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Qual Life Res. 2011 Dec;20(10):1645-54. doi: 10.1007/s11136-011-9911-x. Epub 2011 Apr 16.

Suffering in long-term cancer survivors: an evaluation of the PRISM-R2 in a population-based cohort.

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Department of Medical Psychology and Neuropsychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands.



The Pictorial Representation of Illness and Self Measure-Revised 2 (PRISM-R2) has been developed as generic measure to assess suffering. The aim of this study was to evaluate the ability of this instrument to identify long-term cancer survivors with high levels of suffering who may need additional support.


1299 cancer survivors completed the PRISM-R2, the Short Form Health Survey (SF-36), and the Quality of Life-Cancer Survivors questionnaire (QoL-CS). The PRISM-R2 distinguishes between the Self-Illness Separation (SIS) and Illness Perception Measure (IPM), both measuring aspects of suffering.


112 (9%) cancer survivors reported high suffering according to IPM. This group had a higher cancer stage at diagnosis, more cancer recurrences, more comorbidities, and were lower educated compared to people reporting less suffering. The PRISM-R2 could explain substantial amounts of variance (10-14%) in the psychological aspects of the SF-36 and QoL-CS. The IPM also discriminated statistically and clinically significant between high- and low-health status.


The PRISM-R2 proved to be able to discriminate between individuals with good and deteriorated levels of QoL. Further evaluation of its validity and screening potential is recommended.

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