A cancer diagnosis can have a substantial impact on a patient’s mental health and quality of life. The aim of this study was to investigate the prevalence of fatigue, emotional distress, and uncertainty and examine the predictive value they have on the quality of life of advanced cancer patients. A prospective, multicenter study was conducted between February 2020 and May 2021 of individuals diagnosed with an advanced, unresectable neoplasm prior to initiating systemic antineoplastic treatment. Participants completed questionnaires to quantify fatigue, emotional distress, disease uncertainty, and quality of life. A linear regression analysis was performed to study the predictive QoL variables. The study population comprised 508 patients, 53.7% of whom were male and had a mean age of 54.9 years. The most common cancers were digestive (40.6%), bronchopulmonary (29.1%), and breast (8.5%); the most frequent histology was adenocarcinoma (63%); and most were stage IV (79.7%). More than half (55.7%) suffered fatigue, and 47.7% exhibited emotional distress; both were more prevalent among women. Fatigue, emotional distress, and disease uncertainty all correlate with diminished quality of life. Similarly, ECOG performance status and the demographic variables of age, sex, and comorbidities impacted quality of life. This patient sample displayed a high prevalence of fatigue and emotional distress, together with illness uncertainty, which are clearly linked to waning quality of life. To decrease the experience of fatigue and improve mental health treatment in cancer patients, interventions based on a biopsychosocial model must be intensified.
Purpose The aim of this study was to analyze the internal structure of the EORTC QLQ-C30, to examine the validity and normative data for cancer patients. Method Exploratory and Confirmatory factor analyses were conducted to explore the scale’s dimensionality and test for strong measurement invariance across sex and tumor site. All the analyses were based on a multicenter cohort of 931 patients who completed the Brief Symptom Inventory (BSI-18) and the EORTC QLQ-C30. Results Our findings indicate that the EORTC QLQ-C30 has acceptable psychometric properties and an internal structure that is well accounted for a bifactor model: a general factor that evaluates quality of life and a group factor that would analyze physical health that would be defined by physical function, role function, and fatigue. The result of the multi-group CFA revealed a strong invariance according to sex, tumor, and over time. Reliability of the EORTC exceeding 0.86 and the simple sum of the items of the scale was a good indicator of oncology patients’ quality of life. Both factors correlate closely with depression, anxiety, and psychological distress and are sensitive to change, especially the quality of life, with a significant decrease in the post-test. Conclusion The Spanish version of the EORTC QLQ-C30 proved to be a valid, reliable instrument to appraise quality of life in cancer patients. The normative data collected from this study may be useful for the early detection of initial symptoms of deterioration of quality of life in oncology patients.
Depressive symptoms are common in individuals with advanced cancer. Objectives. This study sought to analyze the relationship between physical and functional status and depressive symptoms, and to assess the role of mental adjustment across these variables in people with advanced cancer. Methods. A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed self-report measures: Brief Symptom Inventory (BSI), Mini-Mental Adjustment to Cancer (Mini-MAC) scale, and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. Results. Depression was present in 44.3% of the participants and was more common among women, patients <65 years old, non-partnered, and those with recurrent cancer. Results revealed a negative correlation with functional status, and functional status was negatively associated with depressive symptoms. Mental adjustment affected functional status and depression. Patients having a positive attitude displayed fewer depressive symptoms, while the presence of negative attitudes increased depressive symptoms in this population. Conclusions. Functional status and mental adjustment are key factors in the presence of depressive symptoms among people with advanced cancer. Assessment of functional status and mental adjustment should be considered when planning treatment and rehabilitation in this population.
