Quality of Life Research

, Volume 12, Issue 1, pp 41–51 | Cite as

The mediating role of optimism on post-radiation quality of life in nasopharyngeal carcinoma

  • Clara L.M. Yu
  • Richard Fielding
  • Cecilia L.W. Chan


Nasopharyngeal carcinoma (NPC) is prevalent in southern China. In non-welfare countries, eating difficulties after radiotherapy may hinder NPC patients' short-term quality of life (QoL) especially regarding work and finance. This study explored the positive mediating role of optimism on the relationship between eating ability and QoL of Chinese NPC patients who received radiotherapy in Hong Kong. A sample of 211 newly referred patients were recruited and followed-up face-to-face or by telephone at four (post-radiation 1) (FU 1) and eight (post-radiation 2) (FU 2) months from baseline. QoL was measured by the FACT-G (Chinese). Optimism and eating ability were measured by two 11-point self-rated items. Mediating effects were tested with a series of multiple regression models. After adjustment for pre-radiation QoL, socio-economic status and cancer stage, optimism significantly mediated the relationship between eating ability at FU 1 and overall QoL at FU 2, in particular physical and social/family well-being. This study is the first to underpin the mediating role of optimism on QoL of NPC patients. Faced with aversive side-effects of radiotherapy, facilitating positive thinking in Chinese NPC patients may accelerate their short-term post-radiation adjustment.

