A study of coping in long-term testicular cancer survivors

The primary objective of this study was to explore approach and avoiding coping strategies in long-term testicular cancer survivors (TCSs) as self-rated by the brief approach/avoidance coping questionnaire (BACQ). As the BACQ is a new instrument, the second objective was to examine critical psychometric properties of the instrument. The third objective was to examine the correlation between the BACQ and established self-rating instruments commonly used in psychosocial oncology to explore if the BACQ added an additional perspective to the characterization of TCSs. In this cross-sectional questionnaire study, 1326 Norwegian TCSs at a mean of 11.3 years (SD 4.2, median 10.7, range 5-21 years) after diagnosis gave information about their medical and social situation, distress, fatigue, quality of life, self-esteem, and neuroticism. The BACQ ratings of the TCSs were compared to those of a control sample of men from the general population (N = 566; NORM). Among TCSs 84% (95% CI 82-86%) used more approach coping, and this proportion did not differ significantly from 86% among NORM (95% CI 83-89%). The mean BACQ approach/avoidance score of TCSs were similar to that observed in NORM adjusted for age and work status (p = 0.33). The BACQ approach/avoidance score showed only moderate associations with established instruments used in psychosocial oncology. TCSs with more avoidance coping (N = 216) differed significantly from TCSs with more approach coping (N = 1110) by showing a lower proportion in paired relations and in paid work, more somatic and mental morbidity, more fatigue and poorer quality of life and self-esteem. In multivariate analyses lower self-esteem, higher cancer-related avoidance, more depression and neuroticism were most strongly associated with avoidant coping. In conclusion, we found that TCSs used similar coping patterns as NORM, avoidant coping was associated with significantly more problems than observed among TCSs who used more approach coping.