Intervention for Cancer Patients: A

Qualitative Study

Dr. Laxmi Vajpeyi

Babu Banarasi Das National Institute of Technology and Management

Lucknow

This Research Paper is a piece of a Project entitled “Intervention for Cancer Patients”, funded by

UGC, New Delhi.

Address: 4/549-550, Vibhav Khand, Email ID: laxmi.vajpeyi@gmail.com

Gomti Nagar, Lucknow.

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ABSTRACT

The present study is conducted on cancer patients suffering from breast or cervix cancer. An

intervention is also planned for the study. In pre intervention condition twenty cancer patients

were administered measures of psychological characteristics of optimism, future orientation,

perceived control, symptom reporting, quality of life and coping strategies. Then those patients

were screened, who scored low on optimism, future orientation and perceived control scale and

using more maladaptive coping strategies. These patients then attended 10 intervention sessions.

Intervention was scheduled for 15 days with 10 sessions. In post test intervention the counseled

patients again completed the psychological measures used in the pre test condition.

The results of quantitative measures and case studies of counseling showed that cancer patients

who believe that they had control over at least some aspects of their illness were better adjusted

to illness, use more active coping strategies and also plan something for near or distant future

than the patients who do not have such beliefs. The intervention sessions indicated that those

patients who enjoyed more social and psychological resources from their family or friends relied

more on active coping such as positive appraisal and seeking guidance and lesson avoidance

coping, especially emotional discharge found that optimistic patients seem to cope in more active

problem oriented way.

It can be concluded on the basis of the findings of the study that psychological dispositions like

having a sense of control, optimism and future oriented outlook along with supportive and caring

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relationships enhances the tendency to effectively and actively manage a deadly chronic disease

like cancer.

KEYWORDS: Cancer, Counseling, Social support, Optimism, Coping, Intervention.

Introduction

Cancer is a set of more than 100 diseases that have several factors in common. All

cancers result from dysfunction in DNA is the part of the cellular programming that controls cell

growth and reproduction. Normally DNA ensures the regular slow production of new cells but in

case of this malfunctioning DNA causes excessively rapid cell growth and proliferation.

Cancerous cells provide no benefit to the body, but harm severely. Uncontrollable cell division

causes cancer. These cells form a visible mass or tumor. This initial tumor is called the “Primary

Tumor” cells from the primary tumor can break off and lodge elsewhere in the body where they

then grow into “Secondary Tumors”. This process is called “Metastasis”. A cancer which has

spread to other organs is called “Metastatic”.

Some species are more vulnerable to some cancer than others because

many cancers are species specific. Many cancers run in families. Recent discoveries implicate

genetic factors in a subset of colon cancer and breast cancer. These facts will help in assessing

the risk status of many individuals. Many things run in families beside genes including diet and

other life style factors that may influence the incidence of a disease.

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Ethnicity is also linked to cancer. For example, in the United States, Anglo men

have a bladed cancer rate twice that of another groups and a relatively high rate of malignant

melanoma. The prostate cancer rate among blacks is higher than the rate for any other cancer in

any other group. Japanese Americans have an especially high rate of stomach cancer, whereas

Chinese Americans have a high rate of liver cancer. Some cancers are culturally linked through

lifestyle. The probability of development of some cancers change with socioeconomic status.

Type C or cancer prone personality characteristics were also suggested by researchers studying

in the field of personality. Cancer prone personality has an individual who is easy going and

acquiescent, repressing emotions that might interfere with smooth social and emotional

functioning. Bahnson (1981) proposed that cancer patients use particular defense mechanisms,

such as denial and repression. The so called Type C or cancer prone personality has been

characterized the muting of negative emotions and the potential for learned helplessness.