Eating ability Mediation Nasopharyngeal carcinoma Optimism Quality of life 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J (eds). Cancer Incidence in Five Continents. Volume VII. France: International Agency for Research on Cancer, 1997.Google Scholar
  2. 2.
    Chan M. Annual Report, Hong Kong Department of Health. Hong Kong: Hong Kong Government Printers, 1999-2000.Google Scholar
  3. 3.
    Morton RP, Benjamin CS. Nasopharyngeal carcinoma in Auckland: A study of racial factors. Aust Radiol 1990; 34: 17–18.Google Scholar
  4. 4.
    Cheng YYJ. Illness trajectory of patients suffering from nasopharyngeal carcinoma. MSS thesis, Hong Kong: The University of Hong Kong, 1997.Google Scholar
  5. 5.
    List MA, D'Antonio LL, Cella DF, et al. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. Cancer 1996; 77: 2294–2301.Google Scholar
  6. 6.
    Bjordal K, Hammerlid E, Ahlner-Elmqvist M, et al. Quality of life in head and neck cancer patients: Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol 1999; 17: 1008–1019.Google Scholar
  7. 7.
    Karnell LH, Funk GF, Hoffman HT. Assessing head and neck cancer patient outcome domains. Head-Neck 2000; 22: 6–11.Google Scholar
  8. 8.
    Ma LC. The adjustment process of patients suffering from neoplasm of nasopharynx throughout the course of illness: A panel study in Hong Kong. PhD thesis, Hong Kong: The University of Hong Kong, 1995.Google Scholar
  9. 9.
    Carver CS, Scheier MF. The role of optimism versus pessimism in the experience of the self. In: Oosterwegel A, Wicklund RA (eds). The Self in European and North American Culture: Development and Processes. Netherlands: Kluwer Academic Publishers, 1995.Google Scholar
  10. 10.
    Scheier MF, Mattews KA, Owens JF, et al. Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. J Pers Soc Psychol 1989; 57: 1024–1040.Google Scholar
  11. 11.
    Carver CS, Pozo C, Harris SD, et al. How coping mediated the effect of optimism on distress: A study of women with early stage breast cancer. J Pers Soc Psychol 1993; 65: 375–390.Google Scholar
  12. 12.
    Johnson JE, Johnson JE. Coping with radiation therapy: Optimism and the effect of preparatory interventions. Res Nurs Health 1996; 19: 3–12.Google Scholar
  13. 13.
    Segerstrom SC, Taylor SE, Kemeny ME, Fahey JL. Optimism is associated with mood, coping and immune change in response to stress. J Pers Soc Psychol 1998; 74: 1646–1655.Google Scholar
  14. 14.
    Anderson KL. The effect of chronic obstructive pulmonary disease on quality of life. Res Nurs health 1995; 18: 547–556.Google Scholar
  15. 15.
    Triemstra AHM, van der Ploeg HM, Smit C, Briet E, Ader HJ, Rosendaal FR. Well-being of haemophilia patients: A model for direct and indirect effects of medical parameters on the physical and psychosocial functioning. Soc Sci Med 1998; 47: 581–593.Google Scholar
  16. 16.
    Lazarus RS, Folkman S. Stress, Appraisal and Coping. New York: Stringer Publishing Company, Inc., 1984.Google Scholar
  17. 17.
    Katsunori S. Optimism, social support, stress, and physical and psychological well-being in Japanese women. Psychol Reports 1997; 81: 299–306.Google Scholar
  18. 18.
    Fournier M, de Ridder D, Bensing J. Optimism and adaptation to multiple sclerosis: What does optimism mean? J Behavioral Med 1999; 22: 303–326.Google Scholar
  19. 19.
    Shnek ZM, Irvine J, Stewart D, Susan A. Psychological factors and depressive symptoms in Ischemic heart disease. Health Psychol 2001; 20: 141–145.Google Scholar
  20. 20.
    Peterson C. The future of optimism. Am Psychol 2000; 55: 44–55.Google Scholar
  21. 21.
    Bandura A. Exercise of personal agency through the self-efficacy mechanism. In: Schwarzer R (ed.), Self-Efficacy: Thought Control of Action, London: Hemisphere, 3-38.Google Scholar
  22. 22.
    Schwarzer R. Optimism, vulnerability, and self-beliefs as health-related cognitions: A systematic overview. Psychol Health 1994; 9: 161–180.Google Scholar
  23. 23.
    Shifren K. Individual differences in the perception of optimism and disease severity: A study among individuals with Parkinson's disease. J Beh Med 1996; 19: 241–271.Google Scholar
  24. 24.
    Chang EC. Cultural differences in optimism, pessimism, and coping: Predictors of subsequent adjustment in Asian American and Caucasian American college students. J Counsel Psychol 1996; 43: 113–123.Google Scholar
  25. 25.
    Lee YT, Seligman MEP. Are Americans more optimistic than the Chinese? Per Soc Psychol Bulletin 1997; 23: 32–40.Google Scholar
  26. 26.
    Miller DL, Manne SL, Taylor KKJ. Psychological distress and well-being in advanced cancer: The effects of optimism and coping. J Clin Psychol Med Settings 1996; 3: 115–130.Google Scholar
  27. 27.
    Fielding R, Tang A, Ku E. 'You can eat for a month then you won't eat any more': Health, illness and food in a Cantonese-speaking community. Proceedings of the First International Conference on Qualitative and Critical Methods in Health Psychology, July 28-31 1999, St. John's, Newfoundland, Canada.Google Scholar
  28. 28.
    Taylor SE, Seeman TE. Psychosocial resources and the SES-health relationship. Ann N Y Acad Sci 1999; 896: 210–225.Google Scholar
  29. 29.
    Yu CL, Fielding R, Chan CLW, et al. Measuring quality of life of Chinese cancer patients. A validation of the Chinese version of the Functional Assessment of Cancer Therapy-General (FACT-G) scale. Cancer 2000; 88: 1715–1727.Google Scholar
  30. 30.
    Lai JCL, Cheung H, Lee WM, Yu H. The utility of the revised Life Orientation Test to measure optimism among Hong Kong Chinese. Int J Psychol 1998; 33: 45–56.Google Scholar
  31. 31.
    Scheier MF, Carver CS. Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychol 1985; 4: 219–247.Google Scholar
  32. 32.
    Lai JCL, Yue X. Measuring optimism in Hong Kong and mainland Chinese with the revised Life Orientation Test. Per Individual Differences 2000; 28: 781–796.Google Scholar
  33. 33.
    Kreitler S, Chaitchik S, Rapoport Y, Kreitler H, Algor R. Life satisfaction and health in cancer patients, orthopedic patients and healthy individuals. Soc Sci Med 1993; 36: 547–556.Google Scholar
  34. 34.
    Carver CS, Pozo C, Harris SD, et al. Optimism versus pessimism predicts the quality of women's adjustment to early stage breast cancer. Cancer 1994; 73: 1213–1220.Google Scholar
  35. 35.
    Leung KF, Tay M, Cheng SSW, Lin F. Hong Kong Chinese version World Health Organization quality of life measure-abbreviated version. WHOQOL-BREF(HK). Hong Kong: Hong Kong Hospital Authority, 1997.Google Scholar
  36. 36.
    Ho JHC. An epidemiologic and clinical study of nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1978; 4: 183–198.Google Scholar
  37. 37.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–1182.Google Scholar
  38. 38.
    Heidrich SM, Forsthoff CA, Ward SE. Psychological adjustment in adults with cancer: The self as mediator. Health Psy 1994; 13: 346–353.Google Scholar
  39. 39.
    Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate Data Analysis. 5th ed. New Jersey: Prentice-Hall International Inc, 1998.Google Scholar
  40. 40.
    Fielding R, Chan C (eds). Psychosocial Oncology in Hong Kong: The First Decade. Hong Kong: University of Hong Kong Press, 1999.Google Scholar
  41. 41.
    Gliklich RE, Goldsmith TA, Funk GF. Are head and neck specific quality of life measures necessary? Head-Neck 1997; 19: 474–480.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Clara L.M. Yu
    • 1
  • Richard Fielding
    • 1
  • Cecilia L.W. Chan
    • 2
  1. 1.Department of Community MedicineUnit for Behavioral SciencesHong Kong SARChina
  2. 2.Department of Social Work and Social AdministrationThe University of Hong KongHong Kong SARChina

Personalised recommendations