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Coping, Distress, and Survival Among Patients With Lung Cancer
Hermann Faller, MD, PhD;
Heinrich Bülzebruck, PhD;
Peter Drings, MD;
Hermann Lang, MD, PhD
Arch Gen Psychiatry. 1999;56:756-762.
Background This study addresses the question of whether coping and emotional state are predictors of survival among patients with lung cancer. The hypotheses were (1) active coping is linked with longer survival time and (2) depressive coping, emotional distress, and depression are linked with shorter survival.
Methods The study was based on a sample of 103 patients who were investigated after their diagnosis and before the beginning of primary treatment. The psychological variables were assessed by means of self-reports and interviewer ratings. After follow-up of 7 to 8 years, 92 patients had died; survival data were censored for the remaining 11 patients. The prediction of the survival time was performed by the Cox regression, while adjusting for biomedical risk factors (tumor stage, histological classification, and Karnofsky performance status).
Results The self-reported depressive coping (P=.007) and the interviewer-rated emotional distress (P=.04) were significantly associated with shorter survival, independent of the influence of the biomedical prognostic factors.
Conclusions Both coping and emotional distress had a statistically independent effect on survival among patients with lung cancer. However, the naturalistic design of the study does not allow for any causal interpretation. Thus, the nature of this relationship warrants further investigation.
From the Institute of Psychotherapy and Medical Psychology, University of Würzburg, Würzburg, Germany (Drs Faller and Lang); and the Departments of Medical Informatics and Biostatistics (Dr Bülzebruck) and Oncology (Dr Drings), Thorax Clinic Heidelberg-Rohrbach, Heidelberg, Germany.
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