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Associated factors of distress in patients with advanced cancer: A retrospective study

Published online by Cambridge University Press:  23 November 2020

Leticia Ascencio-Huertas Open the ORCID record for Leticia Ascencio-Huertas [Opens in a new window] ,
Silvia Rosa Allende-Pérez  and
Tania Pastrana Open the ORCID record for Tania Pastrana [Opens in a new window]
Leticia Ascencio-Huertas*
Affiliation:
Servicio de Cuidados Paliativos, Instituto Nacional de Cancerologia, Mexico City, Mexico
Silvia Rosa Allende-Pérez
Affiliation:
Servicio de Cuidados Paliativos, Instituto Nacional de Cancerologia, Mexico City, Mexico
Tania Pastrana
Affiliation:
Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
*
Author for correspondence: Leticia Ascencio-Huertas, Cuidados Paliativos, Instituto Nacional de Cancerologia, Av San Fernando Núm 22 Col Sección XVI, Mexico City, Ciudad de México, Mexico. E-mail: leash71@yahoo.com.mx
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Abstract

Objective

The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City.

Design

A retrospective study was conducted using electronic records (June 2015 to December 2016).

Sample

A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores.

Findings

Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2–6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538–4.602), sadness (OR = 2.533, 95% CI = 1.615–3.973), transportation (OR = 1.732, 95% CI = 1.157–2.591), eating (OR = 1.626, 95% CI = 1.093–2.417), nervousness (OR = 1.547, 95% CI = 1.014–2.360), and sleep (OR = 1.469, 95% CI = 1.980–2.203).

Conclusion

The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.

Keywords

Advanced cancerDistressDistress thermometerPalliative carePsychosocial support
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 4 , August 2021 , pp. 447 - 456
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

