Coping with metastatic melanoma: The last year of life

Background. Few longitudinal studies have concurrently investigated cogniti ve appraisal, coping and psychological adjustment in patients with terminal cancer. This study aimed to (i) consider patterns of change in these;varia bles during the last year of life and (ii) consider covariates associated w ith patients' psychological adjustment. Methods and patients: Questionnaires were sent to a cohort of stage IV mela noma patients seen at the Sydney Melanoma Unit between 1991 and 1996, appro ximately every 3 months, for up to 2 years. A sub-sample of 110 patients co mpleted at least one questionnaire in the last year of life. Repeated measu res linear regression was used to model cognitive appraisal, coping and psy chological adjustment. Results: In the last year of life, patients' cognitive appraisal of their d isease remained relatively stable, whereas their use of active coping strat egies increased (p = 0.04). There was some deterioration in psychological a djustment, particularly in patients' ability to minimize the impact of canc er on daily life (p = 0.03), but this effect did not remain significant whe n patients' level of tiredness was included in the model. Cognitive apprais al, coping style and quality of life indicators were all associated with ps ychological adjustment. Conclusion: These findings suggest that while patients work hard to activel y cope with their disease, they experience increasing levels of tiredness, and deterioration in their mood and ability to function in their daily live s. Copyright (C) 2000 John Wiley & Sons, Ltd.