Objective and subjective stressors and the psychological adjustment of melanoma survivors Y. Hamama-Raz 1,2 *, Z. Solomon 2,3 , J. Schachter 4 and E. Azizi 5 1 Department of Social Work, College of Judea and Samaria, Ariel, Israel 2 Adler Research Center for Child Welfare and Protection, Israel 3 School of Social Work, Tel-Aviv University, Israel 4 Division of Oncology, Sheba Medical Center, Tel-Hashomer, Israel 5 Dermatology Department, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel * Correspondence to: 17, Shifer st, Petach Tikva, 49291, Israel. E-mail: razizik@zahav.net.il Abstract This study of 300 melanoma survivors examines the relative contributions of objective illness- related factors (stage of illness at diagnosis, time since diagnosis, and change in physical condition) and of subjective factors (cognitive appraisal) to their psychological adjustment. The findings show that lower appraisal of their situation as a threat, higher appraisal of it as a challenge, and higher appraisal of their subjective ability to cope with it all increased their well- being, while lower threat appraisal and higher appraisal of subjective ability to cope also reduced their distress. These findings, which are consistent with Lazarus and Folkman’s stress coping theory, suggest that subjective factors may be more important than objective medical factors in predicting patients’ adjustment. With this, more advanced stage at diagnosis contributed to reducing distress, while being married contributed both to higher well-being and reduced distress. Copyright # 2006 John Wiley & Sons, Ltd. Keywords: cancer survivors; psychological adjustment; objective stress; cognitive appraisal; oncology Introduction Scientific advances have greatly increased the chances of surviving cancer. As welcome as it is, cancer survival brings with it a host of new challenges. Recovered cancer patients often face physical, psychological, and social difficulties. Physically, cancer treatment may damage the heart and endocrine system, impair fertility [1] and sexual functioning, and lead to disfiguring bodily changes [2]. Psychologically, many cancer survivors experi- ence a high sense of vulnerability and fear of recurrence and death [3,4]; many suffer from anxiety, depression, and feelings of loss of control [5], as well as job insecurity [6]. Socially, studies have found impaired family, social, and work relationships among cancer survivors [7]. Some of these difficulties, especially the physical damage of cancer and its treatment, persist for the rest of the survivors’ lives. Similar to survivors of other life threatening events, cancer survivors differ in their subsequent adjustment. Not enough is known, however, about the factors that affect their adjustment. Studies of ‘objective’ factors related to their illness, namely stage of cancer and time since diagnosis, yield inconsistent results. Greater time post-diagnosis has been associated with less distress [8] and greater distress [9], while some studies found no significant association between well-being and time since diagnosis [10–12]. In similar vein, more advanced stage cancer has also been found to be significantly associated both with more distress [8,9] and less distress [5]; and here too some studies have found no significant association at all (e.g. [12]). The differences in findings are difficult to interpret because of differences in the time frames studied, as well as differences in the types of cancer. At this time, the possibility that the differences in the findings are anchored in differences in the types of cancer studied, which could affect things ranging from the gender of the subjects through the treatment and post-cancer residuals, cannot be ruled out. Nor can it be ruled out that other factors may have a greater influence on survivors’ adjustment than their stage of cancer or time since diagnosis, or temper the impact of these variables. Among the possible factors may be the survivors’ subjective appraisal of their situation. The present study takes its cue from Lazarus and Folkman’s theory of adjustment to stress [13–15], which claims that persons’ coping with stress is affected not only by the objective nature of the Received: 9 June 2005 Revised: 17 March 2006 Accepted: 6 April 2006 Copyright # 2006 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology 16: 287–294 (2007) Published online 20 July 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1055