REFERENCES

Akizuki, N, Yamawaki, S, Akechi, T, et al. (2005) Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. Journal of Pain and Symptom Management 29(1), 91–99.CrossRefGoogle ScholarPubMed
Almanza-Muñoz, JJ, Juárez, IR and Pérez, S (2008) Traducción, adaptación y validación del termómetro de distrés en una muestra de paciente mexicanos con cáncer. Revista De Sanidad Militar 6(5), 209–217.Google Scholar
American Cancer Society (2013) American Cancer Society. What is advanced cancer?. Available at: http://www.cancer.org/treatment/understandingyourdiagnosis/advancedcancer/advanced-cancer-what-is (Retrieved 04 June 2020).Google Scholar
Angarita, JRQ (2007) Teoría de las necesidades de Maslow. Obtenido de Teoría de las necesidades de Maslow. Available at: http://doctorado.josequintero.Net/documentos/Teoria_Maslow_Jose_Quintero.pdf.Google Scholar
Blais, MC, St-Hilaire, A, Fillion, L, et al. (2014) What to do with screening for distress scores? Integrating descriptive data into clinical practice. Palliative & Supportive Care 12(1), 25–38. doi:10.1017/s1478951513000059.CrossRefGoogle Scholar
Brenne, E, Loge, JH, Kaasa, S, et al. (2013) Depressed patients with incurable cancer: Which depressive symptoms do they experience? Palliative & Supportive Care 11(6), 491–501. doi:10.1017/S1478951512000909.CrossRefGoogle ScholarPubMed
Bruera, E, Kuehn, N, Miller, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. Journal of Palliative Care 7(2), 6–9. https://doi.org/10.1177%2F082585979100700202.CrossRefGoogle ScholarPubMed
Chan, M (2017) Ten Years in Public Health, 2007–2017. World Health Organization. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/255355/9789241512442-eng.pdf;jsessionid=357D973F878EE11F53C51B97A5892ACD?sequence=1.Google Scholar
Cormio, C, Caporale, F, Spatuzzi, R, et al. (2019) Psychosocial distress in oncology: Using the distress thermometer for assessing risk classes. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 27(11), 4115–4121. doi:10.1007/s00520-019-04694-4.CrossRefGoogle ScholarPubMed
Cruz-Oliver, DM, Talamantes, M and Sanchez-Reilly, S (2014) What evidence is available on end-of-life (EOL) care and Latino elders? A literature review. American Journal of Hospice & Palliative Care 31(1), 87–97. doi:10.1177/1049909113480841.CrossRefGoogle ScholarPubMed
Cutillo, A, O'Hea, E, Person, S, et al. (2017) NCCN Distress Thermometer: Cut off points and clinical utility. Oncology Nursing Forum 44(3), 329–336. doi:10.1188/17.ONF.329-336.CrossRefGoogle Scholar
Dean, LT, Moss, SL, Ransome, Y, et al. (2019) “It still affects our economic situation”: Long-term economic burden of breast cancer and lymphedema. Supportive Care in Cancer 27(5), 1697–1708. doi:10.1007/s00520-018-4418-4.CrossRefGoogle ScholarPubMed
DePinho, RA and Hawk, E (2016) Cancer prevention in developing countries: A vision for preserving health in Mexico. Salud Publica De Mexico 58(2), 93–96.CrossRefGoogle ScholarPubMed
Dessai, SB, Chakraborty, S, Sajeev Kumar, PB, et al. (2015) Pilot study of single-day distress screening with the NCCN Distress Thermometer to evaluate the feasibility of routine distress screening in tertiary cancer center in rural India. Psychooncology 24(7), 832–834. doi:10.1002/pon.3739.CrossRefGoogle ScholarPubMed
Essue, BM and Essue, BM (2017) Economic burden of chronic Ill health and injuries for households in low- and middle-income countries. In Jamison, DT, Gelband, H, Horton, S, Jha, P, Laxminarayan, R, Mock, CN and Nugent, R (eds), Disease Control Priorities: Improving Health and Reducing Poverty. Washington: The International Bank for Reconstruction and Development/The World Bank, pp. 121–143.CrossRefGoogle ScholarPubMed
Evangelista, CB, Lopes, ME, Costa, SF, et al. (2016) Palliative care and spirituality: An integrative literature review. Revista Brasileira de Enfermagem 69(3), 554–563. doi:10.1590/0034-7167.2016690324i.CrossRefGoogle ScholarPubMed
Franke, GH, Jaeger, S, Glaesmer, H, et al. (2017) Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample. BMC Medical Research Methodology 17(1), 1–7. doi:10.1186/s12874-016-0283-3.CrossRefGoogle Scholar
