Types and determinants of coping with cancer and its treatment among adult cancer patients attending two tertiary care hospitals of Karachi

Cancer is a grave illness with long term devastating impact on quality of life and mental health of the patients. It proves to be among the major stressor that people face and try to cope by seeking every kind of support. Each individual cope with stressors differently. Coping is a process through which first the entire situation is appraised and then appropriate working solutions are identified to better handle the stress. Coping is divided into problem focused (adaptive) and emotion focused (maladaptive) types. Purpose: The purpose of this study was to investigate types of coping strategies used by adult cancer patients and also to explore determinants of coping and existence of depression among cancer patients. Methods: A total of 488 cancer patients from The Aga Khan University Hospital (AKUH) and Jinnah Postgraduate Medical Center (JPMC) were recruited. It is an analytical cross-sectional study in which purposive sampling was used to recruit participants who were meeting the eligibility criteria. Data on various socio demographic, illness and coping related variables such as age, sex, site, stage and treatment of cancer, social support, socioeconomic quintiles and depression status was collected using instruments after pretesting. Coping was measured using the Brief Cope inventory. Linear Regression was used to assess linear relationship between different independent variables and coping score. Results: The mean coping score of the cancer patients was 82.5 (SD 6.52). The frequently used coping strategies were active coping, acceptance, religion, selfdistraction, positive reframing, planning, use of instrumental support and humour. Final model revealed that on average, coping score of JPMC patients was 3.88 units lower compared to AKUH. Past substance use and cancer stage II was significantly associated with lower coping score. Cancer sites such as breast, gynecological, lung, invasive thymoma, skin and eye were significant and positively associated with coping score. Age was found to have positive association with coping, mainly with the age group 40 to 49 years. Perceived family and friends support were also found to have positive relationship with coping score. All treatment modalities except surgery were found to be significant and associated with increase in coping score. Third quintile of SES was also significant with higher coping score compared to the highest quintile. Out of 488 participants, 48.4% patients were found to be depressed. Conclusion: This study showed various factors which determine coping of cancer patients. Site, stage and treatment of cancer, age of the patient, socioeconomic quintiles, use of substances and friends and family perceived social support were the significant factors identified by our study. The multivariable model explains only 20% of the factors responsible for coping while there are 80% of the other factors that need to be further explored. Interventions are needed for addressing the mental distress among cancer patients and routine screening is required in their treatment protocol