results of these analyses will be presented. It is hoped this research will provide further empirical support for the biopsychosocialspiritual model of health. No significant financial relationships to disclose.

The role of attachment dimensions and perceived social support in predicting adjustment to cancer

Several studies carried out over the last years show that patients' adjustment is very important to the past experiences of people with cancer. In our study of 96 subjects with cancer, we examined whether patient's working model of attachment anxiety/avoidance and perceptions of social support predicts adjustment to cancer. All participants filled in a demographic questionnaire, the Relationship Scale Questionnaire (RSQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mental Adjustment to Cancer (MAC). Anxious attachment predicted psychological adjustment: patients with high levels of anxious attachment showed high levels of helplessness/hopelessness and anxious preoccupation (p<0.01, and p<0.05, respectively). With regard to the function of perceived social support, the patient's perception of social support from friends was predictive of both fighting spirit and stoic acceptance (p=0.01, and p<0.001, respectively). Conversely, the patient's perception of support from family members was not predictive of adjustment to cancer. Patients in the advanced stages of the illness showed higher levels of helplessness/hopelessness (p<0.05). Anxious attachment and perceived social support predicted different domains of psychological adjustment to cancer. Perceived support from friends may predict the patient's tendency to consider cancer as a challenge and to take an active role in therapy and recovery, whereas social support from family was not predictive of various states of adjustment to cancer.

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.

Perceived control and psychological distress in women with breast cancer: a longitudinal study

The relationship between perceived control and psychological distress in cancer patients has been widely studied, but longitudinal designs are scarce. The aim of this study was to examine whether perceived control could predict changes in the evolution of psychological distress in breast cancer patients at stages I or II. One hundred and one women were assessed on five occasions: one week after surgery, and again 1, 3, 6 and 12 months later, using the Mental Adjustment to Cancer (MAC) Scale, a Self-Efficacy Scale, the Personal Competence Scale, the Hospital Anxiety and Depression Scale (HADS), the Profile of Mood Sates (POMS), and the EORTC questionnaire of quality of life. Latent growth curve (LGC) model analysis was used to test the relationship between perceived control and psychological distress in a longitudinal, 1-year study. The results showed that perceived control increases linearly and that distress also decreases linearly. Moreover, the evolution of distress can be predicted from the initial value and the rate of change of perceived control. This close relationship between perceived control and psychological distress was found to be independent of the evolution of the physical state. These findings suggest that perceived control could be used as an early predictor of psychological adjustment to illness.

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.

Spirituality as a core domain in the assessment of quality of life in oncology

This study investigated including spiritual wellbeing as a core domain in the assessment of quality of life (QOL) in an Australian oncology population. Four hundred and ninety consecutive cancer patients with mixed diagnoses completed the Functional Assessment of Chronic Illness Therapy--Spiritual Well-Being (FACIT-Sp) and the Mental Adjustment to Cancer (MAC) scale. Overall, 449 patients completed assessments. Spiritual wellbeing demonstrated a significant, positive association with QOL (r=0.59), fighting spirit (r=0.49) and a significant, negative relationship with helplessness/hopelessness (r=-0.47) and anxious preoccupation (r=-0.26). A hierarchical multiple regression showed spiritual wellbeing to be a significant, unique contributor to QOL beyond the core domains of physical, social/family, and emotional wellbeing (R(2) change=0.08, p=0.000). However, high levels of meaning/peace or faith did not appear to significantly impact patients' ability to enjoy life despite chronic symptoms of pain or fatigue, making the current results inconsistent with other findings. Results lend further support to the biopsychosocialspiritual model. By failing to assess spiritual wellbeing, the 'true' burden of cancer is likely to be miscalculated. However, at this stage, the exact clinical utility of spirituality assessment is unclear.

Predictors of Fighting Spirit or Helplessness/Hopelessness in People with Cancer

This study was done to identify predictors of the fighting spirit or helplessness/hopelessness in the patients' mental adjustment to cancer. Cancer patients' characteristics like performance status, metastasis and duration of diagnosis with demographic factors, spiritual support and social support were used as predictors of a fighting spirit or helplessness/hopelessness. A total of 124 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale and responded in a structured instrument about their characteristics, spiritual and social support. The results of multiple regression analysis revealed that confidence in the supporter (R(2)=.114, p=.000), duration of cancer diagnosis (R(2)=.041, p=.000) and faith (R(2)=.030, p=.000) were predictive of a fighting spirit (R(2)=.185, p=.000); whereas, education (R(2)=.074, p=.001), performance status (R(2)=.055, p=.000), satisfaction with social support (R(2)=.046, p=.000), and metastasis (R(2)=.037, p=.000) were predictive of helplessness/hopelessness (R(2)=.202, p=.000). Social support, spiritual support and disease related factors like metastasis, performance status, and duration of cancer diagnosis need to be considered in a psychosocial nursing intervention for a fighting spirit or helplessness/hopelessness.

