Distress in the context of cancer and chemotherapy: A mixed‐method study

Abstract

Background There are controversial results about the effects of cancer and chemotherapy on the perception of distress. Aims The purpose to the study is to explore the meaning of the distress experienced by patients with cancer and verify whether the cancer diagnosis, stage and receiving chemotherapy influence this experience. Design This is a mixed‐methods study with cancer patients. Methods Data were collected in 2018 using a phenomenological interview (n = 18) and one suffering inventory (n = 100). Qualitative analysis was performed using the empirical‐comprehensive model and quantitative using statistical tests. The results were triangulated. Results Distress originated from difficulties faced in health services, diagnosis confirmation, beginning treatment and interruption of life projects. Patients mobilized resources in the spiritual dimension that allowed them to redefine their distress positively. Chemotherapy brought hope back and promoted healing expectations. Higher average scores for distress were found in patients with advanced stage and receiving palliative chemotherapy. Not having begun chemotherapy and having head and neck cancer were associated with higher average scores for distress. Conclusion Distress was greater among patients who had not yet begun chemotherapy; nearness of death and difficulty talking about feelings caused distress; distress was redefined by mobilization of spiritual resources.

Distress and Spiritual Well-Being in Brazilian Patients Initiating Chemotherapy during the COVID-19 Pandemic—A Cross-Sectional Study

“…During this period, the country recorded the highest infection, hospitalization, and death rates associated with COVID-19, and the Brazilian health system collapsed [ 67 ]. This suspicion is supported by the findings of Brazilian authors who found, in 2018, low levels of distress in patients with indications for antineoplastic chemotherapy [ 10 ], as well as in a study that compared quality of life before and during the pandemic. They demonstrated that the rescheduling of treatment cycles in Brazil induced emotional imbalance due to the disturbing nature of waiting for treatment [ 68 ].…”

“…Based on the mean number of patients who received chemotherapy for the first time in the outpatient clinic in the previous 12 months, the sample size was calculated by using G-power software, adopting a power of the test of 80% and a level of significance of 5%. Following Kang’s recommendations [ 37 ] for controlling type I (false positive) and type II (false negative) errors, the calculation was performed a priori, and the power of the effect was determined based on a previous study with a similar methodological design [ 10 ]. The result was a sample of 91 patients who were considered to have borderline representativeness, between moderate and high, according to systematic review [ 38 ].…”

“…The feeling of lack of control over the situation can be stronger before the first chemotherapy cycle, originating in erroneous conceptions disseminated in the media and negative experiences of relatives and friends. As a consequence, a distorted picture can be created because of overestimation of adverse effects, which results in increased mental stress, fatigue, sleeplessness, pain, and increased risk of anticipatory nausea and vomiting [ 10 , 11 , 12 ].…”

“…Others have found no association between these variables [ 25 , 26 ]. These differences may be the result of factors that are not entirely understood, such as willingness to report distress, cultural aspects, observation bias, and the subjective nature of the concept [ 10 , 22 , 27 , 28 , 29 ].…”

“…In the religious dimension, they access their faith, practice rituals, and use the support of the church and their relationship with God to adapt to the new situation. Mixed, and even controversial, results about the effects of religiosity and spirituality in this process show that it is still unclear how these dimensions fit into the way patients react to situations that challenge their spiritual beliefs [ 10 , 30 , 31 , 32 ].…”