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

Purpose: Uncertainty in the context of advanced cancer diagnosis often incurs significant psychological distress. The aims were to evaluate the incidence of psychological distress upon 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 across Spain. Individuals with unresectable advanced cancer completed questionnaires on uncertainty (Michel Uncertainty of Illness Scale, coping strategies (Mental Adjustment to Cancer, M-MAC), and psychological distress (Brief Symptom Inventory, BSI-18) 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 (eta p(2) = 0.016), married (eta p(2 )= 0.006), and had a better performance status (eta p(2) = 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 lesser psychological distress.Conclusion: Patients with newly diagnosed unresectable advanced cancer frequently experience psychological distress in the face of uncertainty, potentially influenced by coping strategies like cognitive avoidance.

Automated summary

The diagnosis of advanced cancer often leads to significant psychological distress due to uncertainty. This study evaluated the incidence of psychological distress in patients with unresectable advanced cancer and explored whether coping strategies mediated the relationship between illness uncertainty and distress. The findings showed that a high percentage of patients experienced clinically significant psychological distress. The use of cognitive avoidance as a coping strategy was associated with less distress, while anxious preoccupation was linked to more distress.