Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress

Abstract

Objective: Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship.

Method: Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship.

Results: On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship.

Conclusions: Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress. (PsycINFO Database Record

Figure 1. Structural equation models that estimated direct and indirect (mediating) effects of stressful life events (SLEs) on cancer-related distress via both engagement and disengagement coping

A: Model 1 - Direct effect of life stress (SLEs) and coping on cancer-related distress, *p<0.05 B: Model 2 - Mediating effect of engagement coping on the relationship between life stress and cancer-related distress, *p<0.05 C: Model 3 - Mediating effect of disengagement coping on the relationship between life stress and cancer-related distress, *p<0.05 D: Model 4 - Mediating effect of both engagement and disengagement coping on the relationship between life stress and cancer-related distress, *p<0.05