Lack or loss of social support has also been proposed to affect the onset and

course of cancer. The absence of a current social support network has been tied to a higher

incidence of cancer. A substantial body of research suggests link among stress, coping and

cancer, individuals who cope with stress by being acquiescent and pleasant and by repressing

negative emotions may be more likely to develop malignancies. Cancer has been tentatively tied

more specifically to problems with social support and to stressful life events. Stress may also

impair DNA repair, when lymphocytes are confronted with an antigen, they typically respond

with increases in cellular DNA and subsequent proliferation. This fact suggests the importance of

the DNA link in the development of cancer.

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Thus, we can say that DNA dysfunction is the major cause of cancer. Some

studies suggest that cancers are related to many factors, like life style, social support and socio-

economic status. Some researchers suggested that Characteristics of Type C or cancer prone

personality is the cause of cancer.

Cancer is the second leading cause of death. However, more than one third of

cancer victims live at least 5 years after their diagnosis, thus creating many rehabilitation issues.

Cancer creates a wide variety of problems including physical disability, family and marital

disruptions, sexual difficulties, self esteem problems, social and recreational disruptions and

general psychological distress.

Cancer takes a substantial toll, both physically and psychologically. The physical

difficulties usually stem from the pain and discomfort cancer can produce, particularly in the

advancing and terminal phase of illness. Difficulties also arise as a consequent of treatment.

Many cancer patients also receive debilitating follow up treatments such as radiation therapy and

chemotherapy. Recent work suggests that patients may also develop conditioned immune

suppression in response to repeated pairings of the hospital, staff and other stimuli with the

immunosuppressive effects of chemotherapy. Psychological problems also arise as a

consequence of cancer, which is one of the most frightening and poorly understood diseases in

our country. Some researchers have mentioned that cancer patients are “Victimized” by family

members and friends. They may be avoided and even isolated by others, whose terror about the

disease and mistaken conceptions make unable to provide badly needed social support.

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Certain coping strategies appear to be helpful in dealing with the problems

related to cancer. Coping through social support, focusing on the positive distancing were all

associated with less emotional distress whereas cancer patients who coped with their cancer

related problems through cognitive and behavioral escape avoidant strategies, showed more

emotional distress. In many ways coping with a diagnosis of a chronic illness is like coping with

any other severely stressful event. The appraisal of a chronic disease as threatening or

challenging leads to the imitation of coping efforts. One notable point is that the coping

strategies identified have few direct action factors like planful problem solving of confronting

coping. This may be because certain chronic illnesses in this case, cancer raise so many

uncontrollable concerns that coping strategies employed favor distraction, avoidance and

emotional regulation. There is also some evidence that those who employ multiple coping

strategies cope better with the stress of chronic disease than those who engage in a predominant

coping style. People have to increase their coping skills to manage the stressful situations. Some

of the coping skills are:

Ability to relax and remain calm and composed in times of stress.

Ability to understand the nature of problems and think of possible and feasible

solutions.

Ability to set realistic objectives and goals and try to achieve them.

Ability to have more realistic and appropriate attitude, knowledge and change

the behavior as required by the situation.

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Ability to get the help of family members and others in facing the situation or

the problem.

Maintain self-esteem and take control of the situation.

To develop these coping skills following suggestions can be made to patients:

Introspection: Every body knows his assets and limitations, his strengths and weaknesses, his

resources in terms of knowledge, money materials. People must feel proud of their assets; they

don’t worrying about their weaknesses and limitations. People should try to improve himself and

reduce their limitations. “Do not compare own self with others who are better than you”.

Cultivate Relationship: Stop criticizing others, stop finding fault with others. Show respect to

elders and love to the youngsters, Cultivate friendship. “Expect not too much from the family

members, friends and colleagues, relatives.”

Role Play in Proper Ways: Each one of us have to play different roles in our family, occupation

and social life.

“Understand the role and responsibilities and make an honest effort to fit into the role as

expected in your community.”

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Resource Management: Whether it is time money, materials, every one of us have constraints.

None of us have the luxury of having unlimited resources. “We have to plan, prioritize our needs

and allot time, money and materials accordingly”.

Understand problem and Situation: Before we play action or reaction to the problems, try to

know how and when problem started, who has contributed to it, what are the aggravating factors

and what could be the outcome?

