In a prospective investigation of different types of problem-focused coping strategies,146 women with early-stage breast cancer were studied. Study results showed that a strategy of concentrating on symptoms, measured at the end of treatment, was predictive of less improvement in physical and mental quality of life at 6 months' follow-up, while a strategy of information seeking was associated with greater improvement in physical quality of life. These findings suggest that problem-focused coping consists of a variety of specific coping strategies, some of which may be beneficial-and some of which may not be beneficial-to quality of life.
One criticism of the literature on coping with cancer focuses on the assumption that "coping with cancer" is a single unitary event. In reality, coping with cancer involves coping styles and strategies that may differ and vary according to the nature of the stressors being encountered. For example, in a study of 52 adults receiving palliative care for cancer, patients participated in a semistructured interview during which they were asked about their most significant stressors and how they coped with these stressors. Three stressor domains were identified:
Three categories of coping were also identified:
- Problem focused
- Emotion focused
- Emotion-focused avoidance
Results showed that most participants used a range of coping strategies; however, there were interactions between stressor domains and coping categories. Problem-focused strategies were used less frequently for the existential stressors, while emotion-focused strategies were used less frequently for the physical stressors.
One cognitive theory of coping  proposes that in response to significant life events, a person asks two important questions:
- Is this event personally significant to me?
- What resources do I have to manage/control this event?
When an event is perceived to be of personal significance (nearly all cancer-related life events would be), and when one's personal resources are perceived to be inadequate to the demands of managing the event, distress can occur. One way to conceptualize the amount of distress experienced by patients is the balance or ratio between perception of the demands that a situation (e.g., chemotherapy) places upon them and perception of the resources they possess (e.g., effective antiemetics) to effectively manage these demands:
Distress = Perceived Demands/Perceived Resources
Individuals with the same diagnosis or treatment regimen may experience very different levels of distress. A high level of distress could result from an individual's perceptions that either the demands of a situation are very high or his or her resources are very low (or both). Conversely, low distress is the result of a perception that either the demands of a situation are very low or the individual's resources are high. To lower distress, therefore, either the perceived demands of the situation should be lowered, or the perceived resources should be increased.