A Structural Model of the Relationships Between Perceived Control and Adaptation to Illness in Women with Breast Cancer

Objectives: To examine whether perceived control produces better adaptation to illness in breast cancer patients in stages I or II. Design: Longitudinal, 1-year following study. Methods: One hundred and one women were assessed on five occasions: one week after surgery, and again 1, 3, 6 and 12 months later, using, among other measures, the Mental Adjustment to Cancer (MAC) and the Hospital Anxiety and Depression Scale (HADS). Results: Structural equation models confirmed that patients with higher perceived control showed better adaptation to illness in all five assessments. Conclusions: These data fit well with previous research and suggest that psychological interventions which emphasize a sense of personal control would be effective in enhancing well-being in breast cancer patients at the early stages.

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).

Global quality of life and its potential predictors in breast cancer patients: an exploratory study

This study reflects variables being depicted as predictors of global quality of life in current research. The evaluation was conducted at the Division of Clinical Oncology at the Medical University in Graz, Austria. A sample of 210 breast cancer patients between ages 30 and 80 years was assessed 1-5 years after initial diagnosis in a tumor-free stage. Besides the socio-demographic and medical variables, the Brief Symptom Inventory (BSI), Impact of Event Scale (IES), Mental Adjustment to Cancer (MAC), and the Perceived Family Support (PFS) were used. To identify variables related to quality of life, stepwise multiple regression analyses were calculated. In a regression analysis, the general severity index (BSI) was identified as the most important and helplessness/hopelessness (MAC) as the second important variable related to QoL. Including the BSI-subscales as predictors, the depression-subscale (BSI) explained 25% of the variance; in addition, somatization (BSI), helplessness/hopelessness (MAC), and having financial problems (semi-structured interview) were significantly related to global quality of life, but the medical variables showed no associations to the measured quality of life. Depression itself is associated with negative the impact of cancer, the number of stressful life events, being uncomfortable with the body, having financial problems and anxious preoccupation (MAC). The awareness of the role of multi-factorial and associated variables could provide patients, family, and medical staff with appropriate and adequate tools to treat specific symptoms.

Mental adjustment, coping strategies, and psychological distress among end-stage renal disease patients

Objective The study examines the association between mental adjustment, coping strategies [emotion (EF) and problem focused (PF)], and psychological distress. Method Sixty end-stage renal disease (ESRD) patients were interviewed a year or more after they began dialysis, measured by the COPE, Mental Adjustment to Cancer (MAC), and Brief Symptom Inventory (BSI) scales. Results The main findings indicate that patients with a strong fighting spirit are in less psychological distress. Moreover, patients who tend to use PF strategies rely on a fighting spirit as an adjustment coping style. Conclusion ESRD patients in the adjustment phase (patients diagnosed at least 1 year previously) tend to struggle to lead as normal a life as possible despite the dependency caused by the illness.

The use of denial in an ethnically diverse British cancer population: a cross-sectional study

A total of 82 Asian and 117 randomly selected white Caucasian patients at the Leicestershire Cancer Centre were assessed using measures of coping and adaption to cancer. On the Mental Adjustment to Cancer (MAC) scale, Asian patients were more fatalistic (P<0.0001) and had more significant hopeless/helpless scores (P=0.007). The two ethnic groups answered the three questions thought to assess denial differently. Caucasians were more likely not to dwell on their illness (73 vs 55.5%, P<0.0001) and agree with the statement ‘I have difficulty believing this is happening to me’ (73 vs 60.5%, P<0.0001). However, Asian patients were more likely to agree with the statement ‘I don't really believe I have cancer’ (48.2 vs 31.3%, P=0.019). Within both groups there was an association with denial and anxious preoccupation (P<0.001). On the Hospital Anxiety and Depression (HAD) scale, there was no difference in anxiety scores between either sexes or between the Asian and Caucasian groups. However, Asian patients were more depressed (P=0.001). Although denial was significantly related to the presence of both depression (P<0.0001) and anxiety (P=0.001) in the entire patient population, there were different predictors of denial in each subgroup. On multiple regression analysis depression was linked with denial in Caucasians, whereas Fighting Spirit (minus helplessness/hopelessness) was linked with denial in Asian patients. There are definite differences in coping styles in British cancer patients according to ethnicity. While significant numbers in both groups employ denial in some form, Caucasian patients appear to adapt to the psychological pressures of cancer more successfully than Asian patients at a particular point in time. Further work is required to elucidate longitudinal relationships between denial and adaption to cancer.

