Psychological coping and cancer

Abstract

Editor—The review by Petticrew et al is flawed.1 Firstly, they do not compare like with like and ignore differing methods. Different instruments assess coping styles differently and may not be comparable. Thus conclusions cannot be drawn convincingly. Out of 28 studies, 13 had less than three years' follow up (shortest eight weeks). However, in relation to early breast cancer less than five years of follow up produces inconclusive results. Secondly, our study was relegated to the realms of irrelevance by saying that the recent large UK study (n=578), while of higher quality, reported mixed findings: helplessness or hopelessness predicted recurrence when patients with high and low scores were compared but not when it was the predominant coping style.2 The main importance of our clearly stated findings concerning helplessness and hopelessness was missed. Mixed findings were not reported. Although predominant coping style was arbitrarily defined, helplessness or hopelessness is robust across many studies. A high score on this subscale is a valid measure, reflecting a response amenable to psychological intervention. This finding was crucially important for encouraging adequate provision of psychological care in oncology, as was the small, cautiously interpreted tendency to poorer outcome found in severely depressed patients. Patient responsibility (or blame) is removed, and the onus shifts to the medical profession to identify and provide help for those at risk. Dismissal of our study—which used rigorous methods, controlled for known prognostic variables, was sufficiently large, had a long follow up, and found a survival effect—does the research no service. Better to conclude that many poor studies fail to show any effect of coping response on survival, but high quality studies provide evidence suggesting that further good research is needed. Meanwhile the adverse effect on outcome of a helpless or hopeless coping response clearly argues for the provision of better psychological resources.