Distress among cancer patients attending rehabilitation in the community

Assessment of Health-Related Quality of Life and Distress in an Asian Community-Based Cancer Rehabilitation Program

Cancer survivors have reduced health-related quality of life (HRQOL) and high levels of distress during and after active treatment, due to physical, psychological, and social problems. Understanding the prevalence and associations of HRQOL and distress in a patient population in the community is important when designing rehabilitation programs. This was a cross-sectional observational study conducted at a community-based cancer rehabilitation center, with the aim of investigating the prevalence and associations of HRQOL and distress in cancer patients. There were 304 patients who were recruited. We found low levels of HRQOL and high levels of distress in patients, with a mean FACT-G7 total score of 11.68, and a mean distress thermometer score of 3.51. In the multivariate regression model, significant factors for low HRQOL were metastatic disease (p = 0.025) and Malay ethnicity (p < 0.001). Regression analyses also found that significant distress was associated with family health issues (p = 0.003), depression (p = 0.001), worry (p = 0.005), breathing (p = 0.007), getting around (p = 0.012) and indigestion (p = 0.039). A high prevalence of impaired HRQOL and distress was reported in cancer survivors even in a community rehabilitation setting. The physical and psychosocial well-being of cancer survivors should be monitored and managed as part of community-based cancer rehabilitation.

Distress among cancer patients: some considerations in identification and treatment

This article discusses the merits of screening for distress in the context of a chronic illness, such as cancer, with a particular focus on resource-constrained health care systems such as those in low-and-middle income countries. Despite calls for distress to be considered a vital sign, like pain it is not objectively verifiable as it relies solely on the person’s subjective appraisal. Accordingly, the Distress Thermometer has limited validity considering its concordance with the Hospital Anxiety and Depression Scale, which itself has limitations in terms of its psychometric properties. Indeed, an elevated score on a self-report measure does not indicate caseness for a mental health condition. Distress is often self-limiting and transient, whereas common mental disorders require evidence-informed treatment. In the context of scarce resources as is the case in low-and-middle income countries, efforts should instead be directed at identifying common mental disorders among persons living with cancer and others who have serious health threats. Such an approach will increase the likelihood of resources being directed at those who are most likely to benefit from psychological interventions. Where persons living with cancer indicate the need for psychosocial services, ways to manage distress include problem-solving therapy, motivational interviewing, and mindfulness-based stress reduction.