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The Mental Adjustment to Cancer (MAC) scale was used to assess the cognitive responses to a cancer diagnosis. The aim of this study was to replicate the factorial structure of the Spanish version of the scale and ascertain the correlations between dimensions of the MAC and socio-demographic characteristics or medical variables.The sample included 693 cancer outpatients. In order to validate the MAC questionnaire was applied a principal component analysis. The dimensions of the questionnaire were compared and correlated with socio-demographic characteristics (age and gender), medical variables (cancer site, time since diagnosis) and distress.After the MAC factorial analysis, 28 items were included in five factors: Hopeless, Anxiety, Resignation/Fatalism, Illness Acceptance and Self-Safety Behaviour. In relation to the variables, the women cope with cancer with more Illness Acceptance and Resignation subscales than men. More mature ages were related with Hopeless, Resignation and Self-Safety Behaviour, also correlated negatively with Anxiety. The cancer site showed significant differences on the Hopeless and a tendency on Resignation subscale. Time since diagnosis did not correlate significantly with any subscales in the Spanish version of the MAC. Distress was reflected in the Anxiety and Hopeless subscales, and moreover it was related negatively with Self-Safety Behaviour.The MAC scale was a valid and acceptable tool for Spanish cancer patients, however, these findings provide a factorial structure different from the original MAC scale. Copyright © 2009 John Wiley & Sons, Ltd.