Positive Attitude: Be optimistic and tell yourself that you will succeed; you will be able to

manage and sail through the problems. “Keep trying and keep working.”

Sharing of Failures and Frustrations: Suppressed feelings are painful and make the people

unhappy and uncomfortable. “Ventilation helps the people to feel good and comfortable.”

Relaxation: In between the busy schedule of life, every people try to find a few minutes to relax.

“Look at flowers, plants, trees, birds or children and enjoy the nature’s creation.”

Do Not Be Anxious about Death: Death may strikes us many time but never anxious about

Death because it’s not in our hands. “Be happy and comfortable with what you have.”

Cancer related pain and its associated distress provide a paradigm in which

to apply Counseling schedules for general use with cancer patients and their families. Counseling

is a helping process which by way of talking and discussing helps the client to find solutions and

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feel comfortable. These processes have the potential to reduce isolating dysfunctional and

maladaptive responses that lead to a sense of control and of self efficacy. Increased awareness of

unexamined thoughts feelings and behaviors within the patient, family and health care team

stimulates the potential for the emergence of a true therapeutic alliance. It starts with the first

contact of the client with the counselor. Generally counseling is done in three stages as given

below:

First Stage: Client comes in contact with the counselor. They develop trust and rapport with

each other. The client is helped to talk about his perceived problems and his emotional reactions.

He is assured of help to find solution to his problems.

Second Stage: Understanding the problems, the factors which appear to be the cause, aggravate

or become hurdles in finding solutions for the problems are identified and understood. Reliance

and scientific explanations are worked out.

Third Stage: After knowing the measures taken by the individual to solve the problem and the

results of the same, he is helped to –

i. Work out both short and long term solutions.

ii. Reduce the severity of problems.

iii. Cope with the problems, if no solution is possible.

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Thus, the main goal of counseling is the individual is encouraged to keep

trying to improve his conditions using the available resources and feel comfortable in this

ongoing struggle. With this in view this study tried to counsel cancer patients to use active

coping strategies, inculcate optimism, futurity and sense of control in them. The cancer patients

were make realized through counseling that although they are afflicted with very serious disease

but if they use their resources, e.g., family, friends etc. properly, they actively cope with the

problems arouse by the cancer and perceive quality in life.

Method

Participants

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Fifty female cancer patients from Hanuman Prasad Poddar Cancer Hospital Gorakhpur, suffering

from breast or cervix cancer participated in the study. They were at first or second stage of

cancer. Their mean age was 51.4 years. About 90 percent of the patients were illiterate and came

from rural middle class family background.

Intervention Plan

In pre intervention condition fifty cancer patients were administered measures of psychological

characteristics of optimism, future orientation, perceived control, symptom reporting and coping

strategies. Then those patients were screened, who scored low on optimism, future orientation

and perceived control scale and using more maladaptive coping strategies. These patients then

attended 10 intervention sessions. Intervention was scheduled for 15 days with 10 sessions

according to the following scheme.

Session 1: Forming a good rapport, establishing a working relationship, attempting to show

interest with her problem.

Session 2: After baseline assessment of the LOT, FO, Perceived control the patient was

convinced to take part in intervention.

Session 3: Enlisting the problems in coping (psychological, social, financial and any other) and

emphasis on active coping strategies.

Session 4: Identification of the causes of disease and beliefs of patients.

Session 5: Assessment of the impact of illness on the patient.

Session 6: Focusing on optimism and perceived control.

Session 7: Identifying defense/coping mechanisms.

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Session 8: Suggesting alternatives/ tips for better coping.

Session 9: Reinforcing/ reinstalling Hope.

Session 10: Consolidation of the cognitive behavioral intervention.

In post test intervention the counseled patients again completed the psychological measures used

in the pre test condition.

Measures

Life orientation test: Scheier and Carver (1985) have developed Life Orientation Test to

measure dispositional optimism. The scale had an internal reliability of 0.76 and test-retest

reliability of 0.79.

