JJCO Japanese Journal of

Clinical Oncology
Japanese Journal of Clinical Oncology, 2017, 47(9) 849–855
doi: 10.1093/jjco/hyx079
Advance Access Publication Date: 7 June 2017
Original Article

Original Article

Optimism, pessimism and self-efficacy in female

cancer patients
Maik Thieme1, Jens Einenkel2, Markus Zenger3,4, and Andreas Hinz1,*

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1
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, 2Department of
Gynecology and Obstetrics, University of Leipzig, Leipzig, 3Faculty of Applied Human Studies, University of Applied
Sciences Magdeburg-Stendal, Stendal, and 4Integrated Research and Treatment Center Adiposity Diseases,
Leipzig University Medical Center, Leipzig, Germany

*For reprints and all correspondence: Andreas Hinz, Department of Medical Psychology and Medical Sociology,
University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany. E-mail: andreas.hinz@medizin.uni-leipzig.de
Received 14 March 2017; Editorial Decision 17 May 2017; Accepted 18 May 2017

Abstract
Objective: The aim of this examination was to study whether psychological resource variables
(optimism and self-efficacy) decrease when cancer is present and to test the predictive power of
these variables for anxiety, depression and quality of life (QoL).
Methods: The patient sample was comprised of 354 German women suffering from breast cancer
or gynecological cancer. Participants filled in the resource assessment tools Life Orientation Test-
Revised and the General Self-Efficacy Scale as well as the Hospital Anxiety and Depression Scale,
the Patient Health Questionnaire-4 and the QoL instrument EORTC QLQ-C30 at two time points:
(t1) during patients’ hospital stay and (t2) 3 months later.
Results: The mean scores for optimism (total score: M = 16.2) and self-efficacy (M = 29.8) were
even somewhat higher than the corresponding means of the general population. Optimism and
self-efficacy were positively correlated with QoL (r between 0.15 and 0.17, P < 0.01) and negatively
associated with anxiety and depression (r between −0.17 and −0.36, P < 0.01). However, only opti-
mism was predictive of the t2 anxiety, depression and QoL scores when statistically taking into
account the baseline levels of the outcome variables.
Conclusions: Having cancer does not generally reduce optimism and self-efficacy on the level of
patients’ mean scores. Cancer patients with a high level of habitual optimism will adapt to their
disease better than pessimistic patients, even if the baseline levels of the outcome variables have
been accounted for.

