Exploring Coping Strategies and Quality of Life in Adolescents with Cancer: Pilot Study Findings

  1. Monica Licu
  2. Darren Haywood
  3. Elisabeta Nita
  4. Adrian Pogacian

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Abstract

Objective: The objective of this exploratory pilot study was to examine the relationship between coping strategies and perceived quality of life in adolescents diagnosed with oncological diseases, with attention to the potential role of psychosocial factors in emotional adaptation. Method: The study included 20 adolescents (12 boys, 8 girls), aged 12–18 years, enrolled in the hospital school program in Bucharest, Romania, while receiving active oncological treatment. Participants completed two validated instruments: the Pediatric Quality of Life Inventory (PedsQL—Cancer Module) and the KidCOPE questionnaire. Results: The mean quality of life score was 70, indicating a moderately good level of quality of life. Emotion-focused and avoidance-based strategies (distraction, social withdrawal, and acceptance) were most frequently reported, while problem-focused coping was less common. Regression analysis showed that coping dimensions explained approximately 26% of the variance in quality of life (R2 = 0.26, F(3,16) = 1.83, p = 0.183). Although the overall model was not statistically significant, an observed negative association was found between avoidant coping and quality of life (p = 0.037). These results should be interpreted with caution given the small sample size and cross-sectional design. Discussion: The findings suggest that adolescents with cancer may maintain a functional level of adaptation despite medical and emotional challenges, supported by medical staff and social resources. The predominance of avoidant strategies highlights the need for further investigation of their long-term implications. Conclusions: These preliminary results generate hypotheses and underline the importance of future research on psychological and educational interventions aimed at fostering more active coping strategies and supporting resilience in adolescents with cancer.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17552574.

    This review is the result of a virtual, collaborative Live Review discussion organized by one of PREreview's 2025 Champions on October 18, 2025. The discussion was joined by 6 people: 2 facilitators and 4 live review participants. The authors of this review have dedicated additional asynchronous time over the course of 3 weeks to help compose this final report using the notes from the Live Review. Special thanks to all participants who contributed to the discussion and made it possible to provide feedback on this preprint.

    Summary:

    In this study, the coping strategies and quality of life among adolescent cancer patients were investigated. Two validated instruments were completed by the participants: the pedsQL (oncology version) to assess quality of life and kidCOPE questionnaire to identify coping strategies.

    A total of 20 adolescents (12 boys and 8 girls) with age range between 12 and 18, participated in the study. The scores were converted to a scale from 0 to 100, with higher values indicating a better perceived quality of life. The overall mean score on the Pediatric Quality of Life Inventory (pedsQL) was 70, which suggests a generally good quality of life among patients.

    The responses were visualized using a bar chart showing the perceived quality of life (pedsQL) dimensions and the frequencies of reported coping strategies. The figures showed that acceptance, distraction and social withdrawal were the most frequently reported strategies, which reflects a predominance of coping strategies among patients that focused on emotion and avoidance.

    The study also emphasized that environmental factors and interpersonal relationships can influence the treatment and well-being of oncology patients, suggesting that effective care extends beyond medical treatment alone. However, a key limitation lies in the small sample size and the fact that the study included only in-patients, which limits the generalizability of the findings. Nevertheless, this limitation is understandable, as a small sample size may be appropriate for a pilot study designed to explore feasibility and generate preliminary insights.

    List of major concerns and feedback:

    • The study does not include control groups during the experiment (e.g., healthy adolescents or patients with other chronic illnesses). The absence of the control group makes it difficult to determine whether the coping patterns or quality of life level are specific to cancer or reflect general adolescent responses to stress. Future studies should consider including one or more control groups to provide a clearer benchmark for comparison. This would allow researchers to distinguish coping mechanisms that are specific to a particular disease from general developmental or situational responses.

    • There are potential confounding factors that were not controlled for statistically. For example stage of disease, type of treatment, the time when the cancer was diagnosed, or patient's family support. These could have an influence on coping scores and quality of life scores. Subsequent studies should collect and control for these key variables whether through stratified sampling, covariate analysis, or multivariate regression models. Adding these factors would improve the precision and interpretability of the results, to ensure that observed effects can be more confidently attributed to coping strategies rather than external influences.

    List of minor concerns and feedback:

    • Some statements in the discussion section appeared to be overgeneralized. For example, suggesting that coping "predicts" quality of life despite the correlational nature of the study design. This phrasing should be revised to reflect association rather than causation, using terms like "is related to" or "is associated with", to ensure accuracy with the concept and methodology.

