Women who take an active approach to cope with a diagnosis of gynecologic cancer have a higher quality of life than those who cope by distancing themselves from dealing with the disease, according to a report in the journal Cancer (Vol. 94, No. 1: 131-140).

A year after diagnosis, there wasn't much difference in quality of life between the early-stage patients and those with regionally advanced cancer (without metastasis).

The early-stage patients said they felt less anxiety, depression, and confusion, and had fewer mood swings than immediately after diagnosis, resulting in a QOL equal to that of similar women without cancer.

The regionally advanced stage patients reported similar QOL, but with some additional distress.

But there was a big difference in QOL between those who coped actively and those who disengaged.

Patients who coped in two active ways — positive re-framing and acceptance — reported greater physical, emotional, and functional well-being than at diagnosis.

Positive re-framing is described by the researchers as looking at the cancer diagnosis in a new way, such as using it as a reason to find a new meaning and focus in life.

Acceptance doesn't involve resignation, said the researchers, but is the ability to face unfortunate realities that cannot be changed.

Those who actively sought and got comfort and understanding from someone reported better relationships with their doctors and others.

But patients who disengaged — avoiding dealing with problems brought on by the disease or giving up any attempt to cope — had more distress, poorer emotional well being, worse overall quality of life, and even poorer functional well-being.

Lutgendorf used questionnaires to measure the quality of life (QOL) of 98 women with early-stage or regionally advanced gynecologic (endometrial, cervical, or ovarian) cancers at the University of Iowa health facilities.

The researchers measured QOL immediately after diagnosis and again a year later, rating the women's physical, functional, emotional, and social well-being, and how satisfied they were with their doctors.

Immediately after diagnosis, the regionally advanced cancer patients and early-stage patients generally reported about the same quality of life, with more distress than healthy women of similar ages and backgrounds.

Those with regionally advanced cancer didn't feel physically as well or as fully functional, but they seemed to adjust to that, said the researchers.

An American Cancer Society (ACS) expert on gynecologic cancers said the study confirms earlier ones like it, but must be interpreted with caution because the authors left out some important information.

"Those who disengaged had a poorer quality of life, but the researchers didn't say if those were the patients whose chemotherapy wasn't helping, which could have been the reason for emotional difficulties," noted Carolyn Runowicz, MD, professor at the Albert Einstein College of Medicine in New York, and a practicing gynecologic cancer surgeon.

Runowicz, also a member of the ACS advisory board on gynecologic cancers, said it's not reasonable to criticize patients for coping skills if the reason they're not doing well emotionally is that their cancer is not responding to therapy.

Aside from coping, patients get better during the first year after diagnosis because their treatments — surgery and sometimes chemotherapy — reduce their volume of disease, noted Runowicz.

But Runowicz said the study, like others before it, showed that cancer patients generally get better following diagnosis — that there is light at the end of the tunnel.

"And that's a good thing to know, for a patient who has just been diagnosed," she concluded.