Key words: quality of life, mental health, optimism, cancer

Introduction positive outcomes (1,2). Dispositional optimism is associated with

The detrimental effects of cancer diseases on quality of life (QoL)
and mental health have long been reported. However, over time,
many cancer patients adapt to their illness and report positive men-
tal health states, while other patients have greater difficulties coping
with the disease. With the intention of supporting patients in these
adaptation processes, several studies have been performed to iden-
tify psychological resources that predict better outcomes. One of
these resources is habitual or dispositional optimism, a personality
trait that describes the degree to which a person generally expects
© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
QoL (3,4), positive mood and well-being (5), coping (6), physical
exercise (7,8), and low levels of fatigue (9), anxiety (10) and depres-
sion (11) in patients suffering from cancer. Cross-sectional correla-
tions between optimism and outcome variables such as QoL or
mental distress indicate the magnitude of the association, but they
do not explain the pathways through which optimism or pessimism
operates. For that purpose, a study design with at least two time
points (t1 and t2) is necessary to estimate the effect of optimism at
t1 on the outcome at t2. A study with cancer patients (12) found
849
850 Optimism and pessimism in cancer patients
significant correlations between optimism (at t1) and anxiety and
depression (at t2) of r = −0.39 and r = −0.41, respectively. However,
a more precise evaluation of the impact of optimism on health out-
comes should also take into account the baseline value (t1) of the
health outcome variable, information that makes it possible to assess
the additional or independent impact of optimism. So far, studies that
have used this statistical approach have had contradictory results.
Several studies have found an independent effect of optimism on men-
tal health and QoL (13–17), while others have not (18–21). There are
also studies with mixed results. Two studies (12,22) found a signifi-
cant impact of optimism on anxiety but not on depression in cancer
patients. Another study with breast cancer patients (3) proved a sig-
nificant effect on emotional functioning but not on general QoL. A
study with a 5-year temporal distance between the measurements
detected an independent influence of optimism on depression in the
age range 65–74 years but not in the age range 75–84 years (23).
Possible reasons for these mixed results are differences between
samples of patients (sometimes with low sample sizes, n < 100),
instruments for assessing mental health and QoL, temporal distances
between the t1 and t2 measurements, and statistical techniques (no
baseline control, path analyses, hierarchical regression analyses and
partial correlations). Of the statistical methods available, partial cor-
relations seem to be most appropriate since they express the associ-
ation between optimism at t1 and the outcome variable at t2, while at
the same time controlling for the outcome variable at t1, with a single
coefficient. A study of female cancer patients (17) used this technique
to examine the influence of optimism on anxiety, depression and
QoL. While the correlations between optimism at t1 and the outcome
variables were between 0.19 and 0.44, the partial correlations consid-
ering the baseline scores were lower (between 0.18 and 0.31).
However, two of the coefficients were also statistically significant,
indicating a significant independent contribution of optimism.
Optimism is not the only personal resources variable that can be
assessed. Others are self-efficacy (24), self-esteem (25) and sense of
coherence (26). Self-efficacy is defined as the belief that one can produce
desired outcomes as a result of his/her own actions using skills and cap-
abilities (27). Self-efficacy is effective in predicting health-related behav-
ior in cancer patients (28). Similar to habitual optimism, self-efficacy is
associated with QoL (29,30) and can be considered a buffer between
stressful events such as a cancer disease and poor health outcomes.
However, these studies did not use a longitudinal design. In our study,
we tested whether self-efficacy also serves as a resource variable for pre-
