Denial and helplessness in cancer patients undergoing radiation therapy: Sex differences and implications for prognosis

One hundred consecutive outpatients undergoing radiation therapy were prospectively studied using the Locus of Control Inventory designed by Rotter and a questionnaire covering various aspects of diagnosis, implications of disease, and details of therapy. The Locus of Control Inventory, which measures a person's belief that life's important events are controlled by personal effort (internality) as opposed to factors outside of one's control (externality), revealed a significant difference between men and women in this study. Although women were similar to the general healthy population, men expressed a greater sense of control as their radiation therapy progressed. Men were also more likely to characterize their illness as not very serious and to deny knowledge of their correct diagnoses or details of their treatment. With survival determined at two years following the study, it was found that living and deceased women had initially rated the seriousness of their illnesses appropriately, while deceased men had rated their illnesses as significantly less serious than women or surviving men. It is concluded that sexual differences in coping mechanisms may be accentuated by malignancy and men may actively deny their diagnosis and its implications. This amount of denial and sense of personal control in the face of a potentially fatal illness may indicate a need for more supportive clinical intervention for the radiation therapy patient.