Introduction Anti-neoplastic therapy improves the prognosis for advanced cancer, albeit it is not curative. An ethical dilemma that often arises during patients’ first appointment with the oncologist is to give them only the prognostic information they can tolerate, even at the cost of compromising preference-based decision-making, versus giving them full information to force prompt prognostic awareness, at the risk of causing psychological harm. Methods We recruited 550 participants with advanced cancer. After the appointment, patients and clinicians completed several questionnaires about preferences, expectations, prognostic awareness, hope, psychological symptoms, and other treatment-related aspects. The aim was to characterize the prevalence, explanatory factors, and consequences of inaccurate prognostic awareness and interest in therapy. Results Inaccurate prognostic awareness affected 74%, conditioned by the administration of vague information without alluding to death (odds ratio [OR] 2.54; 95% CI, 1.47-4.37, adjusted P = .006). A full 68% agreed to low-efficacy therapies. Ethical and psychological factors oriented first-line decision-making, in a trade-off in which some lose quality of life and mood, for others to gain autonomy. Imprecise prognostic awareness was associated with greater interest in low-efficacy treatments (OR 2.27; 95% CI, 1.31-3.84; adjusted P = .017), whereas realistic understanding increased anxiety (OR 1.63; 95% CI, 1.01-2.65; adjusted P = 0.038), depression (OR 1.96; 95% CI, 1.23-3.11; adjusted P = .020), and diminished quality of life (OR 0.47; 95% CI, 0.29-0.75; adjusted P = .011). Conclusion In the age of immunotherapy and targeted therapies, many appear not to understand that antineoplastic therapy is not curative. Within the mix of inputs that comprise inaccurate prognostic awareness, many psychosocial factors are as relevant as the physicians’ disclosure of information. Thus, the desire for better decision-making can actually harm the patient.
Cancer causes distress, resulting in anxiety, depression or somatization. The aim was to investigate sociodemographic, clinical, and psychological factors associated with psychological distress in cancer patients. This prospective and multicenter study, conducted by the Spanish Society of Medical Oncology (SEOM), included two cohorts of patients with cancer (localized resected or advanced unresectable). They completed surveys to evaluate psychological distress (BSI-18), coping (MINI-MAC), and spirituality (FACIT-sp). A multivariable logistic regression analysis was conducted. Between 2019-2022, 1807 patients were evaluated, mostly women (54%), average age 64 years. The most frequent primary cancers were colorectal (30%), breast (25%) and lung (18%). Older individuals (OR0.98, CI95% 0.97-0.99), and males (OR0.66, CI95% 0.51-0.84 and OR0.75, CI95% 0.58-0.97) had less anxiety and depression. Colorectal cancer patients had less depression (OR0.67, CI95% 0.47-0.95) and somatization (OR0.71, CI95% 0.52-0.97). Patients with localized cancer and with spiritual beliefs had lower levels of psychological distress, while those with anxious preoccupation had higher levels. After treatment, patients with pre-existing distress and anxious preoccupation experienced an increase in psychological distress while those with localized cancer showed reduced levels of anxiety and somatization. This study suggests that age, sex, extension and location of cancer, coping and spirituality influence psychological distress in cancer patients.
Purpose: Cancer and its treatments changes patients’ quality of life. The aim was to analyze quality of life, psychological distress, and life satisfaction in patients with resected versus unresectable cancer.Methods: Two prospective, multicenter (15 medical oncology departments), studies with consecutive patient recluitment were conducted, NEOetic, in individuals with unresectable advanced disease (2020-2021) and NEOcoping, in subjects with resected non-metastatic cancer (2016-2018). Participants completed quality of life (EORTC QLQ-C30), emotional distress (Brief Symptom Inventory, BSI), and life satisfaction (Satisfaction with Life Scale, SWLS) questionnaires before systemic antineoplastic treatment and after treatment. A descriptive, bivariate chi-square analysis and t-tests were performed to ascertain the differences between localized and advanced cancer.Results: A total of 1450 patients were recruited, 941 (65%) with a resected cancer and 509 with unresectable advanced cancer with a mean age of 59.0 and 64.9 years, respectively. The most common cancers were colorectal (42%) and breast (34%) in resected group and bronchopulmonary (29%), colorectal (17%), and pancreatic (11%) in unresectable advanced cancer group. Subjects with advanced disease exhibited worse scores on functional scales (physical, cognitive, emotional, and social), and had more symptoms than those with resected disease prior to initiating systemic treatment. Individuals with advanced cancer displayed better functional status and fewer symptoms, but more fatigue and nausea and those with resected cancer presented worse physical and cognitive function, more psychological distress, and more symptoms post-treatment. Conclusion: This sample reveals how antineoplastic treatment can enhance quality of life for people with unresectable advanced disease and negatively affect individuals with resected, non-metastatic cancer.Structured Abstract: Our study shows the potential quality of life benefit of systemic antineoplastic treatment in patients with unresectable advanced cancer. In addition, it shows the deterioration of quality of life in patients with resected non-metastatic cancer after completion of adjuvant treatment.
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