Cancer as loss of control: The extent of perceived control and its relevance for mental distress in cancer patients – A cross-sectional comparative study

OBJECTIVE: Cancer is often described as a loss of control. The somatic symptoms and the strict treatment may limit an individual's ability to adapt environmental factors (e.g., career goals, social life) to their own needs (i.e., limited primary control). Facilitating one's individual values and needs to the cancer-related circumstances (i.e., secondary control) thus may be central in maintaining mental health. The current work aims to investigate the roles of primary and secondary controls for mental health in individuals with cancer and compare it to the general population. METHODS: The study included 618 cancer patients and 2513 individuals representing the German population. Sociodemographic and disease-related variables, primary and secondary control (PCSS-6), anxiety (GAD-2) and depressive symptoms (PHQ-2), and suicidal ideation (single items of PHQ9/SCL-90) were assessed. (Logistic) regression analyses were conducted to examine the independent and interactive role of primary and secondary control on mental health outcomes for the combined and the separate samples. RESULTS: Cancer patients reported elevated psychological burden and increased secondary control. Primary and secondary control were independently associated with all mental health outcomes in cancer patients and the general population. Within cancer patients, primary controls' protective role was weaker for suicidal ideation compared to the general population. Additionally, secondary control reinforced the link between primary control and depressive symptoms, but only in cancer patients. CONCLUSION: While both primary and secondary control serve as independent protective factors for mental health, both control strategies may function differently in the context of cancer regarding depressive symptoms and suicidal ideation.