Mental Adjustment To Cancer And Its Relation To

Johansson et al. BMC Cancer 2011, 11:283 http://www.biomedcentral.com/1471-2407/11/283

RESEARCH ARTICLE

Open Access

Mental adjustment to cancer and its relation to anxiety, depression, HRQL and survival in patients with laryngeal cancer - A longitudinal study
Mia Johansson1*†, Anna Rydén2† and Caterina Finizia1†
Abstract
Background: Using a longitudinal design, aim of this study wasto investigate the relation between mental adjustment to cancer and anxiety, depression, health-related quality of life (HRQL) and survival in patients treated for laryngeal cancer. Methods: 95 patients with Tis-T4 laryngeal cancer were assessed at one and 12 months after start of treatment, respectively, using the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the European Organisation forResearch and Treatment of Cancer (EORTC) Study Group on Quality of Life core questionnaire (EORTC QLQ-C30) supplemented with the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) Scale. For survival analyses patients were followed up for a median time of 4.22 years from inclusion. Results: The most commonly used adjustment response at both occasions was FightingSpirit. The use of adjustment responses was relatively stable over time. Correlation analyses showed that patients using HelplessHopeless and Anxious Preoccupation responses reported more anxiety and depression, as well as decreased HRQL. Tumour site and stage showed no effect on adjustment response. Survival analysis indicated that use of a HelplessHopeless response was related to poorer survival(HR 1.17, p 0.001). Conclusion: The relation between adjustment responses Helpless-Hopeless and Anxious Preoccupation and anxiety, depression, HRQL and possibly poorer survival indicate that assessment of mental adjustment should be considered when planning treatment and rehabilitation in laryngeal cancer patients.

Background To be diagnosed with laryngeal cancer places considerable demand onthe patient. Besides the impact of being diagnosed with a life-threatening disease, patients also face psychosocial problems due to impairment in voice and speech and other physical effects caused by treatment [1,2]. As a consequence, laryngeal cancer patients risk mood disorders such as anxiety and depression, as well as decreased health-related quality of life (HRQL) [1,3-5]. Laryngeal cancerpatients’ different ratings of HRQL and psychological well-being have been associated to both treatment and size of tumour [6]. However, differences in HRQL levels and mental well-being may also
* Correspondence: mia.johansson@gu.se † Contributed equally 1 Department of Otolaryngology - Head and Neck Surgery, Sahlgrenska University Hospital, SE 431 80 Mölndal, Sweden Full list of author informationis available at the end of the article

be explained by mental coping responses. Over the last decades, there has been a growing interest in coping and, particularly, in the area of coping with cancer. The most widely spread definition of coping is Lazarus’ and Folkman’s saying coping can be defined as “constantly changing cognitive and behavioural efforts to manage specific external or internaldemands that are appraised as taxing or exceeding the resources of a person” [7]. Related to Folkman’s and Lazarus’ theory of coping is the theory of mental adjustment to cancer, developed by Watson and Greer, where mental adjustment is defined as “the cognitive and behavioural responses the patient makes to the diagnosis of cancer” [8]. Even if the two concepts often are used synonymously, it isargued that there is one predominant difference: the theory of mental adjustment includes emotional reactions to a threatening event, whereas Folkman and Lazarus regard emotional reactions as the outcome of a coping strategy. In this paper we

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