Perceived Control Scale: M...Agarwal, A.K.Dalal, D.K.Agarwal and R.K. Agarwal developed

the perceived control scale. The co-efficient alpha for this scale was 0.78.

Future Orientation: A variation of the technique used by Made (1972). This technique was

successfully adopted and used by Agarwal and Tripathi(1979) and Agarwal (1980). The formula

for calculation of proportion for future event is: Total Future Events/ Total Events. The

proportion was converted into arcsine x to get the future orientation score. The internal reliability

of this technique was found high.

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P.G.I. Health Questionnaire: Developed by Verma, Wig and Prasad (1985) this scale consists

of a total of 38 items which were related to physical and psychological distress. Reliability of the

test using retest and split half methods was 0.80 and 0.86 respectively.

Coping Operation Preference Enquiry (COPE): Carver, Scheier and Weintraub (1989)

developed this scale. The retest and split half reliability was found 0.71 and 0.79 respective.

WHO Quality of life: In order assess the quality of life in health care settings in India, this

questionnaire was developed by a team of researchers of World Health Organization (WHO),

namely Saxena, Chandirmani and Bhargava (1998). The original long version of the scale

consists of 100 items related to domains, like Physical Health, Psychological Health, Social

Relationships, level of Independence and Environment. The short version of the scale was used

for the present investigation, which consists of 28 items related to four facets: physical,

psychological, social, and environmental.

Procedure

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This study was conducted with fifty female cancer patients. The research participants were

administered measures in the following order: Personal memorandum, Life orientation test,

Future orientation test, Symptom reporting, Perceived control, Coping scales and Quality of life

Measures appeared in the same manner for all the participants. They were informed about the

purpose of the study. When these patients completed questionnaires they were thanked and

excused. After this baseline assessment the participants were screened and low scorer

participants were convinced to take part in counseling sessions. All 13 low scorer participants

agreed to take part in counseling session. The detail of the 10 session was already given in

research design section. After counseling the post intervention session was done in the same

manner as had been conducted in the pre- intervention.

Results

Findings of the present investigation were presented in two sections. In

the first section the quantitative analysis was presented and in the second section the cases of the

counseled cancer patients were described.

Quantitative analysis: Table 1 shows scores on all the psychological measures of all the 50

cancer patients. The general findings of the study are that psychological dispositions like having

a sense of control, optimism and future oriented outlook along with supportive relationships

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enhances the tendency to effectively and actively manage the chronic disease. These dispositions

can be foster in patients through interventions.

Table 1 show that there were significant mean differences on optimism, perceived control,

symptom reporting, my future, future orientation and quality of life in pre and post test

conditions. Table 2 shows scores on different coping strategies. There were significant mean

differences on Active, Acceptance coping strategies and a significant t on Acceptance coping

strategy. There were no significant mean differences on humor and substance use and

maladaptive coping strategies.

Qualitative analysis: In this section of results the cases of each counseled patient is presents.

The patients were individually intervened for perceiving the brighter side of the adverse event,

looking forward and plan for future and they were encouraged to perceive increased control in

their life during the intervention sessions the counselor tried to emphasize on those psychological

characteristics on which individual patients had low score. Hence, each patient was counseled

according to hr respective need. The detailed description of the counseling sessions of each

patient is given below-

Case study 1: Mrs. Nazma aged, 45 years, illiterate, house wife, is suffering from ovary cancer,

diagnosed 6 months, earlier. The results of her baseline assessment showed that she was losing

hope. Her way of thinking was pessimistic. She thought that nothing would be good in her way.

She doesn’t want to think her future and she feels that everything in her life is uncontrollable.

Then she attended 10 counseling sessions. During the counseling sessions she listens carefully to

the counselor. Now she improves herself and her way of thinking. She used active coping

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strategy to reduce stress. She thought optimistically in stressful situation. She tries to think

brighter side of adverse rent. She understood that how thinking will determines what we feel.

Now she tries to look forward. She has also improved in her perception that things are not totally

uncontrollable. All these changes are seen in post test assessment.

