Coping strategies as mediators of uncertainty and psychological distress in patients with advanced cancer

Abstract

Abstract Purpose: Uncertainty surrounding entails significant psychological distress.The aims were to evaluate the incidence of psychological distress at diagnosis of advanced cancer and to analyze whether the relationship between illness uncertainty and psychological distress can be mediated by coping strategies. Methods: A multicenter, prospective,cross-sectional study was conducted in 15 medical oncology departments in Spain. Individuals with unresectable advanced cancer completed questionnaires on uncertainty (Michel Uncertainty of Illness Scale, MUIS), coping strategies (Mental Adjustment to Cancer, M-MAC), and psychological distress (Brief Symptom Inventory, BSI) after the diagnostic and treatment appointment and before beginning systemic cancer treatment. Results:841 patients eligible for systemic treatment with palliative intent were included between February 2020 and April 2022. A total of 71.7% had clinically significant levels of psychological distress. Univariate analyses identified that the groups with less psychological distress were male(ηp2=0.016), married (ηp2=0.006), and had better performance status (ηp2=0.007). The most widely used coping strategies were positive attitude and cognitive avoidance. A positive relationship was found between uncertainty, coping strategies,and psychological distress (p<0.05).Participants who responded with anxious preoccupation suffered more helplessness and psychological distress, while those who responded with cognitive avoidance, displayed greater positive attitude and less psychological distress. Conclusion: Most people with unresectable advanced cancer experience psychological distress in the face of uncertainty. This psychological distress can be mitigated through coping strategies such as cognitive avoidance.