Physical factors, related to the illness, seem to be important determinants in the psychological adjustment of patients with advanced cancer. Mild intellectual impairments are associated with a better adaptation and prolonged survival time. It may be that these mildly impaired patients experience a diminution of interests and concerns and an altered time sense, which help reduce anxiety and despair over future difficulties. In addition, although presence of a clinical picture of “apathetic-given-up” did correlate with an earlier death, it also was associated with a greater degree of illness, the presence of a hematological disorder rather than a solid tumor and reduced sleep. These associations raise the possibility that both the psychological reaction and the earlier death are expressions of the disease process. Organic factors may influence adjustment in both positive and negative ways and may indicate restrictions in the individual's functioning which can help us appraise and modify communications with these patients.