Relationship between demoralization and quality of life in end‐of‐life cancer patients

Abstract

Objective To examine the relationship between demoralization and health‐related quality of life (HRQoL) in a sample of end‐of‐life cancer patients with a life expectancy of 4 months or less undergoing palliative care, controlling for sociodemographic, clinical, and psychological variables. Methods Sociodemographic, clinical, and psychological data from 170 end‐of‐life cancer patients were collected using the following scales: Edmonton Symptom Assessment System for palliative care patients' symptoms; Patient Health Questionnaire‐9 (PHQ‐9) for depressive symptoms; Functional Assessment of Cancer Therapy Scale ‐ General Measure (FACT‐G) for HRQoL; Functional Assessment of Chronic Illness Therapy ‐ Spiritual Well‐Being for spirituality (FACIT‐Sp); Demoralization Scale ‐ Italian Version (DS‐IT) for demoralization. Results The DS‐IT showed that 51.8% of cancer patients were severely demoralized. In addition, 36.5% of the sample had clinically significant depressive symptoms and QoL was severely impaired (FACT‐G). The result of regression analysis showed that demoralization (especially “Disheartenment” and “Sense of failure”) was the strongest contributor for HRQoL, followed by ESAS_Lack of Well‐Being and depression (PHQ‐9), with the final model explaining 66% of the variance of the FACT‐G. Conclusions The results highlight a very high prevalence of severe demoralization in end‐of life cancer patients. Moreover, demoralization was not only associated with patients' HRQoL, but it was also the most important contributing factor. This finding underscores the need to identify preventive or therapeutic psychological interventions that focus on preventing existential distress, and thus improve the QoL of dying patients in their last days of life.

Diagnostic Performance of Screening Tools for Depressive Symptoms in Vulnerable Older Patients with Cancer Undergoing Comprehensive Geriatric Assessment (CGA): Results from the SCREEN Pilot Study

“…Although the GDS-15 is not a diagnostic instrument, the cut-off score of 5 indicates the presence of depressive symptoms. This demonstrated good internal consistency with a Cronbach's α = 0.94 and good concurrent validity with the (0.84) Zung Self-Rating Depression Scale and (0.83) the Hamilton Depression Rating scale [19]. Several short-item versions of the GDS are also in use.…”

Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon

“…While demoralization and depression share similarities, they are distinct conditions, with demoralization characterized by feelings of subjective incompetence and a lack of hope [15,16]. Studies have shown that demoralization can impact various aspects of a cancer patient's life, including quality of life, sleep quality, spiritual interests, and suicide risk [17][18][19]. Furthermore, demoralization has been linked to factors such as existential anxiety, masculine self-esteem, resilience, and perceived stress, all of which play a role in predicting psychological well-being and the development of depression in cancer patients [20][21][22][23].…”

The Italian versions of the This Is ME Questionnaire and the Patient Dignity Question: Understanding personhood and supporting dignity in patients with terminal cancer

“…By maintaining relationships with others, patients can discover and construct personal meaning and significance that resonates with the entirety of their life narrative. Patients living with advanced cancer need to receive help from others to avoid feeling hopeless or becoming socially isolated, as well as to avoid other forms of suffering such as psychosocial distress and demoralization (Bovero et al 2023b). Indeed, connection with and social support from family members is essential throughout the course of a patient's illness, as being with family members can enhance the patient's sense of dignity, continuing to affirm their active roles within their family system.…”