dicting developments in QoL and mental health in cancer patients.
Resource variables such as optimism and self-efficacy are assumed
to be personality traits that are only marginally dependent on situ-
ational effects. However, it has rarely been tested whether such
resource variables indeed remain unchanged when a person is faced
with a cancer diagnosis. Several studies of patient groups report
resource variables mean scores, e.g. (23,31), but they generally do not
compare these values with normative scores obtained from the general
population. Therefore, it is also important to test the temporal stability
and to compare patients’ resource variables mean scores with those of
the general population. In our study, we focus on patients with breast
cancer or gynecologic cancer since we did not want to restrict the sam-
ple to one special type of cancer, but nevertheless we intended to omit
a too heterogeneous sample. The aims of this study were
– to examine to what degree specific resource variables remain
unchanged in cancer patients, and
– to test whether these resource variables have an impact on QoL,
anxiety and depression, accounting for the initial values.
Methods
Cancer patients
Patients with gynecological or breast cancer were consecutively
recruited for this study in the gynecological clinics of three German
hospitals. The patients were eligible for this study if they were at
least 18 years old, had histologically proven carcinoma and were
able to understand German well enough to complete the question-
naires. There were no eligibility criteria concerning time since diag-
nosis. In total, 466 patients were asked to take part. Trained
interviewers explained the aims of the study to the patients and
asked them to give informed consent. The Ethics Committee of the
Leipzig University approved the examination. In most cases, the first
test (t1) was performed 1 or 2 days before hospital discharge. A
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second questionnaire was sent to the participants by mail 3 months
after hospital discharge (t2). The study was conducted between
October 2013 and January 2016.
General population
The reference data were taken from two previous German norma-
tive studies that included 2372 persons (Life Orientation Test-
Revised, LOT-R) (32) and 2019 persons (General Self-Efficacy
Scale, GSES) (33) randomly selected from the German general popu-
lation. These publications also present reference scores for women,
broken down by age decades. To compare the patients’ mean scores
with those of the general population, we used the cancer patients’
age categories distribution (as presented in Table 1) as weighting
factors to calculate the weighted mean scores of the female general
population profiled in the papers that reported normative values.
Instruments
The participants filled in the following questionnaires at t1 and t2.
Life Orientation Test-Revised
Habitual optimism was tested with the LOT-R (34). It consists of
two subscales, optimism and pessimism, with three items each, along
with four filler items. Originally, the test was designed as a unidimen-
sional instrument. Though confirmatory factorial analyses found better
fit indices for a two-factorial model (optimism and pessimism) (32,35),
we also consider the original unidimensional sum score (composed of
the optimism and the inverted pessimism subscale). Each item is to be
answered on a five-point Likert scale, ranging from 0 (strongly dis-
agree) to 4 (strongly agree). This results in scale ranges from 0 to 12
for the subscales. Normative values from the general population are
available (32).
General Self-Efficacy Scale
The GSES (36) comprises 10 items with four answer options, coded
from 1 to 4, resulting in a scale range from 10 to 40. Normative
values for the GSES are available (33).
EORTC QLQ-C30
The QoL questionnaire EORTC QLQ-C30 (37) was specifically
designed for cancer patients. It consists of 30 items that belong to
five functioning scales, three symptom scales, six single symptoms
and a 2-item general health/QoL scale. A summary score of the
EORTC QLQ-C30 can be calculated according to (38), averaging
across all functioning scores and symptom scores except financial
difficulties and the global health/QoL subscale. This sum score and
the 2-item global health/QoL score are used as QoL outcome
 Jpn J Clin Oncol, 2017, Vol. 47, No. 9 851

