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Influence
of psychological coping on survival and recurrence in people with cancer:
systematic review
Mark Petticrew,
associate director a, Ruth Bell, lecturer
b, Duncan Hunter, assistant professor
c.
aMRC
Social and Public Health Sciences Unit, Glasgow G12 8RZ, bDepartment
of Epidemiology and Public Health, Medical School, University of Newcastle,
Newcastle upon Tyne NE2 4HH, c Community Health and Epidemiology,
Abramsky Hall, Queens University Kingston, Ontario, Canada K7L 3N6. Correspondence
to: M Petticrew mark@msoc.mrc.gla.ac.uk
Objective.
To summarise the evidence on the effect of psychological coping
styles (including fighting spirit, helplessness/hopelessness, denial,
and avoidance) on survival and recurrence in patients with cancer.
Design.
Systematic review of published and unpublished prospective
observational studies.
Main
outcome measures. Survival from or recurrence of cancer.
Results.
26 studies investigated the association between psychological coping
styles and survival from cancer, and 11 studies investigated
recurrence.
Most of the studies that investigated fighting spirit (10 studies)
or helplessness/hopelessness (12 studies) found no significant
associations with survival or recurrence.
The evidence that other coping styles play an important part was also
weak.
Positive findings tended to be confined to small or methodologically
flawed studies; lack of adjustment for potential confounding
variables was common.
Positive conclusions seemed to be more commonly reported by smaller
studies, indicating potential publication bias.
Conclusion.
There is little consistent evidence that psychological coping styles
play an important part in survival from or recurrence of cancer.
People with cancer should not feel pressured into adopting particular
coping styles to improve survival or reduce the risk of recurrence.
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What
is already known on this topic
Survival from cancer is commonly thought to be influenced by a person's
psychological coping style
Some
studies have shown that a coping style involving fighting spirit rather
than helplessness/hopelessness is associated with survival and recurrence,
though the evidence is inconsistent
What
this study adds
This systematic review suggests that there is no consistent association
between psychological coping and outcome of cancer
Publication
bias and methodological flaws in some of the primary studies may explain
some of the previous positive findings
There
is no good evidence to support the development of psychological
interventions to promote particular types of coping in an attempt to
prolong survival
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