Psychosocial Factors Influencing the Impact of Cancer 277problem-solving ability were also found to report higher lev-
els of depressive and anxiety symptomatology, as well as
more frequent cancer-related problems. Furthermore, poorer
problem-solving ability was also found to predict emotional
distress among a sample of breast cancer survivors who had
undergone surgery between 1 and 13.3 years previously. In
addition, the quality and effectiveness of a person•s problem-
solving skills appear to be important in determining adjust-
ment to a sexual relationship, such as sexual satisfaction or
dysfunction after a BMT. More speci“cally, A. Nezu and
Nezu (1998) conducted a study with 30 participants who un-
derwent a BMT and found that problem solving signi“cantly
predicted post-BMT sexual dysfunction.
A. Nezu, Nezu, Faddis, DelliCarpini, and Houts (1995) re-
ported a study that included 134 adult cancer patients whereby
problem-solving ability was found to moderate the effects of
cancer-related stress. Speci“cally, under similar levels of high
cancer-related stress, persons with cancer characterized by
poor problem-solving ability reported signi“cantly higher
levels of depressive and anxiety symptomatology than oncol-
ogy patients characterized by more effective problem solving.
Monitoring and Blunting
Miller and her colleagues (e.g., Miller, Fang, Diefenbach, &
Bales, 2001) have developed a cognitive-social health infor-
mation processing model that outlines how two types of
coping styles„monitoring and blunting„predict reactions
to a cancer diagnosis. Individuals who dispositionally
scan for threatening cancer cues or information are consid-
ered •monitors,Ž whereas •bluntersŽ are individuals who
dispositionally attempt to distract themselves from and mini-
mize threatening cancer-related information. Monitors are
characterized by greater perceptions of threat, lower self-
ef“cacy expectations, and greater cancer -related distress. The
importance of attempting to identify such coping styles lies in
the manner in which information should be provided to the
differing •typesŽ of patients. For example, framing cancer-
related information in a less negative, nonthreatening manner
can lead to reduced distress among monitors.
Coping and Improved Survival Rates
Psychosocial functioning and coping have also been found to
be related to length of survival and decreased mortality rates.
Early research in the 1950s “rst suggested that cancer patients•
psychological characteristics were systematically related to
length of survival. For example, individuals whose disease
had progressed for the worse were described as polite, cooper-
ative, and unable to express negative affects, particularly
hostility, whereas longer survivors were described as emotion-
ally expressive (Royak-Schaler, 1991). Studies conducted at
the Faith Courtauld Research Unit of King•s College in
London with 160 women with breast cancer found that sup-
pression of anger and passive, stoic response styles were asso-
ciated with poorer disease outcomes, especially in women
under the age of 50 (Royak-Schaler, 1991). Furthermore, a
10-year prospective study continued to show higher survival
rates (55%) for women with a “ghting spirit versus 22% sur-
vival among women who responded with stoic acceptance or
helplessness/hopelessness (Greer et al., 1979). A similar posi-
tive association has been found between “ghting spirit and
good health outcome by Fawzy et al. (1993), whereas anxious
preoccupation (Greer, Morris, Pettingale, & Haybittle, 1990),
hopelessness (Morris, Pettingale, & Haybittle, 1992), and a
stoic acceptance style (Weissman & Worden 1976...1977)have
all been found to be strongly associated with poor health and
disease outcome.
Pessimism has also been found to be linked to cancer sur-
vival. For example, Schulz, Bookwala, Knapp, Scheier, &
Williamson (1996) followed a group of cancer patients for a
period of eight months, at the end of which one-third had
died. Beyond site of cancer and levels of symptoms at base-
line, a measure of pessimism obtained earlier signi“cantly
predicted mortality rates, that is, people with a pessimistic
orientation were less likely to be alive at the eight-month
follow-up.Social SupportThe difference in the level of social support or the perception
of support can have an important impact on patients• sense of
well-being when confronting the stress of cancer and its treat-
ments. Social supports are the resources provided by those
people in an individual•s social network, such as spouses,
family members, friends, coworkers, fellow patients, or
professionals. These resources are helpful in times of stress
(e.g., dealing with an illness) and may consist of instrumental
aid, expressive or emotional aid, and informational aid. The
bene“cial ef fects of social support can be both direct (i.e.,
positive social interactions can directly increase positive cog-
nitions, emotions, and behaviors), and indirect (i.e., as a
stress buffer through the provision of various coping re-
sources, such as emotional or practical support) (Helgelson,
Cohen, & Fritz, 1998).
According to Bloom (1982), it is the perception of social
support, measured by family cohesiveness and the frequency
of social contact, that is the strongest predictor of healthy
coping responses. However, some research suggests that this
relationship appears to be stronger for patients with a good