Denial is a concept of clinical relevance frequently observed in cancer patients and has been the subject of extensive research and discussion. However, the definition of denial in this context has evolved over time, influenced by different theoretical perspectives. From a psychoanalytical standpoint, denial is often viewed as a pathological and ineffective defense mechanism. Conversely, the stress and coping model proposes that denial can be an adaptive strategy, serving to protect individuals from overwhelming events and emotions. This article aims to explore the varying concepts of denial, examine its prevalence among cancer patients, and review the relationship between denial and patient characteristics, as well as its influence on quality of life.
Studies indicate that the prevalence of denial of diagnosis in cancer patients ranges significantly, from 4% to as high as 47%. Denial of the impact of cancer is even more common, reported in 8% to 70% of patients, while denial of affect occurs in 18% to 42% of cases. Age appears to be a factor, with elderly cancer patients showing a higher likelihood of denial. Cultural background also seems to play a role in the prevalence of denial, suggesting that cultural norms and beliefs may influence how patients cope with a cancer diagnosis. Interestingly, neither the specific type of cancer nor gender seems to be consistently related to denial. However, some research suggests that men might be more prone to denial during the terminal stages of the disease.
Longitudinal studies, though limited in number, have indicated a trend of gradual reduction in denial as the cancer illness progresses. This suggests that denial may be a temporary coping mechanism that diminishes over time as patients adjust to their diagnosis and situation. The effect of denial on a patient’s physical and social functioning remains somewhat unclear, with research yielding mixed results. However, the impact on psychological functioning appears to be more nuanced and dependent on how denial is conceptualized. Studies have found that distractive strategies, considered a form of denial in some contexts, can actually reduce distress. In contrast, passive escape mechanisms, another manifestation of denial, have been linked to decreased psychological well-being.
In conclusion, denial in cancer patients is a multifaceted phenomenon with varying definitions and prevalence rates. While factors like age and cultural background seem to influence its occurrence, the impact of denial on patient outcomes, particularly psychological well-being, requires further investigation. Future research aiming to understand the prevalence and adaptive or maladaptive nature of denial must adopt clear and consistent definitions, employ longitudinal study designs, and carefully consider background variables to provide a more comprehensive understanding of this complex coping mechanism in cancer patients.