Case study 2: Mrs. Kamrunissa, aged 50 years, a house wife, belongs to the rural area, upper

middle class family, is suffering from uterus cancer. After baseline assessment it was found that

the patient was low scored in optimism and personal control but she had lowest scored in future

orientation. She felt that her life is coming to an end. She had no hope for her future. She said

that her future is in dark. Then she attended 10 counseling sessions. After attending these

sessions she shows some changes in her way of thinking. She says that evens her suffering from

this deadly disease but is not an end of life. Now she recognizes the positive side of events and

thinks optimistically. She tries to make her life beautiful in her limited resources because she

thought pain is the part of life and everybody has their own pains. Now she used active coping

strategy, she believes in God and finds comfort in prayer and meditation. She had suggestions

from others in stressful situation. She was improved on future orientation in post test condition.

Case study 3: Mrs. Dharma Devi, aged 45 years, illiterate, house wife, belongs to middle class

suffering form uterus cancer. After baseline assessment, the results indicate that even she was

low scorer in all measures but she had lowest score on coping scale. She was pessimistic and had

no hope for life. She blamed herself for all that happened to her. She accepted that in her

stressful situation she criticize herself for all her troubles. She thought that she was unable to

control anything, which happened with her. She accepted that her future is not secure. She had

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lived a very challenging life but at last her disease defeated her. Even she was surrounded with

many problems she has co-operated very much in the counseling session. She attended all

counseling sessions. Then she tries to understand that how she changes her way of thinking, her

coping patterns and how it will benefit in her treatment. She was used active coping strategy in

post test condition. She was actively coping in stressful situation. Her way of thinking is

optimistic. She assured herself to make her life peaceful until death.

Case study 4: Mrs. Kamlawati Devi, aged 48 years, house wife, belongs to rural area, suffering

from intestine cancer. Before attending the counseling session she was pessimistic and not

satisfied with her life. She tells to the counselor that she failed in accomplishing her

responsibilities. She accepted that she doesn’t try to make situation better in stressful

circumstances because it is not in her hand. She felt that everything is uncontrollable in her life

and she can’t do anything, she feels very helpless. Then she attended 10 counseling sessions. She

said that hr family members don’t take care of her needs. She thought that her family members

are totally tired of her illness. After attending 10 counseling sessions she felt comfortable but

post test results shows that she had not improved very much.

Case study 5: Mrs. Usha Shukla aged 52 years, illiterate, house wife, from rural background,

suffering from intestine cancer. The pre test condition results shows that the patient scored low

on optimism, coping, personal control but she was lowest score on future orientation. The

patient’s way of thinking is pessimistic. She has no hope for her life. She was tried with her

illness. She can’t control her mental peace. She was always in stressful mind set. She can’t

understand the cause of hr illness. In the counseling sessions she tries to understand what

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counselor wants to say. She showed much interest to improve herself. She is a god fearing person

and believes in prayer and meditation. She was used adaptive coping strategy to reduce stress in

her life. She had emotional support and suggestions from others which helped her to reduce

stress. In post test condition the results showed that she was improved her on future orientation.

Case study 6: Mrs. Manju Rai, aged 45 years, house wife, educated up to intermediate, belongs

to the middle class urban family is suffering from uterus cancer. The results of the baseline

assessment indicated that even the patient scored low on all measures but she had lowest score

on personal control. The patient thought that most of things in her life are uncontrollable. Her

future is bleak. She co-operated in counseling sessions scheduled for 15 days with 10 sessions.

She catches every point very easily and she understands that everything is not peoples under

control. Something is uncontrollable its true but she has not to dwell with it. She is used active

coping strategy but she scored high on positive reframing subscale. After counseling she thought

most of things in optimistic way. She improved herself in post test condition. Many factors are

responsible for her improvement such as, she has very good family support, and she has form

belief in God, prayer and meditation.

