Cancer is generally considered a low-control situation. Stability of perceptions of control before and after cancer was examined, as well as the adaptive value of maintenance versus relinquishment of control in the psychological adjustment to cancer. This study, conducted in the northern Netherlands, was carried out in a prospective design with four assessment points (one pre-morbid and three post-morbid assessments) involving semi-structured interviews and self-report questionnaires. Ninety-nine newly diagnosed cancer patients all aged over 57 years completed all four assessment points. We found that perceptions of control declined before and after disease, possibly as a consequence of the diagnosis of cancer. Further, maintenance of control after cancer diagnosis was related to lower levels of psychological distress 6 and 12 months after diagnosis. These results suggest that maintenance of perceptions of control is beneficial to the psychological adjustment to cancer. (c) 2009 Published by Elsevier Ltd.