The mental adjustment to cancer (MAC) scale: French replication and assessment of positive and negative adjustment dimensions

The COMFORT trial: a randomised control trial comparing group-based COMpassion-FOcussed therapy and breathing pattern ReTraining with treatment as usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID

BACKGROUND

A cancer diagnosis is a known precipitant of psychological distress, with fear of recurrence being a well-documented distressing consequence of cancer. Cancer recurrence often results in an additional psychological burden, which may exacerbate as a result of the COVID-19 pandemic.

METHODS

This is a single-centre, prospective, randomised controlled trial. Patients identified as having experienced cancer recurrence since March 2020 (the onset of the COVID-19 pandemic in Ireland) will be screened for participation. Eligible, consenting candidates who score 4 or higher on the Distress Thermometer will be enrolled in the study. Participants will be randomly allocated to receive either a 6-week, group-based, online, compassion-focussed therapy and breathing pattern retraining intervention or the control arm. Those in the control arm will all be offered the group intervention after the 18-week study period. The primary outcome is the Distress Thermometer score at 18 weeks post-baseline though secondary outcomes will include measures of mood, traumatic distress and mental adjustment to cancer.

DISCUSSION

To our knowledge, this protocol describes the first RCT which directly examines the effect of a group-based psychological intervention on Irish patients experiencing cancer recurrence in the context of COVID-19. The outcome of this trial is likely to be twofold: It will determine if the psychological intervention achieves its primary objective of distress amelioration 3 months post-intervention and to establish the feasibility of delivering this intervention in a virtual format.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05518591. Registered on 25 August 2022. All items from the World Health Organization Trial Registration Data set have been included.

The importance of using ordinal scores for patient classification based on health-related quality of life trajectories

Changes in health-related quality of life (HRQoL) over time are not necessarily homogeneous within a population of interest. Our study aim was twofold: to determine homogeneous patient subpopulations distinguished by HRQoL trajectories, and to identify the particular patient profile associated with each subpopulation. To classify patients according to HRQoL dimension scores, we compared mixtures of linear mixed models (LMMs) classically applied to scores defined by the EORTC procedure, and mixtures of random effect cumulative models (CMs) applied to scores treated as ordinal variables. A simulation study showed that the mixture of LMMs overestimated the number of subpopulations and was less able to correctly classify patients than the mixture of CMs. Considering HRQoL scores as ordinal rather than continuous variables is relevant when classifying patients. The mixture of CMs for ordinal scores is able to identify homogeneous subpopulations and their associated trajectories. The application focused on changes over time in HRQoL data (collected using the EORTC QLQ-C30 questionnaire) from 132 breast cancer patients from the Moral study. Once the classification is obtained only from HRQoL scores, class membership was then explained through a logistic regression model, given a large panel of variables collected at baseline. Analysis of data revealed that deterioration over time of role functioning and insomnia was closely related to patient anxiety: anxiety at baseline is a prognostic factor for a poor level and/or a deterioration over time of HRQoL. For functional dimensions, large tumor size and high education level were associated with worse HRQoL scores.

Validation of Mini-Mental Adjustment to Cancer scale in a Moroccan sample of breast cancer women

Background

The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) instrument is commonly used worldwide by professionals of oncology, but the scale has not, up to date, been validated in Arabic and Moroccan context, and there is an absence of data in the Moroccan population. This study aims to validate the Mini-MAC, translated and adapted to the Arabic language and Moroccan culture, in women with breast cancer.

Methods

Data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 158). Then, this structure was confirmed in the validation sample (N = 203) using confirmatory factor analysis (CFA).

Results

Confirmatory factor analysis confirmed Watson’s original structure underlying the Mini-MAC items: Helpless/Hopeless, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance, and Fatalism. Absolute, incremental, and parsimonious fit indices showed a highly significant level of acceptance confirming a good performance of the measurement model. The instrument showed sufficient reliability and convergent validity demonstrated by acceptable values of composite reliability (CR =0.93–0.97), and average variance extracted (AVE = 0.66–0.93), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio of correlations values were lesser than 0.85, indicating acceptable discriminant validity.

