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Psychological coping and cancer


Clinical bottom line

There is little evidence that psychological coping styles are important in survival or recurrence in people with cancer.


M Petticrew et al. Influence of psychological coping on survival and recurrence in people with cancer: systematic review. BMJ 2002 325: 1066-1069.

Systematic review

This review had a prodigious searching strategy for finding studies relating the progression of cancer, recurrence of cancer, or survival with psychological coping. Prospective cohort studies were included, but not those with outcomes such as biochemical markers of cancer, or immune responses, or studies of personality type. Authors were contacted for unpublished data.

Methodological criteria considered were whether the sample represented an inception cohort, the degree of adjustment for potential confounders, and whether the assessment of coping was carried out early in the disease process.


There were 26 studies investigating survival and 11 recurrence. Thirteen studies met all methodological criteria. There was no consistent association between any description of coping (fighting spirit, helplessness/hopelessness, denial or avoidance, stoic acceptance, anxiousness, or any other strategy) and outcome. Occasional studies reached some slight degree of statistical significance, but these were often small, or limited by methodological problems, or both.

Studies that reported positive findings were smaller than those that had no significant findings, with average sizes of 89 and 198 respectively (p=0.02).


There is no evidence that coping strategy has any effect on outcome with cancer.