Gessler, S, Low, J, Daniells, E, et al. (2008) Screening for distress in cancer patients: Is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psycho-Oncology 17(6), 538–547. doi:10.1002/pon.1273.CrossRefGoogle Scholar
Gielen, J, Bhatnagar, S and Chaturvedi, S (2017) Prevalence and nature of spiritual distress among palliative care patients in India. Journal of Religion and Health 56(2), 530–544. doi:10.1007/s10943-016-0252-5.CrossRefGoogle ScholarPubMed
Goulia, P, Papadimitriou, I, Machado, MO, et al. (2012) Does psychological distress vary between younger and older adults in health and disease? Journal of Psychosomatic Research 72(2), 120–128. doi:10.1016/j.jpsychores.2011.11.011.CrossRefGoogle ScholarPubMed
Grassi, L, Johansen, C, Annunziata, MA, et al. (2013) Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer 119(9), 1714–1721. https://doi.org/10.1002/cncr.27902.CrossRefGoogle ScholarPubMed
Guan, B, Wang, K, Shao, Y, et al. (2019) The use of distress thermometer in advanced cancer inpatients with pain. Psycho-Oncology 28(5), 1004–1010. doi:10.1002/pon.5032.Google ScholarPubMed
Gunnarsdottir, S, Thorvaldsdottir, GH, Fridriksdottir, N, et al. (2012) The psychometric properties of the Icelandic version of the distress thermometer and problem list. Psycho-Oncology 21(7), 730–736.CrossRefGoogle ScholarPubMed
Hamilton, J and Kroska, EB (2019) Distress predicts utilization of psychosocial health services in oncology patients. Psycho-Oncology 28(1), 61–67. doi:10.1002/pon.4910.CrossRefGoogle ScholarPubMed
Haynes-Lewis, H, Clayton, MF, Viswanathan, S, et al. (2018) Distress and supportive care needs of ethnically diverse older adults with advanced or recurrent cancer. Oncology Nursing Forum 45(4), 496–507. doi:10.1188/18.ONF.496-507.CrossRefGoogle ScholarPubMed
Herschbach, P, Keller, M, Knight, L, et al. (2004) Psychological problems of cancer patients: A cancer distress screening with a cancer-specific questionnaire. British Journal of Cancer 91(3), 504–511. doi:10.1038/sj.bjc.6601986.CrossRefGoogle ScholarPubMed
Herschbach, P, Book, K, Brandl, T, et al. (2008) Psychological distress in cancer patients assessed with an expert rating scale. British Journal of Cancer 99(1), 37–43. doi:10.1038/sj.bjc.6604420.CrossRefGoogle ScholarPubMed
Holland, JC, Andersen, B, Breitbart, WS, et al. (2013) Distress management. Journal of the National Comprehensive Cancer Network: JNCCN 11(2), 190–209.CrossRefGoogle ScholarPubMed
Huey, NS, Guan, NC, Gill, JS, et al. (2018) Core symptoms of major depressive disorder among palliative care patients. International Journal of Environmental Research and Public Health 15(8). doi:10.3390/ijerph15081758.CrossRefGoogle ScholarPubMed
Iskandarsyah, A, de Klerk, C, Suardi, DR, et al. (2014) Consulting a traditional healer and negative illness perceptions are associated with non-adherence to treatment in Indonesian women with breast cancer. Psycho-Oncology 23(10), 1118–1124. doi:10.1002/pon.3534.CrossRefGoogle ScholarPubMed
Jacobsen, PB, Donovan, KA, Trask, PC, et al. (2005) Screening for psychologic distress in ambulatory cancer patients: A multicenter evaluation of the distress thermometer. Cancer 103, 1494–1502. doi:10.1002/cncr.20940.CrossRefGoogle Scholar
Kelly, C, Ghazi, F and Caldwell, K (2002) Psychological distress of cancer and clinical trial participation: A review of the literature. European Journal of Cancer Care 11(1), 6–15.Google ScholarPubMed
Kennard, BD, Stewart, SM, Olvera, R, et al. (2004) Nonadherence in adolescent oncology patients: Preliminary data on psychological risk factors and relationships to outcome. Journal of Clinical Psychology in Medical Settings 11(1), 31–39. doi:10.1023/B:JOCS.0000016267.21912.74.CrossRefGoogle Scholar
Kim, HS, Shin, SJ and Kim, SC (2013) Randomized controlled trial of standardized education and telemonitoring for pain in out patients with advanced solid tumors. Supportive Care in Cancer 21(6), 1751–1759. https://doi.org/10.1007/s00520-013-1722-x.Google Scholar
Küttner, S, Wüller, J and Pastrana, T (2017) How much psychological distress is experienced at home by patients with palliative care needs in Germany? A cross-sectional study using the Distress Thermometer. Palliative & Supportive Care 15(2), 205–213. doi:10.1017/s1478951516000560.CrossRefGoogle Scholar
