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Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients
Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients. Methods: N = 270 cancer patients...
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| Published in: | Psycho-oncology (Chichester, England) England), 2012-01, Vol.21 (1), p.54-63 |
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| creator | Vehling, Sigrun Lehmann, Claudia Oechsle, Karin Bokemeyer, Carsten Krüll, Andreas Koch, Uwe Mehnert, Anja |
| description | Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients.
Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self‐report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p |
| doi_str_mv | 10.1002/pon.1866 |
| format | article |
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Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self‐report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found.
Conclusions: Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning. Copyright © 2010 John Wiley & Sons, Ltd.</description><identifier>ISSN: 1057-9249</identifier><identifier>EISSN: 1099-1611</identifier><identifier>DOI: 10.1002/pon.1866</identifier><identifier>PMID: 21061407</identifier><identifier>CODEN: POJCEE</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adaptation, Psychological ; Adolescent ; Adult ; advanced cancer ; Aged ; Aged, 80 and over ; Anxiety - etiology ; Anxiety - psychology ; Anxiety-Depression ; Attitude to Death ; Attitude to Health ; Cancer ; demoralization ; Depression - etiology ; Depression - psychology ; Emotional disorders ; existential distress ; Factor Analysis, Statistical ; Female ; global meaning ; Health problems ; Humans ; Longitudinal Studies ; Male ; Meaning ; Mental depression ; Middle Aged ; Morale ; Neoplasm Staging ; Neoplasms - pathology ; Neoplasms - psychology ; Neoplasms - therapy ; Oncology ; Palliative care ; Palliative Care - psychology ; physical functioning ; Psychiatric Status Rating Scales ; Psychological distress ; Regression Analysis ; Socioeconomic Factors ; Stress, Psychological - complications ; Stress, Psychological - psychology ; Surveys and Questionnaires ; Tumors ; Tumours ; Young Adult</subject><ispartof>Psycho-oncology (Chichester, England), 2012-01, Vol.21 (1), p.54-63</ispartof><rights>Copyright © 2010 John Wiley & Sons, Ltd.</rights><rights>Copyright John Wiley and Sons, Limited Jan 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4856-d0ee4796ef9aecd422370e7db00ff55f8df8ec116ab4e77e538d5e2a4a774bff3</citedby><cites>FETCH-LOGICAL-c4856-d0ee4796ef9aecd422370e7db00ff55f8df8ec116ab4e77e538d5e2a4a774bff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,30999,31000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21061407$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vehling, Sigrun</creatorcontrib><creatorcontrib>Lehmann, Claudia</creatorcontrib><creatorcontrib>Oechsle, Karin</creatorcontrib><creatorcontrib>Bokemeyer, Carsten</creatorcontrib><creatorcontrib>Krüll, Andreas</creatorcontrib><creatorcontrib>Koch, Uwe</creatorcontrib><creatorcontrib>Mehnert, Anja</creatorcontrib><title>Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients</title><title>Psycho-oncology (Chichester, England)</title><addtitle>Psycho-Oncology</addtitle><description>Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients.
Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self‐report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found.
Conclusions: Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning. Copyright © 2010 John Wiley & Sons, Ltd.</description><subject>Adaptation, Psychological</subject><subject>Adolescent</subject><subject>Adult</subject><subject>advanced cancer</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anxiety - etiology</subject><subject>Anxiety - psychology</subject><subject>Anxiety-Depression</subject><subject>Attitude to Death</subject><subject>Attitude to Health</subject><subject>Cancer</subject><subject>demoralization</subject><subject>Depression - etiology</subject><subject>Depression - psychology</subject><subject>Emotional disorders</subject><subject>existential distress</subject><subject>Factor Analysis, Statistical</subject><subject>Female</subject><subject>global meaning</subject><subject>Health problems</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Meaning</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Morale</subject><subject>Neoplasm Staging</subject><subject>Neoplasms - pathology</subject><subject>Neoplasms - psychology</subject><subject>Neoplasms - therapy</subject><subject>Oncology</subject><subject>Palliative care</subject><subject>Palliative Care - psychology</subject><subject>physical functioning</subject><subject>Psychiatric Status Rating Scales</subject><subject>Psychological distress</subject><subject>Regression Analysis</subject><subject>Socioeconomic Factors</subject><subject>Stress, Psychological - complications</subject><subject>Stress, Psychological - psychology</subject><subject>Surveys and Questionnaires</subject><subject>Tumors</subject><subject>Tumours</subject><subject>Young