Abstract
BackgroundExistential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase.MethodsA cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted.ResultsWe found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02): the effect of age on demoralization was negative for women receiving palliative treatment (b = −.26, P = .02) and positive for men receiving palliative treatment (b = .25, P = .03). Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001) and social support (b = −3.17, P<.001).ConclusionsExistential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential distress in subgroups of cancer patients.
Highlights
Adequate management of existential distress is essential to psychosocial care in cancer, yet it has only recently been focused in specialized interventions and distress measures [1,2,3]
Research has repeatedly applied this concept to severe medical illness, emphasizing that demoralization is essentially characterized by an entrapped feeling that ‘‘nothing can be done’’ and a subsequent loss of hope and meaning, while the two core symptoms of major depression, anhedonia and loss of interest, are typically not present [8,9,10,11]
Predictors of Demoralization Bivariate correlations with demoralization and intercorrelations among predictors are reported in table 2
Summary
Adequate management of existential distress is essential to psychosocial care in cancer, yet it has only recently been focused in specialized interventions and distress measures [1,2,3]. Few studies have examined the occurrence of existential distress and predicting factors, mostly limited to small samples of patients with advanced illness. The concept of demoralization provides a profound base for assessment of existential distress in cancer patients not covered by standard diagnostic approaches. Factor analytic studies support the conceptual and clinical separation of demoralization and major depression in cancer patients [12,13]. Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs palliative treatment phase
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