Styles of coping with cancer: the Italian version of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale.

Mental adjustment to cancer has been explored in a large body of the literature by using the Mental Adjustment to Cancer (MAC) scale. Problems in the factor structure of the scale and the need for refining the instrument have determined the development of the Mini-MAC. The aim of this study was to validate, according to a test-oriented approach, the Italian version of the Mini-MAC. Four hundred and thirty cancer patients in five centres in Northern Italy completed the Mini-MAC and the Brief Symptom Inventory (BSI). A subgroup of 153 patients filled out the instruments again within 3 months of the first assessment. The five original subscales (Fighting Spirit, Hopeless, Fatalism, Anxious Preoccupation and Cognitive Avoidance) showed acceptable levels of reliability (Cronbach alpha coefficients ranging from 0.55 to 0.80) although alphas were lower for the scales Fighting Spirit and Fatalism. Factor analysis (Varimax rotation) identified the same five factors with minor variations from the original version. Again, alpha coefficients were less robust for the factors Fighting Sprit and Fatalism. Hopeless and Anxious Preoccupation were significantly related to all the BSI psychological stress symptoms, including the Global Stress Index (GSI). Test-retest reliability showed no differences in the sub-scales scores between assessments.

The mediating role of appraisal and coping in the relationship between optimism-pessimism and quality of life

Longitudinal data from 165 women diagnosed and treated for breast cancer were used to investigate if the relationship between optimism-pessimism and quality of life (QOL) is attributed to the appraisal and coping strategies. The women completed the Life Orientation Test-Revised (LOT-R), as a measurement of optimism-pessimism, the Mental Adjustment to Cancer (MAC) Scale, as a measure for coping, a VAS for appraisal and the EORTC QLQ-C30, as a measure for QOL at two time points: at diagnosis and 12-months after breast cancer surgery. Optimism-pessimism had both a direct and indirect influence on QOL. Two coping strategies were particularly strong mediators for the indirect influence: fighting spirit and hopeless/helpless. Optimists responded with fighting spirit, which had a positive effect on their QOL. On the other hand, pessimists responded with hopeless/helplessness, which had a negative effect on their QOL. The relationship between pessimism and QOL at time of diagnosis was also mediated by appraisal, such as threat. The two coping strategies remained fairly stable over the 12 months within the optimists and pessimists.The results suggest that the influence of optimism and pessimism on QOL appears to be mediated by coping both before and after treatment for breast cancer. Fighting spirit and hopeless/helplessness appear to reflect the characteristic coping strategies for optimists and pessimists.

A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence

The effects of psychosocial group interventions on improving quality of life (QOL) for patients with recurrent breast cancer are not well known. The objective of this study was to assess the feasibility of a psychosocial group intervention in Japanese women with first recurrence of breast cancer. The subjects were consecutively selected from among patients who were diagnosed with a first recurrence of breast cancer. We conducted a 6-week psychosocial group intervention. QOL was assessed using the Profile of Mood States (POMS), the Impact of Event Scale-Revised, the Mental Adjustment to Cancer (MAC) scale, and the European Organization for Research and the Treatment of Cancer (EORTC) Quality of Life Questionnaire-Cancer 30/Breast module 23 (QLQ-C30/Br23) at baseline then immediately and 3 and 6 months after completion of the intervention. Among 58 eligible patients, written consent was obtained from 28 (48%), and the final evaluation was conducted on 19 subjects. The repeated measured analysis of variance (ANOVA) revealed a significant change in tension-anxiety, depression-dejection, anger-hostility and total mood disturbance on the POMS, helplessness/hopelessness on the MAC scale, and body image and future perspective on the QLQ-C30/Br23. Dunnett's test revealed a significant difference in these scores between baseline and 3 months after the intervention but no difference between baseline and 6 months after the intervention. These results suggested the possibility of a short-term effectiveness of the intervention; however the results were inconclusive because of selected small samples.

