Being active or flexible? Role of control coping on quality of life among patients with gastrointestinal cancer Cecilia Cheng 1Ã , Nga-yan Chan 1 , Jasmine Hin-man Chio 1 , Pierre Chan 2 , Annie On-on Chan 2 and Wai-mo Hui 2 1 Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong 2 Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Abstract Objectives: This study examined the link between coping and quality of life among patients with gastrointestinal (GI) cancer. Two hypotheses were tested. The active-personality hypothesis states that quality of life is associated with the predominant use of primary control coping (PCC) in general. The situational-flexibility hypothesis states that quality of life is related to flexible deployment of PCC and secondary control coping (SCC) according to situational controllability. Methods: Participants were 180 Chinese adult patients diagnosed with colon or liver cancer. Their perceived controllability of stressors, coping, and quality of life were compared with those of a sex- and age-matched community sample. Results: Three groups with distinct coping patterns were identified: (a) a flexible group characterized by the use of PCC in controllable situations but SCC in uncontrollable situations, (b) an active group characterized by predominant use of PCC in most situations, and (c) a passive group characterized by predominant use of SCC or avoidant coping in most situations. Patients in the active and the flexible groups had higher perceived controllability and psychological well-being scores than those in the passive group. Conclusions: Our results provide support for both the active-personality and the situational- flexibility hypotheses among GI cancer patients. Clinical and research implications of the findings are discussed. Copyright r 2010 John Wiley & Sons, Ltd. Keywords: cancer; oncology; coping; quality of life; psychological well-being Introduction Cancer constitutes a source of stress that affects patients’ quality of life. Cancer studies have shown individual differences in psychological experiences such as depression and anxiety [1,2]. Patients need to handle not just the life-threatening disease but also a vast array of cancer-related problems, including controllable (e.g. dietary change) and uncontrollable (e.g. side effect of medications) issues. The impacts of distinct types of stressful events on their psychological experiences may differ. In response to the dearth of studies examining cancer-related events with distinct extents of controllability, this study was the first to systematically examine how cancer patients cope with both controllable and uncontrollable health-related problems. Although numerous studies have examined psychological adjustment to cancer, few studies have investigated two types of life-threatening gastrointestinal (GI) cancer, colon cancer and liver cancer. In the United States, colon cancer was the second leading cause of cancer-related death, and liver cancer ranked eighth [3]. In Hong Kong, colon cancer and liver cancer were the second and third leading causes of cancer-related death, respectively [4]. This study examined the link between coping and quality of life among patients afflicted by these two types of deadly cancer. Proposal of a threefold classification scheme of coping Two conceptual paradigms have been widely adopted for studying coping among cancer patients. The first is derived from the transactional theory of coping [5], which postulates two broad coping strategies: (a) problem-focused coping targets mana- ging the stressful event directly and (b) emotion- focused coping targets regulating unpleasant feelings associated with stress. This paradigm fails to distin- guish approach-oriented (e.g. emotional expression, humor) from avoidance-oriented (e.g. catharsis, emotional distancing) emotion-focused strategies. * Correspondence to: Department of Psychology, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong. E-mail: ceci-cheng@hku.hk Received: 12 August 2010 Revised: 9 November 2010 Accepted: 11 November 2010 Copyright r 2010 John Wiley & Sons, Ltd. Psycho-Oncology Published online 19 December 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.1892 Psycho‐ Oncology 21: 211–218 (2012)