Lee, YP, Wu, CH and Chiu, TY (2015) The relationship between pain management and psycho spiritual distress in patients with advanced cancer following admission to a Palliative Care Unit. BMC Palliative Care 14(1), 3–7. doi: 10.1186/s12904-015-0067-2.CrossRefGoogle Scholar
Lloyd-Williams, M and Friedman, T (2001) Depression in palliative care patients – A prospective study. European Journal of Cancer Care 10(4), 270–274. doi:10.1046/j.1365-2354.2001.00290.x.CrossRefGoogle ScholarPubMed
Mansourabadi, A, Moogooei, M and Nozari, S (2014) Evaluation of distress and stress in cancer patients in AMIR oncology hospital in Shiraz. Iranian Journal of Pediatric Hematology and Oncology 4(4), 131.Google ScholarPubMed
McDowell, ME, Occhipinti, S, Ferguson, M, et al. (2010) Predictors of change in unmet supportive care needs in cancer. Psycho-Oncology 19, 508–516. doi:10.1002/pon.1604.CrossRefGoogle ScholarPubMed
Meggiolaro, E, Berardi, MA, Andritsch, E, et al. (2016) Cancer patients’ emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Palliative & Supportive Care 14(3), 204–2011. doi:10.1017/S1478951515000760.CrossRefGoogle ScholarPubMed
Milne, D, Aranda, S, Jefford, M, et al. (2013) Development and validation of a measurement tool to assess perceptions of palliative care. Psycho-Oncology 22(4), 940–946. doi:10.1002/pon.3071.CrossRefGoogle ScholarPubMed
Moscoso, MS (2011) Chronic stress and the measurement of perceived emotional distress in medicine & health psychology. Liberabit 17(1), 67–76.Google Scholar
Murray, SA, Kendall, M, Boyd, K, et al. (2010) Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: Secondary analysis of serial qualitative interviews. BMJ (Clinical Research Ed.) 340, c2581. doi:10.1136/bmj.c2581.CrossRefGoogle ScholarPubMed
National Institute for the Evaluation of Education (2018) Available at: https://www.inee.edu.mx/evaluaciones/panorama-educativo-de-mexico-isen/cs03a-escolaridad-media/.Google Scholar
NCCN (2018) Clinical Practice Guidelines in Oncology (NCCN Guidelines): Distress Management. Version 2.2018. Retrieved from: https://oncolife.com.ua/doc/nccn/Distress_Management.pdf.Google Scholar
Nishiura, M, Tamura, A, Nagai, H, et al. (2015) Assessment of sleep disturbance in lung cancer patients: Relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliative & Support Care 13, 575–581.CrossRefGoogle Scholar
OECD (2019) Presentación del Estudio Económico de México 2019. Available at: https://www.oecd.org/economy/2019-economic-survey-of-mexico-may-2019-sp.htm (Retrieved 20 May 2020).Google Scholar
Oken, MM, Creech, RH, Tormey, DC, et al. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology 5(6), 649–655.CrossRefGoogle ScholarPubMed
Palesh, OG, Roscoe, JA, Mustian, KM, et al. (2010) Prevalence, demographics, and psychological association of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. Journal of Clinical Oncology 28, 292–298.CrossRefGoogle ScholarPubMed
Prieto, JM, Blanch, J, Atala, J, et al. (2002) Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. Journal of Clinical Oncology 20(7), 1907–1917. doi:10.1200/JCO.2002.07.101.CrossRefGoogle ScholarPubMed
Randazzo, D and Peters, KB (2016) Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients. CNS Oncology 5(4), 241–249. doi:10.2217/cns-2016-0010.CrossRefGoogle ScholarPubMed
Reynoso-Noverón, N, Meneses-García, A, Erazo-Valle, A, et al. (2016) Challenges in the development and impementation of the National Comprehensive Cancer Control Program in Mexico. Salud Pública de México 58(2), 325–333. doi:10.21149/spm.v58i2.7804.CrossRefGoogle Scholar
Roth, AJ, Kornblith, AB, Batel-Copel, L, et al. (1998) Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer: Interdisciplinary International Journal of the American Cancer Society 82(10), 1904–1908. doi:10.1002/(sici)1097-0142(19980515)82:103.0.co;2-x.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Rudilla, D, Soto, A, Pérez, MA, et al. (2018) Intervenciones psicológicas en espiritualidad en cuidados paliativos: Una revisión sistemática. Medicina Paliativa 25(3), 203–212. doi:10.1016/j.medipa.2016.10.004.CrossRefGoogle Scholar