Conclusions

reliability; and both convergent and discriminant validity tests indicated that the Arabic version of the Mini-MAC had a good performance and may serve as a valid tool measuring psychological responses to cancer diagnosis and treatment.

Exploration of coping styles in male patients with head and neck cancer: a prospective cohort study

Majority of head and neck cancer (HNC) patients are male, and more than 85% of patients with HNC have the habit of smoking and drinking. Due to the specific demographic characteristics, HNC patients are anticipated to have specific coping styles, affecting psychological distress, survival, and quality of life. We explored the subscales of the Mental Adjustment to Cancer (MAC) Scale in male patients with HNC, and then examined the correlation between revised subscales of the MAC scale and anxiety/depression. Participants were 150 male inpatients with HNC, and their demographic and medical data were obtained. Coping style was assessed by MAC scale. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Out of 40 items in the original MAC scale, 19 items were excluded by factor analysis, and the remaining 21 items were divided into three factors: Negative Adjustment, Positive Adjustment, and Abandonment. Negative and Positive Adjustments were similar to the copings of mixed gender patients with heterogeneous cancers, and Abandonment was a new subscale specific to male patients with HNC. This subscale had a weak positive correlation with anxiety and depression. Male HNC patients revealed a specific coping style of Abandonment, related with psychological distress. We believe that an understanding of the Abandonment coping style revealed in our study will improve the psychological support offered to male patients with HNC.

Effect on perceived control and psychological distress of genetic knowledge in women with breast cancer receiving a BRCA1/2 test result

Information provision during BRCA1/2 genetic counseling is complex and expected to be increasingly so with gene panel testing. This prospective study evaluated whether genetic knowledge in counselees with breast cancer (BC) after a pre-test genetic counseling visit (T1) enhance their feeling of personal control while minimizing distress after the notification of BRCA1/2 result (T2). At T1, 243 (89% response rate) counselees completed questionnaires on genetic knowledge (BGKQ), perceived cancer genetic risk; of which, at T2, 180 (66%) completed the BGKQ again, scales of anxiety/depression, distress specific to genetic risk, and perceived control. Multilevel models were performed accounting for clinician, and testing an effect of knowledge on psychological outcomes according to the adequacy of counselees' perceived genetic predisposition to cancer. The mean knowledge score was moderate at T1, decreased while not significantly differing by BRCA1/2 test result at T2. Knowledge at T1 had no direct effect on psychological outcomes, but in counselees who over-estimated their cancer genetic risk, higher knowledge at T1 predicted higher specific distress at T2. In BC affected counselees who over-estimate their cancer genetic risk, higher BRCA1/2 pre-test genetic knowledge seem to lead to increased specific distress. Identifying these BC affected counselees who over-estimate their genetic cancer risk and helping them to interpret their genetic knowledge instead of providing them with exhaustive genetic information could minimize their distress after test result receipt.

Satisfaction with fertility- and sexuality-related information in young women with breast cancer--ELIPPSE40 cohort

Background

Young breast cancer survivors are often dissatisfied with the information provided on fertility and sexuality. Our aim was to discuss possible contributing factors and to propose strategies to increase patient satisfaction with such information.

Methods

Using the French National Health Insurance System database, we constituted the ELIPPSE40 regional cohort of 623 women, aged 18–40, diagnosed with breast cancer between 2005 and 2011. As of January 2014, 319 women had taken part in the 10-, 16-, 28 and 48-month telephone interviews. Satisfaction with the information provided about the potential impact of cancer and its treatment on fertility and sexuality was assessed at 48 months after diagnosis on 5-point Likert scales.