Table 1. Sociodemographic characteristics of the study sample Patient Health Questionnaire-4

The Patient Health Questionnaire-4 (PHQ-4) measures mental dis-
Responders Non-responders
tress (42) and is a combination of the ultra-short Generalized
(N = 354) (N = 112)
Anxiety Disorder questionnaire and the ultra-short depression ques-
N % N % tionnaire (PHQ-2). Each of the four items has a range from 0 to 3,
resulting in a total score between 0 and 6 for each subscale. The cut-
Age
Age mean (SD) 61.2 (14.2) 60.0 (15.0)
offs are 3 vs. 4 for both subscales (42). We used two questionnaires
≤49 years 75 21.2 28 25.0 for assessing anxiety and depression (HADS and PHQ-4) in this
50–59 years 79 22.3 26 23.2 study to estimate the consistency of the findings of the relationship
60–69 years 79 22.3 23 20.5 between resource variables and mental health outcome variables.
≥70 years 121 34.2 35 31.3
Cancer location
Peritoneum 3 0.8 0 0.0
Statistical methods
Breast 154 43.5 37 33.0 Mean score differences between the general population and the can-
cer patients were tested with t-tests and expressed in terms of effect

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Vulva 30 8.5 10 8.9
Vagina 0 0 2 1.8 sizes d according to Cohen (43). The raw association between the
Cervix uteri 62 17.5 36 32.1 resource variables and the outcome variables were expressed in
Uterus 65 18.4 10 8.9 terms of Pearson correlations. To dichotomize the patients’ sample
Ovary 33 9.3 17 15.2 based on degrees of optimism and self-efficacy, we used the median
Fallopian tube 7 2.0 0 0 scores of the distributions as the cut-off criteria. The influence of the
Tumor stage (FIGO)
resource variables (optimism and self-efficacy) on the outcome vari-
I 139 39.3 27 24.1
ables (anxiety, depression and QoL) was measured with partial cor-
II 94 26.6 37 33.0
III 61 17.2 23 20.5 relations. These coefficients express the influence of the resource
IV 22 6.2 9 8.0 variable (at t1) on the dependent variable (at t2) in addition to the
Missing 38 10.7 16 14.3 initial score of the dependent variable (at t1) (17). Temporal stability
Time since diagnosis was examined using intra-class correlations. All statistics were calcu-
≤1 month 180 50.8 64 57.1 lated with SPSS version 20.
>1 month 167 47.2 41 39.0
Missing 7 2.0 7 6.3
Civil status
Results
Living without partner 108 30.5
Living with partner 246 69.5 Of the 466 patients eligible for inclusion in the study, 356 agreed to
Education take part and to fill in the questionnaire at t1 (76.4 %). Two women
≤9 years 79 22.3 had to be excluded because of too many missing values. Of the
10–11 years 190 53.6 remaining 354 women, 299 returned the t2 questionnaire with com-
≥12 years 85 24.0 plete data (81.4% of the 354 women). To compare their scores with
Surgery (at t1)
the general population scores, we used the larger sample of partici-
No 16 4.5
pants from the t1 examination; the remaining analyses were
Yes 333 94.1
Missing 5 1.4 restricted to the 299 participants with data from both t1 and t2.
Chemotherapy (at t1) Table 1 shows characteristics of the study sample. There were no
No 279 78.8 significant differences between the participants and the non-
Yes 68 19.2 participants in terms of age and tumor stage, but the distribution of
Missing 7 2.0 tumor sites was significantly different (Chi2 = 27.9, P < 0.01).
Radiotherapy (at t1)
No 297 83.9
Yes 49 13.8 Mean scores of the resource variables
Missing 8 2.3 Table 2 lists resource scales mean scores for the general population
and for the cancer patients. The patients reported having signifi-
cantly more optimism, less pessimism and more self-efficacy than
the general population. The effect sizes of these differences were
measures. There are no established cutoffs for the global health/QoL
between 0.30 and 0.40. The mean scores changed only slightly
scale and the sum score. Half a standard deviation (SD) is often
between t1 and t2. LOT-R optimism was the only scale with a statis-
used to indicate clinical relevance (39). To dichotomize the values,
tically significant mean score difference between t1 and t2 (Table 2).
we subtracted half a SD from the mean to arrive at appropriate
cutoffs for bad QoL, based on normative data from the general
population (40). Mean scores of anxiety, depression and QoL at t2,
depending on the resource scores at t1
Hospital Anxiety and Depression Scale The cross-lagged associations between the (dichotomized) resource
The Hospital Anxiety and Depression Scale (HADS) (41) is a 14- variables at t1 and the dependent variables at t2 are given in
item questionnaire for screening clinically significant anxiety and Table 3. All mental health and QoL scales (at t2) were significantly
depression in patients with somatic illnesses. Both subscales consist associated with the LOT-R total score (at t1), and with one excep-
of seven items each, coded with scores from 0 to 3. The scale range tion (EORTC QLQ-C30 sum score), general self-efficacy also pre-
is 0–21, and the cut-off is 7 vs. 8 for both subscales. dicted the dependent variables. When we compared the optimism
852 Optimism and pessimism in cancer patients

Table 2. Mean scores of the scales for the general population and the cancer patients (t1 and t2)

General Patients t1 Patients t2 General population Patients t1 vs.

population vs. patients t1 patients t2
M SD M SD M SD d P d P

LOT-R optimism 8.3 2.1 9.0 2.5 8.7 2.3 0.30 <0.01 0.12 0.025
LOT-R pessimism 5.6 2.6 4.8 2.5 4.7 2.7 −0.31 <0.01 0.04 0.726
LOT-R total 14.7 3.6 16.2 3.9 15.9 4.0 0.40 <0.01 0.07 0.186
GSES self-efficacy 28.2 5.2 29.8 5.3 29.6 5.1 0.31 <0.01 0.04 0.525

LOT-R, life Orientation Test-Revised; GSES, General Self-Efficacy Scale; M, mean; SD, standard deviation; d, effect size.

