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Time Perception of Cancer Patients Without Evidence of Disease and Advanced Cancer Patients in a Palliative, End-of-Life-Care Setting

van Laarhoven, Hanneke W. M. MD, PhD, MA; Schilderman, Johannes PhD; Verhagen, Constans A. H. H. V. M. MD, PhD; Prins, Judith B. PhD

doi: 10.1097/NCC.0b013e31820f4eb7

Background: Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting.

Objective: The objectives of the study were to assess time perception in disease-free and advanced cancer patients and examine the relation of time perception with patients' distress.

Methods: A descriptive research design was used. Ninety-six disease-free and 63 advanced cancer patients filled out Cottle's Circle Test to assess time coherence and time dominance, Cottle's Line Test to assess temporal extension and Bayes' question on speed of time, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck's Depression Inventory for primary care, and Beck's Hopelessness-Scale.

Results: In patients without evidence of disease, future dominance was most often observed, whereas in advanced cancer patients, the present was the dominant time segment. In both groups, a focus on the past was associated with distress. In contrast with patients without evidence of disease, advanced cancer patients perceived time as moving slowly, and this was correlated with distress.

Conclusions: The time perception of cancer patients without evidence of disease and advanced cancer patients is significantly different and is related to distress.

Implications for Practice: The observed relation between a focus on the past and distress gives room for interventions of nurses and other healthcare professionals. Specific attention is needed for differences between cancer patients without evidence of disease and advanced cancer patients.

Author Affiliations: Department of Medical Oncology (Drs van Laarhoven and Verhagen), Expert Centre of Palliative Care (Dr Verhagen), Department of Medical Psychology, Radboud University Nijmegen Medical Centre (Dr Prins); Comprehensive Cancer Centre East (Dr Verhagen); Department of Empirical Theology, Faculty of Theology, Radboud University (Drs van Laarhoven and Schilderman), Nijmegen, the Netherlands.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Hanneke W. M. van Laarhoven, MD, PhD, MA, Department of Medical Oncology (452), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands (

Accepted for publication January 7, 2011.

© 2011 Lippincott Williams & Wilkins, Inc.