Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis.

OBJECTIVE: Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. METHODS: A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. RESULTS: Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. CONCLUSIONS: The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.

'It was all intertwined': Illness representations and self-management in patients with cancer and anxiety/depression.

OBJECTIVE: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals' multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression. DESIGN: A semi-structured qualitative research design with theoretical thematic analysis. MAIN OUTCOME MEASURES: Multimorbid illness representations, coping behaviours, and self-management strategies. RESULTS: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants' most challenging illness also discussed. CONCLUSIONS: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.

Qualitatively Comparing the Support Needs of People with Cancer Based on Their History of Anxiety/Depression.

INTRODUCTION: Research rarely considers the origin or history of a cancer patient's anxiety and/or depression, instead assuming that these illnesses are related to the cancer experience. The aim of this study was to compare differences in the support needs of people who have experienced anxiety/depression as part of the cancer experience and people who have not, as well as between people who have experienced episodic anxiety/depression and people who have experienced long-term anxiety/depression. METHODS: Twenty-one semi-structured interviews were conducted with people with a current or previous diagnosis of cancer, and a current or previous experience with anxiety and/or depression. Participants were split into four groups based on their history with cancer and anxiety/depression, and an inductive thematic analysis was conducted to identify themes across groups. RESULTS: Two superordinate themes (with three and two subordinate themes respectively) were found: 'coping with cancer' and 'health care system support provision'. Important differences were found across groups, with participants who had a history of anxiety/depression that was unrelated to their cancer diagnosis coping better with the combined burden of cancer and anxiety/depression, experiencing less fear of cancer recurrence, and highlighting more positive hospital and support service related experiences, than those whose anxiety/depression was cancer related. CONCLUSION: The origin and history of a person's anxiety/depression is important to consider when determining how they might cope with cancer, what their support needs are, and how much support they may require.