Symptom Distress, Catastrophic Thinking, and Hope in Nasopharyngeal Carcinoma Patients

Abstract

The purposes of this study were to explore symptom distress, catastrophic thinking (catastrophizing) and hope, and factors predicting hope in Taiwanese nasopharyngeal carcinoma (NPC) patients within 3 years of receiving radiation therapy (RT). Instruments used were the modified Symptom Distress Scale, disease catastrophizing scale (modified from Coping Strategies Questionnaire), and Herth's Hope Index. Adult NPC patients (N = 115; 33 undergoing RT, 44 who completed RT within 1 year, and 38 who completed RT more than 1 year but less than 3 years) were recruited from an outpatient RT center in Northern Taiwan. Although participants' overall symptom distress was mild to moderate, they scored moderate level for several distressful symptoms: dry mouth, fatigue, hearing difficulty, loss of appetite, insomnia, and pain. Patients undergoing RT had greater symptom distress than subjects in the other 2 groups. Regression analysis revealed that catastrophizing was the only predictor of hope. Patients who engaged in catastrophizing reported much lower levels of hope. Particular care and attention are recommended to help NPC patients deal with the top distressful symptoms listed. Nursing interventions to reduce catastrophic thinking and enhance hope are discussed.

The Relationships among Hope, Pain, Psychological Distress, and Spiritual Well-Being in Oncology Outpatients

“…The mean hope level found in this study's patient population was in the upper range but comparable to those found in other studies with HHI scores ranging between 32.5 and 39. [17][18][19][20][34][35][36] The average pain score in the study population was also well within the range found in other related studies. 17,21,34,35 Our results expand on the existing research in this field by incorporating additional psychospiritual factors into the assessment of the relationship between pain and hope.…”

Psychologic Interventions for Cancer Pain

“…Pain catastrophizing refers to the tendency to ruminate upon and magnify the threat value of pain sensations. Cancer patients who engage in pain catastrophizing not only report higher levels of pain, but also experience much higher levels of anxiety and interference with daily activities due to pain [8,9]. Third, recent evidence suggests that cancer patients who hold back on sharing their concerns about pain or who are unwilling to express emotions related to the cancer experience are more likely to experience high levels of pain and lower quality of life [10].…”

Multidimensional Pain Inventory-Screening Chinese version (MPI-sC): psychometric testing in terminal cancer patients in Taiwan

“…However, test-retest reliability was not examined due to logistical concerns in readministering the test to hospice cancer patients. Construct validity was tested by five theoretically or empirically related assumptions: (1) higher levels of pain severity (measured by the MPI-sC Pain Severity subscale and four items in BPI-Pain intensity subscale) are related to increased affective distress (assessed by the MPI-sC Affective Distress subscale), mood disturbance (measured by the Hospital Anxiety and Depression Scale [HADS], one of the most frequently used depression and anxiety scales in cancer pain populations) [3,5,32,36], and decreased sense of control in life because of pain (measured by the MPI-sC Life Control subscale); (2) higher levels of pain intensity are related to increased pain interference with activities (assessed by the MPI-sC Pain Interference subscale and the Karnofsky Performance Scale [KPS]) [15]; (3) higher levels of pain interference with activities are related to affective distress (assessed by the MPI-sC Affective Distress subscale and HADS subscales); (4) higher levels of Pain Interference are related to lower Life Control because of pain (both assessed by MPI-sC subscales); and (5) higher levels of pain-related Affective Distress are related to lower levels of Life Control because of pain [10,11,17,18,20,21,27,33,35].…”

“…Thus, the construct validity of the MPI-sC was examined by comparing its scores to those of four instruments: (1) the MPI-screening (Chinese) [16,34] (2) the HADS [36], (3) four pain-intensity measures from the BPI-short form (worst pain, least pain, pain on average, and pain now) [11,18], and (4) the KPS [15]. All these instruments have been translated into Chinese.…”

“…Based on our previous studies [18,19], however, advanced cancer patients with moderate to severe pain usually perceived less control over pain and life (pain-related cognitive dysfunction) and more psychological/affective distress. Pain-related negative cognition and psychological distress have also been significantly related to cancer patients' hopelessness [2] and disease adjustment [31,32].…”