    • There are some other factors like disease severity, treatment phase, pain levels, socioeconomic status, time since diagnosis, age and or gender differences, that are not included in the analysis of this study. These factors may significantly affect coping styles and perceived quality of life. Incorporating these variables either as covariates or subgroup analyses will help readers to gain a more comprehensive understanding of the psychosocial determinants of quality of life.

    • Table 3 could benefit more from using letters or asterisks to show the level of significance among the predictors. This would enhance the clarity and readability of the table, allowing readers to more easily identify significant and non-significant results.

    • The contents of the anonymous questionnaire was not revealed, so it cannot be replicated. The authors should include sample items or a detailed description of questionnaire structure and scoring (either in the main text or as an appendix) to facilitate replication by future researchers.

    • The study does not specify the software used for data analysis, how missing data were handled, or whether any data-cleaning procedures were performed. In addition, the sampling timeframe beyond February 2025 was not reported. The authors should specify the statistical software (e.g., SPSS, R, etc), describe the handling of missing or incomplete responses, and clarify the duration of the data collection period to enhance transparency in methods and reproducibility.

    Figures and Tables 

    • Table 3 could benefit more from using letters or asterisks to show the level of significance among the predictors. This would enhance the clarity and readability of the table, allowing readers to more easily identify significant and non-significant results.

    • The figures are clearly labeled and well presented, making the data easy to interpret and visually accessible. The graphical representations effectively complement the text and help readers understand the distribution of quality of life dimensions and coping strategies among participants.

    Additional comments

    • There are several minor typographical errors and issues with style in the manuscript. For example, the phrase "predominantly would predominantly" appears redundant, and the discussion section repeats the point about interventions promoting autonomy more than once. The authors should carefully proofread and edit the manuscript to remove typographical errors and redundant expressions. This will improve overall readability and maintain the academic quality of the manuscript.

    • The manuscript does not report the reliability coefficients (e.g., Cronbach's alpha) for the instruments (PedsQL and KidCOPE) as obtained in this study, even though such values are essential for confirming internal consistency within the sample. In addition, the study would benefit from a short paragraph clarifying the participants' treatment stage, diagnosis type, and time since diagnosis, as these clinical characteristics may influence both coping and quality of life.

    • Although the study briefly mentions its small sample size, this limitation could be expanded upon to better reflect its methodological implications.

    Concluding remarks

    We thank the authors of the preprint for posting their work openly for feedback. Many thanks also to all participants of the Live Review call for their time and for engaging in the lively discussion that generated this review.

    Toba Isaac Olatoye was a facilitator of this call and one of PREreview's 2025 champions. No other competing interests were declared by the reviewers.

    Competing interests

    The authors declare that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The authors declare that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.3390/children12101312
  3. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/17107537.

    Does the introduction explain the objective of the research presented in the preprint? Yes The introduction (p. 2) clearly describes the study's aims, "to investigate the relationship between coping strategies and perceived quality of life among adolescents diagnosed with cancer, and to examine the influence of psychosocial factors."
    Are the methods well-suited for this research? Neither appropriate nor inappropriate There are several issues of note. However, in raising theses questions and comments, I do note that the authors clearly indicate in the title and in the limitations section (p. 5) that this is an exploratory, pilot study: (1) This study has a fairly small sample size (n = 20), with a wide age range (12-18 years). This raises questions about statistical power, generalizability, etc. (2) The study is exploratory, rather than preregistered. This is neither a good, nor a bad thing, given it's nature as a pilot study. However, it is unclear the extent to which other analyses were conducted, but not reported. (3) Missing data is not described or addressed in the manuscript. (4) The measures used (PedsQL and KidCOPE) are described in some detail, but no information is provided about their reliability/validity.
    Are the conclusions supported by the data? Somewhat supported The authors do an adequate job signaling that these findings are preliminary and tentative. The conclusions are more or less in line with the reported results. The sole p-value reported was checked by the reviewer for consistency and was accurate, based on the reported test statistics.
    Are the data presentations, including visualizations, well-suited to represent the data? Neither appropriate and clear nor inappropriate and unclear I thought the mean scores for the PedsQL could have been enhanced by also reporting standard deviations to better account for how varied responses may have been in the sample for each dimension.
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Somewhat clearly
    Is the preprint likely to advance academic knowledge? I don't know
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, but it needs to be improved
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes I think the manuscript could be enhanced with more detail about the methods, recruitment practices, handling of missing data, and inclusion of a data sharing statement, among other comments made in this review. Moreover, I think it would benefit from a more thorough literature review in the background section, describing previous work, in this or other populations, which look at the relationship between coping and QOL.

    Competing interests

    The author declares that they have no competing interests.

  4. Version published to 10.20944/preprints202509.0485.v1