Ryan, DA, Gallagher, P, Wright, S, et al. (2012) Sensitivity and specificity of the Distress Thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a ‘help' question for psychological distress and psychiatric morbidity in patients with advanced cancer. Psycho-Oncology 21(12), 1275–1284.CrossRefGoogle Scholar
Sah, GS (2019) Psychosocial and functional distress of cancer patients in a tertiary care hospital: A descriptive cross-sectional study. JNMA Journal of Nepal Medical Association 57(218), 252–258.Google Scholar
Sharma, N, Holm, C, O´Connor, M, et al. (2012) Sleep problems in cancer patients: Prevalence and association with distress and pain. Psycho-Oncology 21, 1003–1009.CrossRefGoogle ScholarPubMed
Shimizu, K (2013) Effects of integrated psychosocial care for distress in cancer patients. Japanese Journal of Clinical Oncology 43(5), 451–457. doi:10.1093/jjco/hyt024.CrossRefGoogle ScholarPubMed
Singh, T and Harding, R (2015) Palliative care in South Asia: A systematic review of the evidence for care models, interventions, and outcomes. BMC Research Notes 8(172), 1–15. doi:10.1186/s13104-015-1102-3.CrossRefGoogle Scholar
Skaczkowski, G, Sanderson, P, Shand, M, et al. (2018) Factors associated with referral offer and acceptance following supportive care problem identification in a comprehensive cancer service. European Journal of Cancer Care 27(5), e12869. doi:10.1111/ecc.12869.CrossRefGoogle Scholar
Snowden, A, White, CA, Christie, Z, et al. (2011) The clinical utility of the distress thermometer: A review. British Journal of Nursing 20, 220–227. doi:10.12968/bjon.2011.20.4.220.CrossRefGoogle ScholarPubMed
StataCorp (2011) Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.Google Scholar
Syrjala, KL, Jensen, MP, Mendoza, ME, et al. (2014) Psychological and behavioral approaches to cancer pain management. Journal of Clinical Oncology 32(16), 1703–1711. doi:10.1200/jco.2013.54.4825.CrossRefGoogle ScholarPubMed
Teunissen, SC, Wesker, W, Kruitwagen, C, et al. (2007) Symptom prevalence inpatients with incurable cancer: a systematic review. Journal of Pain and Symptom Management 34(1), 94–104. https://doi.org/10.1016/j.jpainsymman.2006.10.015.CrossRefGoogle Scholar
Van den Beuken-Van, MH, Hochstenbach, LM, Joosten, EA, et al. (2016) Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. Journal of Pain and Symptom Management 51(6), 1070–1090.e1079. doi:10.1016/j.jpainsymman.2015.12.340.CrossRefGoogle Scholar
VanHoose, L, Black, LL, Doty, K, et al. (2015) An analysis of the distress thermometer problem list and distress in patients with cancer. Supportive Care in Cancer 23(5), 1225–1232. doi:10.1007/s00520-014-2471-1.CrossRefGoogle ScholarPubMed
van Scheppingen, C, Schroevers, MJ, Smink, A, et al. (2011) Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psycho-Oncology 20(6), 655–663. doi:10.1002/pon.1939.CrossRefGoogle ScholarPubMed
Waller, A, Williams, A, Groff, SL, et al. (2013) Screening for distress, the sixth vital sign: Examining self-referral in people with cancer over a one-year period. Psycho-Oncology 22(2), 388–395. doi:10.1002/pon.2102.Google ScholarPubMed
World Health Organization (2018) https://www.who.int/cancer/en/ (Accessed on 30 May 2019).Google Scholar
Wüller, J, Küttner, S, Foldenauer, AC, et al. (2017) Accuracy of the Distress Thermometer for home care patients with palliative care needs in Germany. Palliative & Support Care 15(3), 288–294. doi:10.1017/s1478951516000699.CrossRefGoogle ScholarPubMed
Xie, J, Ding, S, He, S, et al. (2017) A prevalence study of psychosocial distress in adolescents and young adults with cancer. Cancer Nursing 40(3), 217–223. doi:10.1097/NCC.0000000000000396.CrossRefGoogle ScholarPubMed
Zabora, J, Brintzenhofeszoc, K, Curbow, B, et al. (2001) The prevalence of psychological distress by cancer site. Psycho Oncology 10(1), 19–28. doi: 10.1002/1099-1611(200101/02)10:13.0.co;2-6.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Zaza, C and Baine, N (2002) Cancer pain and psychosocial factors: A critical review of the literature. Journal of Pain and Symptom Management 24(5), 526–542. doi:10.1016/s0885-3924(02)00497-9.CrossRefGoogle ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6), 361–370.CrossRefGoogle ScholarPubMed