Adult</subject><issn>1057-9249</issn><issn>1099-1611</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqF0s1u1DAQB_AIgWgpSDwBsrjAJcV2_BGfEKroUqnaciiqxMVy4smuixMHO8t2eSleEaddioQEnDxyfvO3I09RPCf4mGBM34xhOCa1EA-KQ4KVKokg5OFcc1kqytRB8SSla4wzVuJxcUAJFoRheVj8OEvI2G9maMGidl4iMimF1pkp72zdtEYW-hCNd9_N5MKAzGCRD9sMVz40xqMezOCG1Vt0uQYUgwcUOjRtchNKk1nBbce43iXXZj3G0HjoE3IDgpvRGzc359KlCYbJZWJzGSHdkv2dxnx2_pqeFo864xM8269HxafT95cnH8rzi8XZybvzsmU1F6XFAEwqAZ0y0FpGaSUxSNtg3HWcd7XtamgJEaZhICXwqrYcqGFGStZ0XXVUvLrLzdf9uoE06d6lFrw3A4RN0kowKpSkMsvX_5SE1pzxmhPxf4opYZwKgTN9-Qe9Dps45F_WijBVVYTi33ltDClF6PQYXW_iLifpeTB0Hgw9D0amL_Z5m6YHew9_TUIG5R3YOg-7vwbpjxfLfeDez892c-9N_KKFrCTXV8uFPr3iZEE_L_Vl9ROnhtRr</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Vehling, Sigrun</creator><creator>Lehmann, Claudia</creator><creator>Oechsle, Karin</creator><creator>Bokemeyer, Carsten</creator><creator>Krüll, Andreas</creator><creator>Koch, Uwe</creator><creator>Mehnert, Anja</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201201</creationdate><title>Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients</title><author>Vehling, Sigrun ; Lehmann, Claudia ; Oechsle, Karin ; Bokemeyer, Carsten ; Krüll, Andreas ; Koch, Uwe ; Mehnert, Anja</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4856-d0ee4796ef9aecd422370e7db00ff55f8df8ec116ab4e77e538d5e2a4a774bff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adaptation, Psychological</topic><topic>Adolescent</topic><topic>Adult</topic><topic>advanced cancer</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anxiety - etiology</topic><topic>Anxiety - psychology</topic><topic>Anxiety-Depression</topic><topic>Attitude to Death</topic><topic>Attitude to Health</topic><topic>Cancer</topic><topic>demoralization</topic><topic>Depression - etiology</topic><topic>Depression - psychology</topic><topic>Emotional disorders</topic><topic>existential distress</topic><topic>Factor Analysis, Statistical</topic><topic>Female</topic><topic>global meaning</topic><topic>Health problems</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Meaning</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Morale</topic><topic>Neoplasm Staging</topic><topic>Neoplasms - pathology</topic><topic>Neoplasms - psychology</topic><topic>Neoplasms - therapy</topic><topic>Oncology</topic><topic>Palliative care</topic><topic>Palliative Care - psychology</topic><topic>physical functioning</topic><topic>Psychiatric Status Rating Scales</topic><topic>Psychological distress</topic><topic>Regression Analysis</topic><topic>Socioeconomic Factors</topic><topic>Stress, Psychological - complications</topic><topic>Stress, Psychological - psychology</topic><topic>Surveys and Questionnaires</topic><topic>Tumors</topic><topic>Tumours</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vehling, Sigrun</creatorcontrib><creatorcontrib>Lehmann, Claudia</creatorcontrib><creatorcontrib>Oechsle, Karin</creatorcontrib><creatorcontrib>Bokemeyer, Carsten</creatorcontrib><creatorcontrib>Krüll, Andreas</creatorcontrib><creatorcontrib>Koch, Uwe</creatorcontrib><creatorcontrib>Mehnert, Anja</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Psycho-oncology (Chichester, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vehling, Sigrun</au><au>Lehmann, Claudia</au><au>Oechsle, Karin</au><au>Bokemeyer, Carsten</au><au>Krüll, Andreas</au><au>Koch, Uwe</au><au>Mehnert, Anja</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients</atitle><jtitle>Psycho-oncology (Chichester, England)</jtitle><addtitle>Psycho-Oncology</addtitle><date>2012-01</date><risdate>2012</risdate><volume>21</volume><issue>1</issue><spage>54</spage><epage>63</epage><pages>54-63</pages><issn>1057-9249</issn><eissn>1099-1611</eissn><coden>POJCEE</coden><abstract>Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients.
Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self‐report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found.
Conclusions: Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning. Copyright © 2010 John Wiley & Sons, Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>21061407</pmid><doi>10.1002/pon.1866</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adaptation, Psychological Adolescent Adult advanced cancer Aged Aged, 80 and over Anxiety - etiology Anxiety - psychology Anxiety-Depression Attitude to Death Attitude to Health Cancer demoralization Depression - etiology Depression - psychology Emotional disorders existential distress Factor Analysis, Statistical Female global meaning Health problems Humans Longitudinal Studies Male Meaning Mental depression Middle Aged Morale Neoplasm Staging Neoplasms - pathology Neoplasms - psychology Neoplasms - therapy Oncology Palliative care Palliative Care - psychology physical functioning Psychiatric Status Rating Scales Psychological distress Regression Analysis Socioeconomic Factors Stress, Psychological - complications Stress, Psychological - psychology Surveys and Questionnaires Tumors Tumours Young Adult |
| title | Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients |
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