Coping Patterns, Pain Intensity, and Death Anxiety in Stage-II Cancer Patients

Abstract

Death anxiety is a common psychological concern among people with cancer and is linked to poorer adjustment and reduced quality of life. Despite evidence connecting coping strategies and pain intensity with psychological outcomes, their combined relationship with death anxiety remains underexplored among patients with Stage II cancer in Pakistan.This study examined the relationships among coping strategies, pain intensity, and death anxiety; identified predictors of pain intensity and death anxiety; and assessed differences according to cancer type. A cross-sectional correlational design was used with 1,200 patients diagnosed with Stage II cancer. Participants were recruited through purposive sampling from oncology outpatient departments at selected Pakistani hospitals. They completed the Brief COPE Questionnaire, Numeric Pain Rating Scale (NPRS), and Death Anxiety Inventory (DAI). Data were analysed in Jamovi using Pearson’s correlation, multiple linear regression, Welch’s one-way ANOVA, and Games–Howell post hoc tests.Problem-focused coping was negatively correlated with death anxiety (r = −.148, p < .001). Denial coping was positively correlated with death anxiety (r = .211, p < .001) but negatively correlated with pain intensity (r = −.172, p < .001). The regression model explained 43.2% of the variance in pain intensity (R² = .432). Active coping positively predicted pain, while positive and denial coping were negative predictors. The death anxiety model accounted for 44.3% of the variance (R² = .443), with positive and denial coping identified as significant positive predictors. Coping strategies, pain intensity, and death anxiety differed significantly across cancer types, except for denial coping. Coping strategies and pain intensity were significantly related to death anxiety among patients with Stage II cancer. Problem-focused coping may reduce death anxiety, whereas denial coping is associated with greater psychological distress. These findings support incorporating culturally sensitive psychosocial assessments and coping-based interventions into routine oncology care to strengthen patients’ psychological well-being.