Case study7: Mrs. Kamlawati Devi, aged 62 years, illiterate, house wife, belongs to rural middle

class suffering from uterus cancer. The pre test results showed that the patient had low scored on

optimism, personal control and future orientation. She is very neutral about her future. She feels

that future events are not in her hands. Then she attended the counseling sessions. She talked

very freely with the counselor. She told that their family members were tired with her illness;

they do not do-operate and not take care of all her needs. In counseling sessions she listened very

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carefully to the counselor and tried to understand that how to change these things to make her

happy. She used adaptive coping strategy and she feels that most of the pain can be managed

with appropriate medication. In post test condition she improved on optimism and future

orientation.

Case study 8: Mrs. Poonam Chauhan, 46 years, educated up to 8th, house wife, belongs to rural

middle class family suffering from ovary cancer. After baseline assessment the results showed

that even she scored low on all measures but she had scored lowest on coping. Her thought is

pessimistic and she has no hope for her life. She lives with her problem, her illness and her pain.

She doesn’t want to take any kind of support from others in stressful situations. She is used

acceptance coping strategy in the beginning of counseling sessions and she had not supported to

the counselor but after attending some counseling sessions she changed her attitude towards

counselor. She told that her Husband is unemployed and her economical condition is not good.

She had regret about hospital management and staff. She feels very helpless and hopeless now.

After attending counseling sessions she feel much better and in post test condition although she

improved but because her social support system and economic condition is very weak and this

create hurdle in treatment.

Case study 9: Mrs. Prabhawati Srivastva, aged48 years, belongs to rural middle class family,

illiterate, suffering from uterus cancer. Baseline assessment data reported that the patient scored

low on all measures but she scored lowest on optimism. She felt that her life is coming to an end.

She accepted that her family supported her very much in illness, they take care of all her needs

even that she feel that there is no ray of hope for her life. In stressful situation she is using

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adaptive coping strategy. In post test condition she showed some changes in her way of thinking.

She understood that even she is suffering from awesome disease but that is not an end of the life,

It can be managed by medication. In post test condition she showed certain changes in coping

strategies.

Case study 10: Mrs. Poornima Devi, aged 50 years, house wife, illiterate and from rural

background suffering from uterus cancer. The pre test condition results showed that the patient

was low scored in optimism, coping, future orientation and personal control. She was not

satisfied with her life. She accepted that she don’t try to make situation better in stressful

circumstances. She was used acceptance coping strategy. She thought that she can’t control

things; everything in her life is uncontrollable. In counseling sessions she told that she was tired

of her illness and her family members don’t take care of her. The post test condition results

showed that she had not gained very much from counseling sessions but she said that she regain

the confidence that she can.

Case study 11: Mrs. Gulshan Devi, 65 years, a house wife, illiterate and from urban middle

class family suffering from ovary cancer. The baseline assessment showed that the patients had

low scores on optimism, personal control and future orientation. The patient is pessimistic and

she has no mental peace. She always felt herself in stressful mind-set and she was used adaptive

coping strategy. When she attended all counseling sessions she displayed much interest to

improve herself. In post test condition she improved because she wants so and she improved on

future orientation.

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Case study 12: Mrs. Geeta Devi, 45 years, house wife, educated up to intermediate, belongs to

urban middle class family suffering from uterus cancer. The baseline assessment indicated that

the patient had low score on optimism, personal control and future orientation. She realizes that

she had not fulfilled her liabilities and this makes her restless. She felt very helpless and

dependent. In the counseling sessions she catches every point very easily. In post test condition

she restored hope.

Case study 13: Mrs. Aarti Gupta, 52 years, illiterate, house wife, comes from rural upper middle

class suffering from uterus cancer. Baseline assessment showed that the patient was low scorer

on optimism, personal control and future orientation. She doesn’t hope for the best in stressful

circumstances. She felt that future events are not in her hands. Then she attended the counseling

sessions and after that she showed contentment and she improved on optimism.

