The diagnosis and treatment of cancer are sources of considerable psychological stress for patients and their families. Although treatments have become increasingly effective for a wide range of cancers, the initial diagnosis still involves a threat of loss of life for many patients. Even in those cases in which the prognosis for survival is good, there may be the threat of the loss of some significant aspect of personal functioning, damage to physical appearance, or loss of physical functioning (e.g., Heinrich, Schag, & Ganz, 1984). In addition to its importance in its own right, the diagnosis of cancer represents a prototype of acute, extreme stress that confronts many families. A necessary first step in research on stressors such as cancer is to document levels of psychological distress and identify individual differences among family members in order to set the stage for subsequent research on the processes that may contribute to distress.Cancer appears to present at least a short-term threat or crisis to patients, as reflected in increased symptoms of depression and anxiety near the time of diagnosis (e.g., Andersen, Andersen,

Cognitive appraisals and coping were examined in children, adolescents, and young adults (N = 134) faced with the diagnosis of cancer in a parent. All 3 age groups perceived low personal control and high external control over their parent's illness and used relatively little problemfocused coping. Adolescents and young adults reported more emotion-focused coping and dual-focused coping (both problem-and emotion-focused in intent) than did preadolescent children. Stage and prognosis of parent's cancer were related to appraisals of greater seriousness and stressfulness, and to more avoidance; however, only appraisals of stress were related to symptoms of anxiety-depression. Emotion-focused coping was related to greater avoidance and to higher symptoms of anxiety-depression; coping and control beliefs did not interact in their association with anxiety-depression symptoms.

This article discusses developmental changes in perceptions of control, the relationship between perceived control and strategies used by children to cope with stress, and the interaction between perceived control and coping in their association with psychological adjustment and disorder. Developmental research on children's perceptions of control has identifed both changes and consistencies in contingency, competence, and control beliefs during childhood and early adolescence. Developmental changes in coping have also been documented, with problem-focused skills emerging during childhood, and more rapid development of emotion-focused coping skills during later childhood and early adolescence. Studies have shown that perceptions of control are related to the ways that children and adolescents cope with stress. The implications of this research for interventions aimed at enhancing children's problem-solving and coping skills are discussed.Josh, an 11-year-old boy, and Amy, an 11-year-old girl, both share the common experience of being teased by other children. They find such experiences stressful, but they differ considerably in their beliefs about the controllability of these problems and in their actions to try to deal with them. Although Josh believes children in general can stop others from teasing them, he sees

This study assessed anxiety/depression and stress response symptoms in adult cancer patients (n = 117), spouses (n = 76), and their children (n = 110, ages 6 to 30 years old) near the patients' diagnoses to identify family members at risk for psychological maladjustment. Patients' and family members' distress was related to appraisals of the seriousness and stressfulness of the cancer but not related to objective characteristics of the disease. Patients and spouses did not differ in anxiety/depression or in stress-response symptoms. Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient. Adolescent girls whose mothers had cancer were the most significantly distressed. Implications for understanding the impact of cancer on the family are highlighted.