276 Psychosocial Oncology
Collectively, research has underscored the signi“cant
negative impact of having cancer and being treated for it.
However, not all oncology patients experience severe and
long-lasting psychological dif“culties. Similar to other major
stressful events, the negative effects of cancer can be attenu-
ated as a function of various psychosocial factors. In the
next section, the stress-buffering roles of coping and social
support regarding cancer are reviewed.
PSYCHOSOCIAL FACTORS INFLUENCING
THE IMPACT OF CANCER
Coping
Although the type of tumor, treatment, diagnosis, and prior
quality of life greatly determine the course of the disease,
there are certain coping responses that signi“cantly in”uence
the adaptation process (Burgess, Morris, & Pettingale, 1988;
A. Nezu, Nezu, Houts, Friedman, & Faddis, 1999). When
facing a stressful life event, such as cancer, various coping
skills and styles are valuable in maintaining adequate func-
tioning and can actually moderate the negative impact of
such traumatic events on physical, social, and emotional
functioning (Billings & Moos, 1981; Moyer & Salovey,
1996).
According to Lazarus and Folkman (1984), the termcoping
refers to the cognitive and behavioral activities by which a
person attempts to manage a potentially stressful situation (see
also chapter by Manne in this volume). Researchers have in-
vestigated the association between various coping styles and
psychological adaptation and health outcome among oncology
patients. Such variables include avoidance/denial, “ghting
spirit/optimism, problem solving, and health information.
Avoidance/Denial
In the psychosocial oncology literature, denial generally is
de“ned by constructs such as avoidance, distancing, and
emotional suppression (Moyer & Levine, 1998). In general,
research has yielded con”icting results regarding the impact
of denial on adjustment. For example, Watson, Greer, Blake,
and Shrapnell (1984) interviewed cancer patients after sur-
gery and found that those who initially denied the seriousness
of the illness reported less mood disturbance as compared to
those patients who initially accepted the implications of the
disease and admitted fears of death. Other studies further
suggest that avoidance acts as an escape from the stressful
situation or as a positive short-term coping mechanism for
avoiding the overwhelming problems associated with the
diagnosis of cancer (Barraclough, 1994; Moyer & Levine,
1998). However, Carver et al. (1993) found avoidance coping
to be positively correlated with emotional distress. In addi-
tion, Penman (1982) found that oncology patients who
reported using avoidance coping also reported poorer adapta-
tion to the cancer experience. More recently, C. M. Nezu
et al. (1999) found that avoidance coping was strongly corre-
lated with increased levels of anxiety, depression, and more
frequent cancer-related problems.Fighting Spirit/OptimismIndividuals with cancer who demonstrate more of a con-
frontational coping style, optimism, and a •“ghting spiritŽ
have been found to have a more positive psychological ad-
justment compared to those with passive acceptance, help-
lessness, anxious preoccupation, avoidance, and denial
(Greer, Morris, & Pettingale; 1979; van•t Spijker, Trijsburg,
& Duivenvoorden, 1997). In general, the construct of opti-
mism has been associated with less distress in individuals
facing a diagnosis of cancer. For example, Carver et al.
(1993) studied optimism in breast cancer patients for a year
postsurgery and found this construct to be positively associ-
ated with higher levels of acceptance, use of humor as a
coping tactic, and positive reframing of the experience, par-
ticularly in the early stages following surgery. Furthermore,
Weisman and Worden (1976...1977) found that persons with
cancer who experienced high levels of emotional distress
were found to be pessimistic, tending to give up easily and to
expect little support. Such individuals were found to have
more interpersonal and intrapersonal dif“culties prior to the
diagnosis of cancer, and, during the course of treatment, per-
ceived more health concerns, doubts, and a worse prognosis.
Further, C. M. Nezu et al. (1999) found a positive orientation
toward coping with stress to be negatively correlated with
emotional distress among adult cancer patients.Problem SolvingProblem solving in real-life situations (referred to as •social
problem solvingŽ see A. Nezu et al., 1998) is de“ned as
•a general coping approach that can help people manage
or adapt to any stressful situation, thereby enhancing their
”exibility and perceived control and minimizing their emo-
tional distress even in situations that cannot be changed for
the betterŽ (p. 10, A. Nezu et al., 1999). De“cits in problem-
solving ability have also been found to be associated with
psychological distress in patients with cancer. For example,
C. M. Nezu et al. (1999) reported that a sample of adult
cancer patients who were characterized by less effective