Results

Four years after diagnosis, only 53.0 and 42.6 % of women were satisfied with fertility- and sexuality-related information, respectively, without any significant change over the 2009–2014 period (P = 0.585 and P = 0.676 respectively). The two issues were moderately correlated (ρ = 0.60; P <0.001). General satisfaction with medical follow-up was the only common correlate. Irrespective of sociodemographic and medical characteristics, satisfaction with fertility-related information was greater among women with a family history of breast/ovarian cancer who had the opportunity to ask questions at the time of cancer disclosure. Satisfaction with sexuality-related information increased with the spontaneous provision of information by physicians at cancer disclosure.

Conclusions

Promoting both patients’ question asking behavior and more systematic information could improve communication between caregivers and young breast cancer survivors and address distinct unmet needs regarding fertility- and sexuality- related information.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1542-0) contains supplementary material, which is available to authorized users.

Affect mediates the association between mental adjustment styles and quality of life among Chinese cancer survivors

This study examined the association between mental adjustment styles and quality of life, and affect as a mediator among 238 Chinese cancer survivors. Regression analysis showed that quality of life was positively associated with fighting spirit and negatively associated with fatalism. Path analysis showed that greater fighting spirit was associated with more positive affect, which in turn was associated with higher quality of life. Greater fatalism was associated with less positive affect and more negative affect, which in turn was associated with lower quality of life. Findings suggest that positive affect and negative affect are important in understanding mental adjustment styles and its health implications.

Coping response and survival in breast cancer patients: a new analysis

PURPOSE

The purpose of this study was to analyse the impact of coping response on survival of breast cancer by using a new method of assessing coping.

METHOD

Adjustment to cancer was assessed using a revised measure in a large cohort of breast cancer patients (N = 578) followed up over a period of 10 years. Impact of coping response measured early in the disease process (<4 months from primary diagnosis of early-stage breast cancer) was assessed, and survival analyses were undertaken including known clinical staging data and cancer treatment details.

RESULTS

After 5 years of follow-up from primary diagnosis, the effect of prior 'negative adjustment' was statistically significantly linked to increased risk of death and relapse of breast cancer, and for the 10-year analysis, this result remained for both risk of death and relapse. There was no statistically significant effect on survival of the novel 'positive adjustment' response.

CONCLUSIONS

Coping with cancer was assessed using a new methodology and is linked to an adverse impact of negative adjustment on overall survival. Positive adjustment was unrelated to survival. The current study strengthens previous evidence that there is a link between survival and coping response. The question remains of how coping response might affect physical outcome. It is considered that coping response likely impacts survival through the mediating effects on lifestyle and health behaviour that may contribute to an adverse prognosis.

Cultural health beliefs and health behaviors in Asian American breast cancer survivors: a mixed-methods approach

PURPOSE/OBJECTIVES

To explore the relationships between cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors among Asian American breast cancer survivors (AABCS), and the contextual meaning of those relationships among Korean American breast cancer survivors (KABCS) and AABCS.

DESIGN

A mixed-methods triangulation design.

SETTING

Community- and hospital-based support groups and hospital cancer registries in California.

SAMPLE

206 AABCS were included in the quantitative phase, and two focus groups were conducted with KABCS (N = 11) during the qualitative phase.

METHODS

The quantitative phase used secondary data for AABCS. Standardized (i.e., cultural health beliefs, doctor-patient relationship, and acculturation) and newly developed instruments (i.e., health behaviors and treatment-related decisions) were used in the quantitative phase. An exploratory, descriptive, qualitative study of KABCS then was undertaken.

MAIN RESEARCH VARIABLES

Cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors.

FINDINGS

Inter-intrapersonal health beliefs, doctor-patient relationship, and shared decision making were positively associated with adopting healthy lifestyle practices. Findings from the quantitative phase were explained further by the diverse themes that emerged in the KABCS focus groups.

CONCLUSIONS

This study provides new knowledge about cultural health beliefs and health behaviors among KABCS using a mixed-methods approach.

IMPLICATIONS FOR NURSING

The results highlight the need for greater attention to the cultural contexts of AABCS to promote healthy behaviors and recognition of the significant relationship between health professionals and breast cancer survivors.

Two years after cancer diagnosis, what is the relationship between health-related quality of life, coping strategies and spirituality?

