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Influence of psychological coping on survival and recurrence in people with cancer: systematic review

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1066
  1. Mark Petticrew, associate director (mark{at},
  2. Ruth Bell, lecturerb,
  3. Duncan Hunter, assistant professorc
  1. a MRC Social and Public Health Sciences Unit, Glasgow G12 8RZ
  2. b Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH
  3. c Community Health and Epidemiology, Abramsky Hall, Queens University Kingston, Ontario, Canada K7L 3N6
  1. Correspondence to: M Petticrew
  • Accepted 19 July 2002


Objective: To summarise the evidence on the effect of psychological coping styles (including fighting spirit, helplessness/hopelessness, denial, and avoidance) on survival and recurrence in patients with cancer.

Design: Systematic review of published and unpublished prospective observational studies.

Main outcome measures: Survival from or recurrence of cancer.

Results: 26 studies investigated the association between psychological coping styles and survival from cancer, and 11 studies investigated recurrence. Most of the studies that investigated fighting spirit (10 studies) or helplessness/hopelessness (12 studies) found no significant associations with survival or recurrence. The evidence that other coping styles play an important part was also weak. Positive findings tended to be confined to small or methodologically flawed studies; lack of adjustment for potential confounding variables was common. Positive conclusions seemed to be more commonly reported by smaller studies, indicating potential publication bias.

Conclusion: There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence.

What is already known on this topic

What is already known on this topic Survival from cancer is commonly thought to be influenced by a person's psychological coping style

Some studies have shown that a coping style involving fighting spirit rather than helplessness/hopelessness is associated with survival and recurrence, though the evidence is inconsistent

What this study adds

What this study adds This systematic review suggests that there is no consistent association between psychological coping and outcome of cancer

Publication bias and methodological flaws in some of the primary studies may explain some of the previous positive findings

There is no good evidence to support the development of psychological interventions to promote particular types of coping in an attempt to prolong survival


  • Funding MP is funded by the Chief Scientist Office of the Scottish Executive Department of Health and is a member of the ESRC-funded Evidence Network.

  • Competing interests None declared.

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