Psychometric analyses of the Mental Adjustment to Cancer (MAC) scale in a Greek palliative care unit.

The purpose of the study was to assess the Mental Adjustment to Cancer (MAC) scale on a heterogeneous Greek sample of 200 advanced cancer patients. The results presented regard the validation analysis of the Greek version. The homogeneity of the original subscales proved to be satisfactory (alpha coefficients ranged from 0.81 to 0.91). A factor analysis was carried out using the LISREL 8.3 procedure. This yielded five factors, including 25 of the 40 original items (alpha coefficients 0.62-0.93). The resulting factors were called 'hopeless', 'positive attitude', 'acceptance', 'mental engagement', and 'fatalistic'. Correlations between the MAC scale and the disease severity as measured by the ECOG performance status have shown difference only between patients with 'good' versus 'poor' performance status in the 'hopeless' scale (p=0.047). The results suggest that the Greek version, as measured in advanced cancer patients attending a palliative care unit, is a reliable and valid clinical tool in Greece.

Associations between Depression, Anxiety, Hostility and Fighting Spirit among Cancer Patients in a Cancer Center in Korea.

The aim of this study was to examine the associations between depression, anxiety, hostility and fighting spirit among patients with stomach, colorectal or breast cancer. 223 patients, diagnosed as with stomach, colorectal or breast cancer, undergoing chemotherapy or follow up care, were the subjects of the study. The study design was cross-sectional at the time of the survey. The degrees of depression, anxiety and hostility of the patients were assessed by the SCL-90-R scores, and the fighting spirit was measured by the Mental Adjustment to Cancer (MAC) scale score. The scores of anxiety and hostility of the patients at younger age were higher than those at older age (p<0.01). The patients with metastasis were more depressed than those without it (p<0.01). There was a negative association between depression and fighting spirit (p<0.001). The study showed the more depressed cancer patients had lower fighting spirit score, which was known to be one of the most active psychosocial contributors in adjusting to cancer and survival.

Factors related to patient's mental adjustment to breast cancer: patient characteristics and family functioning.

Previous studies have suggested that patients who adopted a coping response characterized as helplessness or hopelessness reported higher levels of psychological distress than patients who adopted a response characterized as fighting spirit. There are also studies suggesting a relationship between family functioning and psychological well-being of cancer patients and their family members. The aim of this cross-sectional study was to investigate the relationship between breast cancer patients' coping response to the diagnosis of cancer and family functioning. A total of 46 postoperative ambulatory female breast cancer patients and their husbands participated in this study. Patients and husbands completed the Family Assessment Device (FAD), and patients also completed the Mental Adjustment to Cancer (MAC) scale. They filled in these self-report questionnaires at home. The results of multiple regression analysis showed that patients' perception of poor family functioning in the area of Communication measured by the FAD correlated with high Helplessness/Hopelessness score of the MAC, whereas high education in the patients was correlated with low Fighting Spirit score on the MAC. The results suggested a link between a patient's attitude of helplessness or hopelessness in the face of cancer and inappropriate communication among family members. Consequently, health care professionals should devote attention not only to the patient but also to other family members and intervene to promote appropriate communication patterns among the family members.

The mental adjustment to cancer (MAC) scale: French replication and assessment of positive and negative adjustment dimensions.

The Mental Adjustment to Cancer (MAC) scale was validated on a heterogeneous French sample of 317 cancer patients. Internal consistency was satisfactory for the original subscales (alpha coefficients=0.62-0.80), except for the Fatalism subscale (alpha=0.40). The intercorrelations of the subscales and the correlations between the subscales and Anxiety and Depression criteria were congruent with the values reported in the literature. Multidimensional Scaling revealed three positive and three negative subsets of items revealing adjustment to cancer. Congeneric factor analysis of the subsets was performed with LISREL 8.3 and only three of them (after discarding certain items) were retained: Fighting Spirit (FS) Hopelessness/Helplessness (HH) and Anxious Preoccupation (AP). A confirmatory hierarchical factor analysis on the 21 items included showed that FS measured positive adjustment to cancer and HH and AP measured negative adjustment. A differential adjustment hypothesis was proposed in order to explain the stability and instability of the measures of the diverse constructs. The three revised subscales showed the same validity pattern as the corresponding original scales, but the magnitude of the correlations was considerably improved with respect to the original subscales. The practical and the theoretical importance of FS, HH and AP are emphasized.