Table 3. Relationship between resource variables at t1 and anxiety, depression and QoL at t2

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LOT-optimism t1 LOT-pessimism t1 LOT-total t1 GSES t1

≤9 >9 P ≤4 >4 P ≤16 >16 P ≤30 >30 P

HADS anxiety t2 M 6.14 4.95 0.008 4.95 6.15 0.025 6.42 4.67 <0.001 6.12 4.94 0.008
(SD) (4.00) (3.54) (3.67) (3.86) (3.90) (3.50) (4.07) (3.35)
HADS depression t2 M 6.03 3.77 <0.001 4.23 5.65 0.007 6.16 3.68 <0.001 5.84 3.94 <0.001
(SD) (4.16) (3.19) (3.62) (4.04) (4.27) (2.96) (4.16) (3.29)
PHQ-4 anxiety t2 M 1.50 1.26 0.085 1.15 1.60 0.014 1.69 1.05 <0.001 1.61 1.11 0.001
(SD) (1.39) (1.36) (1.34) (1.38) (1.44) (1.23) (1.45) (1.24)
PHQ-4 depression t2 M 1.45 1.00 0.003 1.03 1.42 0.043 1.55 0.88 <0.001 1.45 0.98 0.004
(SD) (1.43) (1.29) (1.39) (1.37) (1.47) (1.19) (1.48) (1.21)
EORTC QLQ QoL t2 M 55.6 61.4 0.018 60.3 56.5 0.208 54.1 63.1 0.001 56.0 61.0 0.044
(SD) (23.3) (21.0) (23.4) (21.6) (22.5) (21.6) (22.0) (22.8)
EORTC QLQ Sum t2 M 68.2 71.9 0.051 71.1 68.9 0.408 67.3 72.8 0.009 68.3 71.9 0.078
(SD) (18.6) (18.9) (18.9) (18.7) (18.7) (18.6) (18.2) (19.4)

with the pessimism subscales of the LOT-R, optimism was more
strongly associated with seven of the eight dependent variables than
pessimism was. The weakest relationships between the resource vari-
ables and the dependent variables were observed for the EORTC
QLQ-C30 sum score (Table 3).
Predictive value of optimism and self-efficacy
Table 4 lists correlations between the resource variables at t1 and (i)
the dependent variables at t2 (upper part) as well as (ii) the depend-
ent variables at t2 controlled for their base levels (lower part of
Table 4). When the baseline scores of the dependent variables were
not taken into account (upper part of Table 4), most correlations
were statistically significant with magnitudes between 0.16 and 0.36
for the LOT-R total score and between 0.15 and 0.30 for self-
efficacy. The partial correlations (lower part of Table 4) are lower
than these raw correlations; nevertheless, several of them remain
statistically significant. With one exception (HADS anxiety), the
LOT-R total score predicts the dependent variables to a statistically
significant degree, with partial correlations between 0.13 and 0.20.
The GSES, however, provided no additional variance explanation;
all partial correlations of the GSES are insignificant. Table 5 pre-
sents the relationship between the resource variables (at t1) and the
dichotomized dependent variables (at t2) in terms of odds ratios.
Temporal stability
The test–retest correlations between t1 and t2 for the resource vari-
ables were as follows: r = 0.50 (LOT-R optimism), r = 0.55 (LOT-R
pessimism), r = 0.60 (LOT-R total) and r = 0.65 (GSES). Test–retest
correlations between the outcome variables were as follows: r = 0.61
(HADS total), r = 0.42 (PHQ-4 total), r = 0.29 (EORTC QLQ-C30
Global health/QoL) and r = 0.45 (EORTC QLQ-C30 Sum).
Discussion
The first aim of this study was to test whether a cancer diagnosis
leads to reductions in habitual optimism and self-efficacy. The com-
parison between the patients’ mean scores and those of the general
population shows that there is no such decrease. The cancer
patients’ mean scores were even somewhat higher than the norma-
tive scores. This is in line with other studies. LOT-R mean scores in
breast cancer samples were between 16.3 and 16.9 in four studies
(11,16,17,31), which is even higher than the mean score of this
study (M = 16.2) and also higher than the mean score of the general
population. In a sample of 50 oral cavity cancer patients from Hong
Kong (15), the mean score of the LOT-R was lower (M = 14.2), but
it is difficult to assess the impact of the cancer type or the cultural
context. Self-efficacy was also relatively high (M = 29.9) in a sample
of patients suffering from neuroendocrine tumors (44), a score
nearly identical with the patients’ t1 mean score in our study.
Though a cancer diagnosis and treatment often evokes anxiety, the
general expectation that things will develop in a positive way (opti-
mism) as well as the belief that one is able to contribute to the devel-
opment of things in a positive direction (self-efficacy) are not
affected in terms of the mean scores. However, individual differences
are possible. While there are patients who show reduced optimism,
there are other patients for whom the disease stimulates increases in
optimism and self-efficacy. The coefficients of the temporal stability
of optimism (LOT-total: rtt = 0.60) and self-efficacy (rtt = 0.65)
were not as high as personality traits should be. Stability coefficients
 Jpn J Clin Oncol, 2017, Vol. 47, No. 9 853

