Coping strategies and patient-reported outcomes (PROs) in early phase cancer clinical trial (EP-CT) participants.
Authors: Lundquist Debra , Lam Anh B. , Pelletier Andrea , Durbin Sienna , Petrillo Laura A. , Jimenez Rachel , Turbini Victoria , Bame Viola , Lynch Kaitlyn , Boulanger Mary Catherine , Moore Cynthia , Yalala Vaishnavi , Ollila Nicholas , Malowitz Benjamin , McIntyre Casandra , Juric Dejan , Nipp Ryan David 
Published: September 2024

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Background:
Individuals with cancer often rely on various coping strategies as they navigate their cancer course. Little is known about coping strategies among patients enrolled on EP-CTs or associations of these coping strategies with other PROs.
Methods:
We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed coping strategies (Brief COPE), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4), and financial wellbeing (COST tool). We used regression models to explore associations of coping strategies with patient characteristics and PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing).
Results:
Among 205 participants (median age=63.3 [range: 31.8-88.6], 57% female), the most common cancer types were gastrointestinal (35%) and breast (20%). Patients in this cohort utilized the following coping strategies (range 0-6): acceptance (mean=4.81), emotional support (mean=4.63), active (mean=4.30), positive reframing (mean=3.13), religion (mean=2.77), self-blame (mean=.87), denial (mean=.59), and behavioral disengagement (mean=.36). Older age was associated with decreased use of self-blame coping (B=-0.02, p=.025). Female sex was associated with higher scores for denial (B=0.42, p=.009), emotional support (B=0.50, p=.037), positive reframing (B=0.57, p=.036), and religion (B=1.02, p=.001) coping compared with males. See table for associations of coping strategies with PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing).
Conclusions:
In this cohort of EP-CT participants, we demonstrated that patients use multiple coping strategies and identified differences by age and sex. Notably, we found that some coping behaviors (acceptance, emotional support, positive reframing) were more favorably associated with QOL, hope, depression/anxiety symptoms, and financial wellbeing than others (denial, self-blame, behavioral disengagement). Interventions seeking to enhance PROs in this population should address patients’ use of coping strategies.

Coping Strategy
QOL
Depression
Anxiety
Hope
Financial Wellbeing

Beta

P

Beta

P

Beta

P

Beta

P

Beta

P

Denial
-2.81

.001

0.27

<.001

0.39

<.001

-1.26

<.001

-0.96
.100

Active
0.51
.428
-0.06
.315
0.01
.874
0.98

<.001

0.84
.065

Acceptance
3.13

<.001

-0.15

.013

-0.22

.004

1.31

<.001

1.40

.003

Self-Blame
-5.30

<.001

0.44

<.001

0.56

<.001

-1.35

<.001

-2.94

<.001

Emotional Support
1.34

.023

-0.12

.014

0.004
.945
1.03

<.001

0.39
.328

Positive Reframing
1.19

.027

-0.11

.020

-0.08
.184
1.12

<.001

0.13
.715

Behavioral Disengagement
-5.99

<.001

0.62

<.001

0.52

<.001

-2.66

<.001

-1.38
.112

Religion
0.57
.195
-0.04
.307
-0.01
.812
0.62

<.001

-0.31
.309