title: Coping with metastatic melanoma: the last year of life.
abstract: BACKGROUND
  Few longitudinal studies have concurrently investigated cognitive appraisal, coping and psychological adjustment in patients with terminal cancer. This study aimed to (i) consider patterns of change in these variables during the last year of life and (ii) consider covariates associated with patients' psychological adjustment.
  
  
  METHODS
  Questionnaires were sent to a cohort of stage IV melanoma patients seen at the Sydney Melanoma Unit between 1991 and 1996, approximately every 3 months, for up to 2 years. A sub-sample of 110 patients completed at least one questionnaire in the last year of life. Repeated measures linear regression was used to model cognitive appraisal, coping and psychological adjustment.
  
  
  RESULTS
  In the last year of life, patients' cognitive appraisal of their disease remained relatively stable, whereas their use of active coping strategies increased (p=0. 04). There was some deterioration in psychological adjustment, particularly in patients' ability to minimize the impact of cancer on daily life (p=0.03), but this effect did not remain significant when patients' level of tiredness was included in the model. Cognitive appraisal, coping style and quality of life indicators were all associated with psychological adjustment.
  
  
  CONCLUSIONS
  These findings suggest that while patients work hard to actively cope with their disease, they experience increasing levels of tiredness, and deterioration in their mood and ability to function in their daily lives.
authors.affiliation: Medical Psychology Unit, University of Sydney, Sydney, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Brown
authors.forename: R F
authors.initials: RF
authors.lastname: Brown
authors.forename: R M
authors.initials: RM
authors.lastname: Miller
authors.forename: S M
authors.initials: SM
authors.lastname: Dunn
authors.forename: M T
authors.initials: MT
authors.lastname: King
authors.forename: A S
authors.initials: AS
authors.lastname: Coates
authors.forename: P N
authors.initials: PN
authors.lastname: Butow
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D001362:Avoidance Learning; D003071:Cognition; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008545:Melanoma / Q000523:psychology* / Q000556:secondary*; D008875:Middle Aged; D008960:Models, Psychological; D011340:Problem Solving; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*