This study aimed to analyze the relationship between spirituality, coping strategies and health-related quality of life (HRQL) among a large representative sample of patients two years after cancer diagnosis. Using a cross-sectional design, medical and self-reported data were collected by physicians and a patient telephone interview, respectively. Among 4270 participants, 54.6% reported that spirituality was not a source of comfort at all during the disease, 23.4% stated that it was a source of moderate comfort and 22.5% a source of great comfort. After adjustment for age, gender, educational level and living in a couple, a multivariate analysis showed that a lower mental HRQL score was independently associated with finding moderate comfort in spirituality when compared with finding no comfort at all. After multiple adjustment, a lower score of physical HRQL and a higher score of fighting spirit were independently associated with having found great comfort in spirituality when compared with those who found no comfort at all. This study aimed to understand the dynamics of religious beliefs among cancer patients over the disease duration and to understand how these beliefs could be considered and utilized by patients as a source of comfort and support. The results highlight not only the role spirituality may play in disease management and the extent to which it may be a valuable source of comfort during the follow-up of cancer patients, but also its role in the evaluation of the different dimensions of HRQL.

Evaluation of a Psychosocial Intervention on Social Support Perceived Control, Coping Strategies, Emotional Distress, and Quality of Life of Breast Cancer Patients

The purpose of this research was to demonstrate that a specific psychosocial intervention changes reactions to cancer and quality of life. This study was carried out on 66 patients with a first breast cancer. Patients were randomly divided into two groups: a specific intervention group (G1, 8 sessions) or a support group (G2, 8 sessions). A control group (G3) was composed of patients who refused to participate in psychological intervention. Social support, perceived control, repression of emotions, coping strategies, emotional distress, and quality of life were assessed one week before (T1) and at the end (T2) of the psychological intervention. Results showed that G1 did not have significantly modified quality of life or psychological scores. Patients of G2 had poorer emotional quality of life, use of internal causal attributions, and minimized their illness at T1 as compared to patients of G3. At Time 2 these differences were not observed.

Barriers to procreational intentions among cancer survivors 2 years after diagnosis: a French national cross-sectional survey

OBJECTIVES

To determine the procreational intention rates among cancer survivors whose fertility was unimpaired and to identify the factors associated with their procreational intentions.

METHODS

Six thousand nine hundred and fifty-seven adult cancer patients treated between September and October 2002 were randomly selected from the French National Health Insurance Fund's Chronic Disease File. Of the 6957, 4270 responded to a cross-sectional questionnaire 2 years after diagnosis, of whom 959 reported being fertile and responded to a question about their procreational intentions.

RESULTS

Among the 257 male and female survivors aged 20-44, 86 (33.5%) had procreational intentions. After adjusting for age, gender, and already having children, only a high educational level (adjusted odds ratio: 3.1, 95% confidence interval 1.3-7.8) and stable or increasing financial resources (2.4, 1.0-5.7) were independently associated with the respondents' procreational intentions. Neither cancer stage at diagnosis nor the present stage significantly affected their plans in this respect.

CONCLUSIONS

Two years after cancer diagnosis, the reasons why some survivors who are still fertile have no parenthood projects were similar to those earlier given by members of the general population.

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients

OBJECTIVES

The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients.

METHODS

Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time.

RESULTS

In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test-retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test-retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses.

CONCLUSION

The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross-national usefulness of the MAC scale.

The Ways of Coping Checklist (WCC): validation in French-speaking cancer patients

We explore the psychometric properties of the French version of the Ways of Coping Checklist Revised (WCC-R) for a cancer patient sample. The WCC-R was completed by 622 patients and 464 completed the State-Trait Anxiety Inventory (STAI). A confirmatory factor analysis (CFA) on the original factor structure did not fit the data. The sample was randomly divided into two subsamples. Exploratory factor analysis was conducted on one subsample and revealed three factors: 'Seeking social support', 'Problem focused-coping' and 'Self-blame and avoidance', including 21 items. A CFA confirmed this structure in the second subgroup. These scales correlated with the anxiety scores.