Table 4. Correlations and partial correlations of resource scales at t1 and anxiety, depression and QoL at t2

LOT-optimism t1 LOT-pessimism t1 LOT-total t1 GSES t1

r P r P r P r P

HADS anxiety t2 −0.23 <0.001 0.18 0.002 −0.28 <0.001 −0.17 0.003
HADS depression t2 −0.33 <0.001 0.20 0.001 −0.36 <0.001 −0.30 <0.001
PHQ-4 anxiety t2 −0.13 0.028 0.21 0.001 −0.23 <0.001 −0.18 0.002
PHQ-4 depression t2 −0.20 <0.001 0.15 0.012 −0.23 <0.001 −0.17 0.004
EORTC QLQ QoL t2 0.15 0.010 −0.09 0.109 0.16 0.005 0.17 0.003
EORTC QLQ Sum t2 0.14 0.015 −0.11 0.055 0.17 0.003 0.15 0.009
HADS anxiety t2 −0.07 0.209 0.05 0.350 −0.09 0.119 −0.01 0.845
contr. for HADS anxiety t1
HADS depression t2 −0.17 0.003 0.12 0.037 −0.20 <0.001 −0.08 0.173
contr. for HADS depression t1
−0.07 −0.18 −0.09

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PHQ-4 anxiety t2 0.216 0.20 0.001 0.002 0.115
contr. for HADS anxiety t1
PHQ-4 depression t2 −0.09 0.137 0.11 0.061 −0.13 0.022 −0.06 0.298
contr. for PHQ-4 anxiety t1
EORTC QLQ QoL t2 0.14 0.016 −0.06 0.335 0.13 0.023 0.11 0.053
contr. for EORTC QoL t1
EORTC QLQ Sum t2 0.10 0.077 −0.11 0.053 0.14 0.013 0.05 0.370
contr. for EORTC Sum t1

Table 5. Odds ratios for anxiety, depression and QoL at t2

LOT-optimism t1 LOT-pessimism t1 LOT-total t1 GSES t1

OR P OR P OR P OR P

HADS anxiety t2 0.840 0.001 1.112 0.044 0.879 <0.001 0.921 0.001
HADS depression t2 0.805 <0.001 1.109 0.068 0.860 <0.001 0.895 <0.001
PHQ-4 anxiety t2 0.944 0.470 1.101 0.245 0.928 0.164 0.983 0.644
PHQ-4 depression t2 0.847 0.044 0.994 0.944 0.925 0.173 0.944 0.138
EORTC QLQ QoL t2 1.157 0.003 0.935 0.159 1.100 0.003 1.063 0.006
EORTC QLQ Sum t2 1.151 0.011 0.898 0.043 1.115 0.003 1.062 0.015

