Demoralization in cancer survivors: an updated systematic review and meta‐analysis for quantitative studies

Abstract

BackgroundDemoralization can cause impairments across all life aspects of cancer patients. Cancer patients are also vulnerable during their survivorship. The purpose of this review is to examine the risk of demoralization and associated risk factors among cancer survivors who have completed their primary anti‐cancer treatment or time since diagnosis ≥5 years without recurrence.MethodsWe searched databases of PubMed, Cochrane, Embase, PsycINFO and ClinicalTrial.gov to identify eligible studies which reported the demoralization level among cancer survivors. A random‐effect meta‐analysis model was used for calculating mean demoralization level. Heterogeneity was evaluated by I2 statistics. Funnel plots and Egger's regression tests were performed for checking publication bias. We used one‐study‐removed method for sensitivity analysis. Subgroup analysis was also done to examine the difference of demoralization level between cancer types. Meta‐regression was performed to reveal risk factors of demoralization.ResultsA meta‐analysis of 12 articles involving 2902 cancer survivors was conducted. The mean demoralization score among cancer survivors was 25.98 (95% CI: 23.53–28.43). Higher demoralization level was seen in participants with older age, higher female ratio, higher married/living together status ratio and higher patient health questionnaire‐9 score. The literature review revealed correlations between demoralization and suicide risk, anxiety and quality of life. No consistent correlation between demoralization and post‐traumatic stress symptoms could be seen.ConclusionsHigh demoralization level is noticed among cancer survivors. Risks for females, elder patients or breast cancer survivors are identified. More longitudinal or interventional studies for cancer survivors' demoralization are expected in the future.

Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood

“…Here, the findings for an effect of age on demoralization were mixed, showing either no association (39), a positive relationship (40) or a negative correlation (36,41,42) between age and demoralization, which might be influenced by treatment status (41). However, a recent meta-analysis including cancer patients with a mean age between about 50 and 68 years, and thus potentially biased by rather older participants, identified age as a risk factor for demoralization (43). This leads to the suggestion that the magnitude and directionality of an age effect on demoralization in cancer likely depend on the included agegroups.…”

Research progress on the psychological burden and intervention measures in cancer patients

“…In mainland China, clinicians often conflate demoralization with depression, but unlike the lack of pleasure in depression, patients with demoralization syndrome can still experience happiness. Reports suggest that demoralization is more common than depression in cancer patients and more closely associated with suicidal intentions (31,32). The systematic review of Lin et al indicated that about 25.98% of cancer survivors experience demoralization, with breast cancer patients scoring higher than others (32).…”

“…Reports suggest that demoralization is more common than depression in cancer patients and more closely associated with suicidal intentions (31,32). The systematic review of Lin et al indicated that about 25.98% of cancer survivors experience demoralization, with breast cancer patients scoring higher than others (32). A cross-sectional study in China found that over half of the patients in Xiamen showed signs of demoralization which may be related to living standards, family income, etc.…”