A Comparison of Psychosocial and Physical Functioning in Patients with Motor Neurone Disease and Metastatic Cancer

Abstract

Although their disease processes and treatments are different, patients with motor neurone disease (MND) and those with late-stage cancer share a common situation—one in which the quality of life, rather than a cure, becomes the focus of care. We report here a comparison of 126 patients with MND and 125 with metastatic cancer on a range of physical and psychosocial measures. Compared to cancer patients, MND patients were younger, had greater social contacts, but were more physically impaired. Cancer patients had more pain and were on more medication (opioids, steroids, and analgesics). Although the Beck depression scores were similar in both groups, MND patients had significantly higher scores for demoralization, hopelessness, and suicidal ideation. Cancer patients, on the other hand, scored significantly higher on anhedonia. We suggest this difference in the quality of depression represents a difference in illness experience of the two groups and has relevance for the ways we treat depression in the medically ill.

Apathy is associated with poor prognosis in amyotrophic lateral sclerosis

“…Depression was assessed with the Depression, Anxiety and Stress Scales 21 (DASS‐21) , a self‐report measure with 21 items, each rated from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). To accurately evaluate the relationship between apathy and symptoms of depression, each item on the depression subscale was categorized into specific symptom clusters of depression referred to as depression with demoralization (sum of DASS‐21 items 10, 13, 17 and 21 ≥1 indicated the presence of symptoms) or depression with anhedonia (sum of DASS‐21 items 3, 5 and 16 ≥1 indicated the presence of symptoms) according to a previous ALS study (Table ).…”

Is dignity therapy feasible to enhance the end of life experience for people with motor neurone disease and their family carers?

“…This will be assessed utilizing the Herth Hope Index [21,22], a validated instrument developed for use with the terminally ill. Distressed MND patients score higher on hopelessness than distressed cancer patients at the end of life [23], and interest in hastened death or suicidal ideation in the MND population has been shown to correlate with hopelessness [3,24], which indicates that the level of hopefulness a key factor of psychological distress in this disease population.…”

Dignity Therapy for People with Motor Neuron Disease and Their Family Caregivers: A Feasibility Study

“…8 Previous research has shown that patients with MND experience significantly more negative emotions, particularly hopelessness and helplessness, than patients with cancer. 9 A comprehensive review of the literature revealed that the experience of diagnosis, assisted ventilation, cognitive changes, and end-of-life decision-making create challenges within a short time for MND caregivers, underscoring the need for supportive interventions. 3 People with MND and their families often describe their care experiences as unrelenting and worse than cancer because of the progressive nature of the disease and the hopelessness of recovery.…”