The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study

BACKGROUND

Many women with breast cancer need psychological help to cope more effectively after treatment. Cognitive and behavioural techniques are not yet well established in France. A multi-site randomized study was conducted to evaluate the effects of a psycho-educational group intervention in this population.

METHODS

Two hundred and three patients, recruited after primary treatment, were randomly assigned either to a treatment group (psycho-educational intervention) or to a waiting-list control group. The 8-week programme of 2 h sessions comprised of thematic discussions, information and training in stress management techniques. Evaluation at baseline, after 8 sessions, and 1 month after programme completion, included evaluations using the STAI, POMS, MAC, EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales.

RESULTS

We observed a significant reduction in anxiety (STAI, POMS) among group participants, a reduction in anger, depression and fatigue (POMS), a significant improvement in vigor and interpersonal relationships (POMS), in emotional and role functioning, in health status and fatigue level (EORTC QLQ-C30). In contrast, coping strategies (MAC) were not significantly different between groups. No group-related negative effects were observed and the global satisfaction levels were very high.

CONCLUSION

This study demonstrates the feasibility and effectiveness of a psycho-educational intervention, which can accelerate the reduction of those negative affects which are present at the end of treatment. It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support, widely proposed in France, and should now be tested in groups with other types of cancer and at other disease phases.

Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer

INTRODUCTION

Women with breast cancer may have significant problems adjusting to disease and therapy due to their association with significant changes in body image and sexuality. The aim of this study was to evaluate the effect of beauty treatments in combination with routine cancer care.

METHODS

One hundred women with breast cancer were randomly assigned to a group receiving beauty treatments during hospitalization or a control group. Psychological distress, body image and coping were assessed twice during the hospitalization period: the day before surgery (baseline) and 6 days later (Time 1). A follow-up assessment was performed three months later (Time 2).

RESULTS

Three months after surgery, patients who had received beauty treatments reported higher body-image scores than the control group, but there was no effect in psychological distress. Helplessness/hopelessness increased over time in the control group but not in the group receiving beauty treatments.

CONCLUSION

Overall, this study provides evidence of the usefulness of beauty treatments for breast-cancer patients, in combination with routine care. Although these treatments did not seem to alleviate psychological distress directly, they had a beneficial impact on body image and may strengthen patients' social support and self-esteem.

Determinants and implications of cancer patients' psychosocial needs

GOALS OF WORK

Cancer patients often experience distress. However, the majority of newly diagnosed patients gradually adapt to the crisis. When symptoms of distress and anxiety persist over months, patients require psychosocial support. The aim of the present study was to determine the proportion of cancer patients who indicate the need for psychosocial support and to identify sociodemographic, psychological and illness-related factors predicting the need for psychosocial support in a German sample.

MATERIALS AND METHODS

The cross-sectional retrospective study was administered to 710 cancer patients who had been inpatients at the University Hospital of Cologne. The response rate was 49.5%. Patients suffering from bronchial, oesophageal, colorectal, breast, prostate and skin cancer participated in the study. The severity of depressive symptoms was assessed using the German version of the Major Depression Inventory. The level of anxiety was assessed with the state subscale of the German version of the State-Trait Anxiety Inventory. To measure the functional aspects of health-related quality of life, the scales "physical functioning", "role functioning", "emotional functioning", "cognitive functioning" and "role functioning" of the European Organisation for Research and Treatment of Cancer QLQ-C30 Questionnaire (EORTC QLQ-C30) were used.

MAIN RESULTS

Of the cancer patients, 18.9% indicate an unmet need for psychosocial support and 9.5% are actually using psychosocial services. In a multiple logistic regression, significant indicators of the need for psychosocial support are gender [p = 0.014; standardised effect coefficient (sc) = 1.615] and emotional functioning (p < 0.001; sc = 1.533). The estimated model has a specificity of 92.2% and a sensitivity of 54.0%.

