Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress.

Abstract

OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to: 1) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and 2) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHODS Patients (n=893), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised (IES-R). Coping strategies since beginning chemotherapy were assessed with the Brief COPE; two latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and IES-R scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.0 (standard deviation 4.0; range 0–23 out of 30) SLEs. Patients who were not married/partnered, lived alone, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. CONCLUSIONS Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress.

The role of coping in the relationship between stressful life events and quality of life in persons with cancer

“…They also have an impact on biomarkers such as telomere length, nucleotide sequences at the end of chromosomes that provide genomic stability, and are associated with cellular aging, disease morbidity and mortality (Osler, Bendix, Rask, & Rod, 2016). Recent evidence, in the context of cancer, has supported the relationship between SLEs and physiological and psychological outcomes such as atypical blunted cortisol reactivity (Costanzo, Stawski, Ryff, Coe, & Almeida, 2012;Couture-Lalande, Lebel, & Bielajew, 2014), distress (Langford et al, 2017) and compromised quality of life (QOL; Golden-Kruetz et al, 2005). Moreover, SLEs prior to a diagnosis of breast cancer may place women at higher risk for physical, psychological, and social problems (Beatty, Lee & Wade, 2009) in the post-diagnosis phase.…”

Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance

“…Post-traumatic stress symptoms and PTSD have been linked to non-adjusted coping strategies (Jacobsen et al, 2002), such as anxious worrying (Pérez et al, 2014), cognitive avoidance, helplessness, fatalism (Pérez et al, 2014), self-blame, denial, and behavioral disengagement (Richardson et al, 2016; Langford et al, 2017). Furthermore, PTG has been directly linked to the patient’s active coping strategy (Bellizzi and Blank, 2006; Lelorain et al, 2012; Svetina and Nastran, 2012; Tong et al, 2012; Danhauer et al, 2013) problem solving (Widows et al, 2005), positive reappraisal (Sears et al, 2003; Carver and Antoni, 2004; Urcuyo et al, 2005; Widows et al, 2005; Lechner et al, 2006), religious coping (Urcuyo et al, 2005; Jim et al, 2006; Lechner et al, 2006; Gall et al, 2011), and acceptance (Urcuyo et al, 2005).…”

Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy

“…In addition, lifetime exposure to stressful experiences (e.g., physical or sexual assault) and current life stressors (e.g., cancer diagnosis and treatment) influence coping [16]. Coping is often described in terms of the use of engagement (e.g., actively doing something to alter the stressor) or disengagement (e.g., avoidance) strategies [16][17][18]. In the four studies that examined the association between coping and fatigue during CTX, greater fatigue severity was associated with disengagement coping [19,20], while lower fatigue severity was associated with engagement coping [21,22], However, these studies did not examine the impact of cumulative exposure to SLEs on coping and fatigue.…”