Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study

Abstract

Objective: To investigate whether the observed elevated levels of psychological distress in cancer survivors relate specifically to aspects of cancer diagnosis, to treatment or to disability. Design, participants and setting: Self‐reported questionnaire data on demographic, health and lifestyle factors and mental health from 89 574 Australian men and women aged 45 years or older, sampled from the Medicare database for the 45 and Up Study from 1 February 2006 to 30 April 2008. Logistic regression was used to examine the risk of high levels of psychological distress in relation to cancer diagnosis and disability, adjusting for age, sex, income and education. Main outcome measure: High psychological distress (Kessler Psychological Distress Scale score ≥22). Results: Overall, 7.5% of participants had high levels of psychological distress. Among cancer survivors, the median time since diagnosis was 7.3 years. Compared with people without cancer, the odds ratios (95% CIs) for psychological distress were: 1.17 (1.09–1.26) in people reporting having had any cancer apart from non‐melanoma skin cancer; 1.34 (1.08–1.67) in those with cancer diagnosed in the previous year; 1.53 (1.33–1.76) for those reporting treatment for cancer in the previous month and 1.11 (1.03–1.19) for those with cancer but without recent treatment. Using individuals with neither cancer nor disability as the reference group, the adjusted odds ratio (95% CI) for psychological distress was 6.51 (5.95–7.12) in those reporting significant disability but no cancer, 1.14 (1.04–1.24) in those without disability but with cancer and 5.81(4.88–6.91) in those with both cancer and disability. Conclusion: The risk of psychological distress in individuals with cancer relates much more strongly to their level of disability than it does to the cancer diagnosis itself.

Do social interactions explain ethnic differences in psychological distress and the protective effect of local ethnic density? A cross-sectional study of 226 487 adults in Australia

“…33 K10 has been used in this binary manner, with 22 as the cut-point, in the previously published analyses of the 45 and Up Study. [34][35][36] Other individual-level measures Social interactions were measured using four questions from the shortened version of the Duke Social Support Index. 37 Three of the questions asked a number of times over the past week were whether or not a participant (i) spent time with friends or family they did not live with; (ii) talked to someone (friends, relatives or others) on the telephone and (iii) attended meetings at social clubs or religious groups.…”

Characterization of Cancer Patients in Inpatient Rehabilitation Facilities: A Retrospective Cohort Study

“…11,12 Among cancer survivors, poor physical quality of life is reported more frequently than poor mental quality of life, 12 and patient distress is strongly related to impaired physical functioning. 11 Rehabilitation programs may serve to improve functional capacity lost as a result of cancer etiology and treatment. Early intervention through participation in comprehensive rehabilitation therapies across the care continuum may be effective in restoring functional deficits and preventing long-term disability related to cancer.…”

To what extent is the elevated risk of psychological distress in people with diabetes accounted for by physical disability? Findings from a large population-based study

“…Previous studies have shown similar mediation by PFL in the association between psychological distress and other disease outcomes, such as heart disease, arthritis and cancer 26 27. The excess risk of psychological distress attributable to disability is about 40 times greater on average than that attributable to cancer diagnosis, in the absence of disability, among long-term cancer survivors 26.…”

“…The excess risk of psychological distress attributable to disability is about 40 times greater on average than that attributable to cancer diagnosis, in the absence of disability, among long-term cancer survivors 26. Further, the risk of depression in those with arthritis or heart disease was shown to attenuate when activities of daily living and instrumental activities of daily living limitation were considered, demonstrating that physical limitation mediates, to some extent, the association between depression and these conditions 27…”

“…Concomitant psychological distress and diabetes have been associated with poor glycaemic control, increasing disabilities, loss of productivity and all-cause mortality 11–14. Psychological distress is also increased—to an even greater extent—in people living with Physical Functional Limitations (PFLs) 15 16. It is unclear how much of the elevation of psychological distress in people with diabetes is attributable to their higher levels of physical disability.…”