Characteristics of patients who believe they can control their cancer

Abstract 

Purpose: Receiving the diagnosis of cancer has frequently led people to feel out of control, yet there is evidence that people who feel in control of their cancer adjust better to their illness. Identifying correlates of control will aid in the development of interventions to enhance patients feelings of control over their disease. The purpose of this study was to determine the sociodemographic, clinical, and psychological characteristics of cancer patients who believe they have control over their disease.

Methods: This was a pilot study of patients diagnosed with cancer in the previous 6 to 24 months who were recruited from three oncology practices that varied socio-demographically and in their use of complementary therapies. Participants were asked verbally if they had done anything to try to gain control over their cancer or situation. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. For each of these domains, the scores can range from 0 to 21, with ⩽7 considered normal. Six coping styles were assessed with the Mental Adjustment to Cancer Scale. The raw score for each coping style was transformed to a scale ranging from 0 to 100, with higher scores indicating increased use of this coping style. Patients were also asked Likert-response questions about their perceptions of the seriousness of the cancer, and the impact of the cancer and its treatment on their lives. Other clinical information was obtained at the interview or by chart review. T-tests and chi-square were used to compare the groups who did and did not feel in control.

Results: Of the 44 participants, 38% were male and 84% Caucasian. The mean age was 57 years and median education was 16 years. There were 19 different cancer diagnoses, with breast (34%) and lung cancers (21%) most common; 23% had metastases and 57% were on treatment. Compared to the 11 participants who said they had not done anything to try to control their cancer or situation, the 18 who said they did try to take control were younger (50 vs 71 years old, p<0.001), more likely to be married (89% vs 46%, p=0.03) and less likely to live alone (6% vs 64%, p=0.003). They also had lower scores for depression (2.9 vs 5.2, p=0.05) and helpless/hopelessness (8.3 vs. 18.2, p=0.04), and higher scores for fighting spirit-positive orientation to the illness (81.5 vs 66.3, p=0.02). There were no statistically significant clinical differences. The 15 participants who were ambivalent in their response to the question of control were not included in this analysis.

Conclusions: People with cancer who believe they are doing things to control their disease or situation are younger, married, living with others, and more positive in their approach to their illness. With this information, health care providers may be better able to identify patients who are likely to feel a loss of control and then address this issue along with the associated feelings of depression and helplessness.

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