obtained in other studies were even smaller, with coefficients
between rtt = 0.39 and rtt = 0.50 for the LOT-R subscales (23,45)
and a coefficient of rtt = 0.60 for general self-efficacy (46). Though
optimism and self-efficacy are designed as personality traits, the fluc-
tuations are as great as those observed for mental and physical
health variables. That means that interventions might be effective in
changing or improving these variables. However, interventional
studies are necessary to prove this hypothesis.
The second aim of this examination was to test whether opti-
mism and self-efficacy contribute to the prediction of anxiety,
depression and QoL. As was to be expected, there were substantial
correlations between the resource variables and these outcome vari-
ables. The crucial question was whether optimism and self-efficacy
provide a supplementary contribution to the variance explanation in
addition to the baseline values of these variables. As in previous
studies, there were positive partial correlations between the LOT-R
scores and the outcome variables, though the partial correlations of
this examination were somewhat lower than those reported in a pre-
vious study (12). The partial correlations of the LOT-R total score
were higher than those of the two subscales for most of the depend-
ent variables (Table 4). This is an argument for the combination of
the two subscales, optimism and pessimism, though confirmatory
factorial analyses generally find that the model fits are best when
two subscales are considered separately (35,47). A further result is
that the partial correlations are roughly similar for the outcome
variables. Concerning the HADS, the correlation with depression
was higher than that of anxiety, while the order was reversed for the
PHQ-4.
The partial correlations between optimism and the 2-item scale
General health/QoL of the EORTC QLQ-C30 (r = 0.13) were nearly as
high as those with the EORTC QLQ-C30 sum score (r = 0.14). The
similarity of these two correlation coefficients is not at all self-evident
because of differences in the degree of generality: while the focus of the
2-item scale is on a generalized health assessment, the sum score is an
aggregation of specific symptoms (48). Comparisons between the opti-
mism and the pessimism subscales revealed no dominance of any one
subscale. This contrasts with the results obtained in a previous study
(17) whereby the pessimism scores were markedly higher than the opti-
mism coefficients.
In contrast to optimism, the contribution of self-efficacy was
negligible in predicting the t2 scores of anxiety, depression and QoL
3 months later. All eight partial correlations between GSES and the
dependent variables failed to reach the significance criterion
(Table 4). Because the reliability of the GSES was high (alpha =
0.91 in this study), a lack of reliability cannot be the reason for the
low coefficients. Future research should aim to systematically com-
pare several resource concepts (optimism, self-efficacy, self-esteem,
sense of coherence) concerning their predictive value.
Some limitations of this study should be mentioned. We do not
know whether the results are generalizable across other types of
854 Optimism and pessimism in cancer patients
cancer. The study is restricted to patients who were able to take part
in examinations both at t1 and t2. It is possible that patients with a
bad prognosis at t1 were less likely to take part in the t2 examin-
ation and that they are, therefore, excluded from the analysis here.
It is also possible that the selection yielded a sample of people with
relatively high levels of optimism and self-efficacy; we have no infor-
mation on the optimism of the non-responders. However, the nor-
mative values taken as references are also based only on those
people who were willing to take part in these normative studies.
This might have contributed to a similar bias. Though we demon-
strated the predictive value of optimism, there are several possible
pathways through which the associations with mental health and
QoL can work. Social support (11), stress appraisal (9) or fighting
spirit (3) has been identified as mediators for this relationship. In
our study, however, we cannot know which of these pathways
mediated the relationship between optimism and the outcome
variables.
Taking the results together, a cancer diagnosis does not generally
decrease the mean level of optimism and self-efficacy. Optimism but
not self-efficacy predicts the development of mental health and QoL
in cancer patients. Patients with a low degree of optimism are at
greater risk of experiencing mental distress, worse QoL and a great-
er need for psychosocial support. The LOT-R is effective in detecting
such at-risk patients. Using this short screening instrument in clinical
practice may help healthcare providers identify these patients and
offer them more in-depth mental health diagnostics and further psy-
chosocial help. Strengthening an optimistic attitude may be an
effective tool for supporting patients in adapting to their disease.
Funding
This research received no specific grant from any funding agency in
the public, commercial or not-for-profit sectors.
Conflict of interest statement
None declared.
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