Denial in cancer patients, an explorative review

Denial is a clinically relevant concept in cancer patients. It has been investigated and discussed extensively. Its definition, however, has been subject to different theoretical trends over time. From a psychoanalytical viewpoint, denial is a pathological, ineffective defence mechanism. On the other hand, according to the stress and coping model denial can be seen as an adaptive strategy to protect against overwhelming events and feelings. In this explorative review the different concepts and the prevalence of denial in cancer patients are described. The relationship between denial and background characteristics and the influence of denial on quality of life are reviewed also. The prevalence of denial of diagnosis in cancer patients ranged from 4 to 47%, denial of impact occurred 8-70% and denial of affect in 18-42% of patients. Elderly cancer patients were more likely to deny. Cultural background seemed to play a role in the prevalence of denial. Neither type of cancer nor gender seemed to be related to denial. At the most, men might be more likely to deny during the terminal phase. In a limited number of longitudinal studies, a gradual reduction in denial was found over the course of the illness. The effect of denial on physical and social functioning remained unclear while the effect on psychological functioning seemed to depend on the concept of denial used. Distractive strategies were found to reduce distress, whereas passive escape mechanisms turned out to decrease psychological well-being. Future research on the prevalence and the (mal)adaptive properties of denial in cancer patients has to be based on a clear concept, longitudinal designs and careful recording of background variables.