Differences in coping strategies among young adults and the elderly with cancer

Abstract

Background Coping with cancer and the oncologist–patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non‐metastatic, resected cancer. Methods Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non‐metastatic, resected cancer requiring adjuvant chemotherapy from a pre‐exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects’ emotional responses, perceptions of the physician–patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini‐Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire‐C30, Shared Decision‐Making Questionnaire‐Physician's version, Shared Decision‐Making Questionnaire‐Patient's version, and Informed Risk (physician and patient versions). Results Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision‐making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment. Conclusion Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician–patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision‐making, can display more anxiety about their diagnosis, but also greater capacity to fight.

Biopsychosocial and clinical characteristics in patients with resected breast and colon cancer at the beginning and end of adjuvant treatment

“…Previous studies evaluating patient preferences revealed that breast cancer patients are younger, healthier, and have more active or cooperative roles [5, 26] while individuals with colon cancer would like to be informed and involved in decision-making, but do not necessarily want to make autonomous treatment choices and many prefer a more passive role [27]. In addition, the greater psychological impact of breast cancer, with more symptoms of anxiety, depression, and somatization is not only explained by the fact that it affects younger patients, at a time of maximum professional and family activity, but also by significant changes in appearance (hair loss, mastectomy, weight gain due to hormonotherapy), physical symptoms, and uncertainty about prognosis [6, 7].…”

“…Breast cancer is diagnosed when patients are still young, around the age of 50. This makes the emotional impact even greater at a time when they tend to be the healthy and independent and when their family and professional lives are of great importance [6]. Moreover, adjuvant treatment for breast cancer tends to be more aggressive than for colon cancer; as such, sequelae are potentially greater, last longer, and are more likely to interfere with their job and social interactions.…”

“…Moreover, adjuvant treatment for breast cancer tends to be more aggressive than for colon cancer; as such, sequelae are potentially greater, last longer, and are more likely to interfere with their job and social interactions. Changes in physical appearance (hair loss, mastectomy, weight gain due to hormone therapy), the decline of their overall physical condition, mainly due to adverse treatment effects, and the uncertainty surrounding prognosis mean that they are more likely to experience psychological distress than patients with other types of tumors such as colon, which is typically diagnosed after the age of 60 [6]. A study by Gibbons et al [7] and a recent meta-analysis [8] show that coping strategies in breast cancer mediate the relationship between illness perceptions and adjustment to illness.…”

Coping Mechanism in Women with Breast Cancer

“…Besides that the feeling that arises such as distrust of what happened and feeling angry about what happened to him is a bad thing for his life (Castillo, Mendiola and Tiemensma, 2019). However, although breast cancer causes psychological problems, the hope of healing triggers an effort to be made (Baniasadi, kashani and Jamshidifar, 2014;Ye et al, 2018;You et al, 2018) (Hernández et al, 2019).…”

“…They focus more on priorities such as maintaining relationships with family and self-care (Drageset, Christine and Underlid, 2016). Hopes continue to build despite worries and fears of recurrence and uncertainty in the future (Drageset, Christine and Underlid, 2016;Hernández et al, 2019). Awareness raising and pressure reduction need to be done to accelerate the adaptation process in order to achieve what is expected (Drageset, Christine and Underlid, 2016).…”