CONCLUSION

Almost a third of the cancer patient population indicates an unmet need for psychosocial support or is actually using psychosocial services. Emotional functioning is a central predictor of the requirement for psychosocial support. Women are emotionally more affected than men and need more psychosocial support. The prognostic validity of the severity of depression and anxiety is limited.

[To test the impact of hypnotherapy upon immunity and circadian rhythms among palliative cancer patients: a promising goal?]

Epidemiological and clinical researches in the borderline domain between psychology and cancer have produced consequent results, despite the large variety of employed approaches and aimed goals: these results permit to define domains where new investigations still appear promising. If randomized prospective controlled trials that test the impact of psychosocial interventions, constitute to our mind a strategy that must not be bypassed, a special attention should be focussed on the following topics: 1) it seems necessary to add to standard goals (survival and quality of life) the evaluation of the impact on immunity and main biological rhythms (circadian and ultradian). Specific questionnaires should be included (pain, sleep, mood, self-esteem, life events...) and others may need to be developed or adapted (sexuality, spirituality, coping with death); 2) among types of psychosocial management, hypnosis and/or learning of self-hypnosis appears to be a modality of choice since some results have already been obtained on immune pathologies and also on cancer. Mixed to an approach of clinical psychology, such a management could arouse behavior changes toward pathology but also promote an improvement of biological rhythms (action on sleep...) and perhaps, by the way, an immune rebound; 3) on a methodological point of view, trials cannot be double-blind. The effort must then concern sample sizes, that were often insufficient in many trials, but also targeted populations: palliative cancer patients with a good performance status seem more relevant for this type of investigation, since psychosocial interventions usually improve quality of life.

The use of denial in an ethnically diverse British cancer population: a cross-sectional study

A total of 82 Asian and 117 randomly selected white Caucasian patients at the Leicestershire Cancer Centre were assessed using measures of coping and adaption to cancer. On the Mental Adjustment to Cancer (MAC) scale, Asian patients were more fatalistic (P<0.0001) and had more significant hopeless/helpless scores (P=0.007). The two ethnic groups answered the three questions thought to assess denial differently. Caucasians were more likely not to dwell on their illness (73 vs 55.5%, P<0.0001) and agree with the statement ‘I have difficulty believing this is happening to me’ (73 vs 60.5%, P<0.0001). However, Asian patients were more likely to agree with the statement ‘I don't really believe I have cancer’ (48.2 vs 31.3%, P=0.019). Within both groups there was an association with denial and anxious preoccupation (P<0.001). On the Hospital Anxiety and Depression (HAD) scale, there was no difference in anxiety scores between either sexes or between the Asian and Caucasian groups. However, Asian patients were more depressed (P=0.001). Although denial was significantly related to the presence of both depression (P<0.0001) and anxiety (P=0.001) in the entire patient population, there were different predictors of denial in each subgroup. On multiple regression analysis depression was linked with denial in Caucasians, whereas Fighting Spirit (minus helplessness/hopelessness) was linked with denial in Asian patients. There are definite differences in coping styles in British cancer patients according to ethnicity. While significant numbers in both groups employ denial in some form, Caucasian patients appear to adapt to the psychological pressures of cancer more successfully than Asian patients at a particular point in time. Further work is required to elucidate longitudinal relationships between denial and adaption to cancer.

The Mini-Mental Adjustment to Cancer (Mini-MAC) scale: construct validation with a Greek sample of breast cancer patients

This investigation is a Greek validation of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale, an instrument derived from the MAC and designed to measure styles of coping with cancer. A sample of 225 women diagnosed with breast cancer completed this questionnaire. Statistical analyses using structural equation modeling (SEM) confirmed Watson's original five first-order factors underlying Mini-MAC items: Helplessness/Hopelessness (HH), Anxious Preoccupation (AP), Fighting Spirit (FS), Avoidance (AV) and Fatalism (F). On a higher-order level, SEM and Multidimensional Scaling revealed two second-order factors: adaptive coping (being measured by FS, AV, and F) and maladaptive coping (being measured by HH and AP). Results are discussed in terms of the theoretical framework needed to account for the relationships among Mini-MAC factors and the refinement of the applications of SEM in the study of the mental adjustment to cancer construct.