Discussion

Once a person is diagnosed as having cancer, the realization that now I have

to live with the disease, push him/her to make many compromises in life. After the diagnosis of

cancer, the patient experiences disorientation, anxiety, fear, loss of control etc. He/ she feel that

now life is slipping of his/ her hands. At this moment many times the patient and their caretakers

need outside help to reconcile the life. Frankl (1963) argued that if illnesses were associated with

the lack of hope, then successful treatment must involve it, restoration.

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In the present investigation the researchers tried to restore the hope in the

patients that this is not an end of life. Although these patients do not have many years to love but

they are counseled to live their rest of life successfully, gracefully and with worth.

A substantial body of researches indicated that optimism is associated

with psychological and physical well-being. Optimism helped to people to cope with stress and

reduce risk of illness. (Carver etal, 1993; Horowitz, Adler&Kegeles, 1988; Scheier&Carver,

1985). In the present study it was also observed that optimistic cancer patients think positively

and tried to see positive aspects of the negative situation, as they also scored higher on the

positive reframing subscale of the cope questionnaire and their doctors also admitted that these

patients co-operate in the treatment and had a better recovery. It was also found that house

women caner patients, who scored higher on pessimism, denied the reality of the situation and

reported feeling that the treatment was hopeless and their condition will not be going to improve.

But when all these patients were counseled to look at the brighter side of the events, those who

already thought of a little bit optimistically modified themselves more than those who were

pessimistic. The findings of the study also showed that the support by different groups-family,

friends, social groups and special support groups are important variable in fighting the diseases

like cancer. Seligman (1991) had cited how social isolation may result in worsening of an illness

and hastening of death. During the counseling sessions, patients repeatedly said that support

from the family members is the key to successful recovery to the disease.

The results of quantitative measures and case studies of counseling showed

that cancer patients who believe that they had control over at least some aspects of their illness

22

were better adjusted to illness, use more active coping strategies and also plan something for near

or distant future than the patients who do not have such beliefs. When the illness condition was

perceived being modifiable and under one’s control, the recovery from myocardial infraction

was enhanced. (Bar-on, 1987). Having a sense of control make the patients to perceive quality in

life and judge their life satisfactory and less distress full. In the results it was also noted that

orientation towards future activities and goals was also increased. The motivational aspect of

future orientation is the anticipation of instrumental acts to attain positive and to avoid negative

future developments.

The intervention session indicated that those patients who enjoyed more

social and psychological resources from their family or friends relied more on active coping such

as positive appraisal and seeking guidance and lesson avoidance coping, especially emotional

discharge found that optimistic patients seem to cope in more active problem oriented way.

It can be concluded on the basis of the findings of the study that

psychological dispositions like having a sense of control, optimism and future oriented outlook

along with supportive and caring relationships enhances the tendency to effectively and actively

manage a deadly chronic disease like cancer. Although the cancer patient do not have 10 or 20

years of life but an intervention programs me along with treatment regime may ensure a positive

life with quality and satisfaction and without grudge and regret. Although 10 sessions counseling

has made effective on the patients but there is a need for regular intermittent counseling of these

patients and their family members.

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Table 1.1

Scores of cancer patients on psychological measures before and after CBT interventions

Measures Pre-Intervention Post Intervention t

Optimism 24.7 (2.80) 28.3 (4.69) 2.12*

Perceived Control 19.3 (1.84) 21.6 (2.91) 2.13*

Future Orientation 7.51 (1.69) 10.89 (1.80) 2.12*

My future 49.2 (1.41) 54.6 (1.73) 2.08*

Symptom Reporting 9.3 (1.69) 9.6 (1.80) 1.64

Quality of life 22.5 (3.68) 26.7 (3.28) 2.27*

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Table 1.2

Means and SDs of scores on the measures of coping strategies

Coping Strategies Pre-Intervention Post-Intervention t

Active Coping 18.3 (3.60) 22.4 (3.74) 2.12*

Acceptance Coping 17.2 (3.60) 22.8 (1.91) 2.07*

Maladaptive Coping 16.3 (2.39) 12.3 (1.74) 2.12*

Note: **p<.01, *p<.05.

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