Perceived Positive and Negative Life Changes in Testicular Cancer Survivors.

Michael Hartmann,Karin Oechsle,Anja Mehnert-Theuerkauf,Carsten Bokemeyer,Sigrun Vehling

doi:10.3390/medicina57090993

Michael Hartmann, Karin Oechsle

Open Access

https://doi.org/10.3390/medicina57090993

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Abstract

Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized outpatient treatment facilities were approached at follow-up visits or via mail. We assessed a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4) by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range: 0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic status was associated with more positive changes (β = 0.25, 95% CI 0.08 to 0.42); no other association with demographic and disease-related predictors emerged. While positive life changes were not associated with depression (β = −0.05, 95% CI −0.17 to 0.07) and anxiety (β = 0.00, 95% CI −0.13 to 0.13), more negative life changes were significantly associated with higher depression (β = 0.15, 95% CI −0.03 to 0.27) and anxiety (β = 0.23, 95% CI 0.11 to 0.36). There was no significant interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive life changes after testicular cancer are common, a significant number of survivors perceive negative changes in life domains that have been primarily investigated in terms of personal growth. Early identification of and psychosocial support for patients who perceive predominantly negative changes may contribute to prevention of prolonged symptoms of anxiety and depression.

Highlights

IntroductionDespite its stressfulness, the diagnosis and treatment of cancer has had positive consequences on their lives [1,2]
Many survivors report that, despite its stressfulness, the diagnosis and treatment of cancer has had positive consequences on their lives [1,2]
We aimed to investigate the frequency and extent of perceived positive and negative life changes in survivors of testicular cancer, the extent to which sociodemographic and disease-related variables are associated with perceived positive and negative changes, the association of positive and negative life changes with depression and anxiety, and whether positive life changes moderated the association of negative life changes with depression and anxiety

Summary

Introduction

Despite its stressfulness, the diagnosis and treatment of cancer has had positive consequences on their lives [1,2]. Frequent areas of such perceived positive changes are one’s sense of relatedness with others, appreciation of life, and ability to cope with challenges in life [3], often accompanied by a sense of personal growth as a result of having gone through cancer-related adversity. The perceived positive changes in the face of a stressful life event can be understood as an outcome of successful psychological adaptation efforts. At the same time, perceived positive changes have been understood as adaptive illusions that help individuals to cope with the losses and negative consequences of a critical life event by positive reappraisal and benefit-finding [5,6]

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