The effects of response bias on self-reported quality of life among childhood cancer survivors

Background Several studies of long-term adjustment in childhood cancer survivors (CCS) report very positive outcomes, while other studies find significant adjustment problems. These inconsistencies have prompted some investigators to suggest survivors may be biased responders, prone to underreporting on self-report measures. This study tested the hypothesis that CCS are elevated on self-deception response bias (SDRB), and that SDRB is associated with higher ratings of quality-of-life (QOL). Methods One hundred and seven adult (mean age = 31.85) survivors of childhood cancers completed a demographic questionnaire, Short Form-12 (SF-12), Functional Assessment of Cancer Therapy-General (FACT-G), and Self-Deception Enhancement scale (SDE), an SDRB measure. Results Survivors' QOL scores were similar to normative groups, but they evidenced much higher levels of response bias. SDE scores were significantly correlated with the FACT-G, and SF-12 Mental Health (but not Physical Health) scores even after accounting for demographic and treatment-related variables. Conclusions CCS show a biased response style, indicating a systematic tendency to deny difficulties on QOL measures. This may complicate QOL studies by inflating survivors' reports of their socio-emotional functioning. Understanding how response bias develops may help us learn more about cancer survivors' adaptation to illness, and the effects of the illness experience on their perceptions of QOL.