The Perceived Adjustment to Chronic Illness Scale (PACIS): a global indicator of coping for operable breast cancer patients in clinical trials

Abstract

Subjective well-being is a major aspect of quality of life and is therefore increasingly used as an endpoint in clinical trials. It is influenced to a great extent by the complex process of coping with the disease and its treatment. Assessment of coping is methodologically demanding, especially in large clinical trials. We therefore developed a single-item measure, the Perceived Adjustment to Chronic Illness Scale (PACIS), as an indicator of coping, complementary to other scales related to quality of life. We sought to validate this instrument in a subgroup of 121 Swiss patients participating in the International Breast Cancer Study Group (IBCSG) adjuvant trials. At months 3 and 6 of adjuvant treatment PACIS showed a distinct pattern of highly significant rank correlations with several disease- and treatment-related problem areas from the Herschbach coping inventory (FBBK); 42% of the variance of PACIS at month 3 was explained by the FBBK (P = .0001). The portion of explained variance was considerably higher for the Italian- (70%) than for the German-speaking (30%) subgroups. Patients who rated more effort to cope with their disease on PACIS indicated more frequent use of 3 of 15 coping strategies in relation to psychological distress. These were "crying and becoming desperate", "taking tranquillizers and alcohol" and "other people are far worse off". These three coping strategies may define a high-risk group for poor psychosocial outcome. Patients whose PACIS scores showed that it required less effort to cope tended to use the strategy "seeing a positive side of the problem". We conclude that PACIS can be used as a global indicator of the coping process in large multicultural clinical trials of adjuvant therapy for breast cancer.

Clinical relevance of single item quality of life indicators in cancer clinical trials

“…Among the indicators this change was most obviously expressed in perceived coping effort, the most subjective measure (Hürny et al, 1993). This finding speaks for a summative effect of various factors.…”

“…4 LASA indicators were incorporated in the IBCSG QL form: physical well-being (PWB) (Priestman and Baum, 1976), mood (Priestman and Baum, 1976;Hürny et al, 1996a) and effort to cope (PACIS) (Hürny et al, 1993) were designed as global indicators, appetite as a more specific indicator for cytotoxic side-effects (Bernhard et al, 1997). All indicators were scored by measuring in millimetres from 0 to 100 and were reversed, with higher numbers reflecting better QL (e.g., less effort to cope).…”

Capecitabine in hormone-resistant metastatic prostatic carcinoma – a phase II trial

“…A higher score for a functional scale represents a higher level of functioning, a higher score for the global health status/QL scale a better QL, and a higher score for a symptom scale or item a higher level of symptoms or problems. In addition, a global indicator for overall treatment burden (Bernhard et al, 2002) and another for coping effort (Hurny et al, 1993) were included. These two indicators were transformed accordingly (0 -100), with higher scores indicating better QL.…”

Psychosocial predictors of outcome: time to relapse and survival in patients with early stage melanoma

“…Indicators of QOL were assessed using 3 single-item LASA scales measuring physical well-being, mood and perceived effort to cope (Priestman and Baum, 1976;Hurny et al, 1993). The scales were scored from 1 to 100 using a 100 mm line.…”