Styles of coping with cancer: The Italian version of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale

Mental adjustment to cancer has been explored in a large body of the literature by using the Mental Adjustment to Cancer (MAC) scale. Problems in the factor structure of the scale and the need for refining the instrument have determined the development of the Mini-MAC. The aim of this study was to validate, according to a test-oriented approach, the Italian version of the Mini-MAC. Four hundred and thirty cancer patients in five centres in Northern Italy completed the Mini-MAC and the Brief Symptom Inventory (BSI). A subgroup of 153 patients filled out the instruments again within 3 months of the first assessment. The five original subscales (Fighting Spirit, Hopeless, Fatalism, Anxious Preoccupation and Cognitive Avoidance) showed acceptable levels of reliability (Cronbach alpha coefficients ranging from 0.55 to 0.80) although alphas were lower for the scales Fighting Spirit and Fatalism. Factor analysis (Varimax rotation) identified the same five factors with minor variations from the original version. Again, alpha coefficients were less robust for the factors Fighting Sprit and Fatalism. Hopeless and Anxious Preoccupation were significantly related to all the BSI psychological stress symptoms, including the Global Stress Index (GSI). Test-retest reliability showed no differences in the sub-scales scores between assessments.

Psychometric analyses of the Mental Adjustment to Cancer (MAC) scale in a Greek palliative care unit

The purpose of the study was to assess the Mental Adjustment to Cancer (MAC) scale on a heterogeneous Greek sample of 200 advanced cancer patients. The results presented regard the validation analysis of the Greek version. The homogeneity of the original subscales proved to be satisfactory (alpha coefficients ranged from 0.81 to 0.91). A factor analysis was carried out using the LISREL 8.3 procedure. This yielded five factors, including 25 of the 40 original items (alpha coefficients 0.62-0.93). The resulting factors were called 'hopeless', 'positive attitude', 'acceptance', 'mental engagement', and 'fatalistic'. Correlations between the MAC scale and the disease severity as measured by the ECOG performance status have shown difference only between patients with 'good' versus 'poor' performance status in the 'hopeless' scale (p=0.047). The results suggest that the Greek version, as measured in advanced cancer patients attending a palliative care unit, is a reliable and valid clinical tool in Greece.

Escala de Afrontamiento al Cáncer en pacientes oncológicos en población mexicana

Introducción: Los estilos de afrontamiento son variables psicológicas que pueden predecir la adaptación psicológica y en sentido contrario una mayor disfunción psicosocial en pacientes con cáncer. Se han descrito dos dimensiones: centrados en el problema o activos positivos, caracterizados por la búsqueda de información, planificación y resolución de problemas; y los dirigidos a la emoción o evitativos caracterizados por el escape, distanciamiento o desesperanza. Objetivo: Determinar las propiedades psicométricas de la Escala de Afrontamiento del Cáncer en una muestra de pacientes con cáncer de la población mexicana. Método: Participaron 317 pacientes del Instituto Nacional del Cáncer, de los cuales 148 eran mujeres (46,7%) y 169 hombres (53,4%), con una edad media de 46,2 años. Los participantes completaron al mismo tiempo el Mental Adjustment to Cancer (MAC), el HADS y el Termometro del Distress. Resultados: Mediante el análisis factorial se identificaron cinco factores que explicaron el 53,32% de la varianza, con 22 reactivos. La consistencia interna de la escala global fue satisfactoria (0,81). La validez concurrente mostró asociaciones significativas (Pearson r = - 0,120 – 0,586, p <0,05). Discusión y conclusión: La Escala de Afrontamiento del Cáncer derivada del Mental Adjustment to Cancer tiene propiedades psicométricas adecuadas. Es una herramienta útil para fines de investigación y atención en salud mental durante el tratamiento oncológico.