Four years of continued funding are requested for the project entitled """"""""Coping and Adjustment in Families Under Extreme Stress"""""""" to continue to pursue the initial goals of the project as well as to initiate the investigation of several additional research questions. The goals of the project include the continued investigation of the degree of risk for psychological maladjustment and processes of coping in an expanded sample of adult cancer patients, their spouses, and their children. This will include longitudinal analyses of stress, coping and adjustment in these families as well as comparisons of families in which patients experience remission of their cancer, recurrence or metastasis of the original cancer, or death as a result of the cancer. Specifically, the continuation is designed to initiate the investigation of the following research questions with a sample of cancer patients and their families: (a) follow-up of these families over a period of 3 to 5 years after the patients' initial diagnosis of cancer to determine the long-term impact of the illness, (b) examination of the impact of the stress associated with a recurrence or metastasis of the original cancer, (c) examination of the impact of the death of the patient on spouse and children, (d) examination of within family differences between siblings in the ways that they cope with parental cancer and in their psychological adjustment, (e) examination of families, resilience under the stress of cancer by assessing the quality of life experienced by patients and family members, and (f) examination of the impact of parental cancer on children's perceived vulnerability to cancer and other illnesses and their ways of coping with increased perceptions of vulnerability. These research questions will be pursued through the longitudinal investigation of a sample of 300 cancer patients and their families. The original cancer cohort (n = 150) recruited during the first 3 years of the project will continue to complete measures of stress, coping, psychological symptoms, quality of life, and perceived vulnerability to illness every six months for up to 5 years post diagnosis. A second cohort of cancer patients and their families (n = 150) will complete measures of these variables every four months for a period of 1 year after diagnosis.
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