Correlates of Death Anxiety Among Taiwanese Cancer Patients

The Relationship Between Death Anxiety and COVID-19 Fear and Anxiety in Women With Breast Cancer

This study determined the relationship between death anxiety and COVID-19 related fear and anxiety in women with breast cancer. This is a descriptive correlation-seeking study. The research included 140 women with breast cancer who visit the day treatment unit of the oncology department of a state university hospital. Personal Information Form, Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), and Death Anxiety Scale (DAS) were used to collect data. A significant difference was found between the DAS score and body mass index (p = .019) and between FCV-19S score and COVID-19 vaccination status (p = .007). As the fear of COVID-19 and coronavirus anxiety of women with breast cancer increase, death anxiety also increases. In conclusion, death anxiety should be taken into consideration for this patient group while maintaining the continuity of care for these patients now and in future pandemics.

Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.

DESIGN

This systematic review and meta-analysis followed the PRISMA 2020 guidelines.

METHODS

Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.

RESULTS

In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.

CONCLUSIONS

Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.

RELEVANCE TO CLINICAL PRACTICE

Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a meta-analysis based on data from previous studies.

A Systematic Review and Meta-analysis of Death Anxiety Among Iranian Patients With Cancer

Death anxiety in cancer patients can cause and exacerbate mental disorders and affect the healing process and survival. In this study, percentage score of death anxiety among Iranian cancer patients was reported. The databases of Scopus, PubMed, ISI, MagIran, and Scientific Information Database were searched and 396 articles were retrieved. Twenty-three eligible studies were included in the analysis considering the inclusion criteria. Heterogeneity among selected studies was assessed through the Cochrane Q test and I2 test. The percentage of death anxiety scores in Iranian patients with cancer was 59.91% (95% confidence interval: 51.57-62.24). The results of subgroup analysis showed that the percentage of death anxiety scores in patients with breast cancer was 67.55% (95% CI: 56.50-78.60) and in patients with other malignancies was 53.78% (95% CI: 50.20-57.36). Death anxiety is high among Iranian patients with cancer and counseling sessions to control and manage this challenge seems necessary.

Death anxiety predicts fear of Cancer recurrence and progression in ovarian Cancer patients over and above other cognitive factors

Death anxiety is understudied in people with cancer, especially in relation to fear of cancer recurrence (FCR) and fear of progression (FOP). The present study aimed to identify if death anxiety can predict FCR and FOP over and above other known theoretical predictors. One hundred and seventy-six participants with ovarian cancer were recruited for an online survey. We included theoretical variables, such as metacognitions, intrusive thoughts about cancer, perceived risk of recurrence or progression, and threat appraisal, in regression analyses to predict FCR or FOP. We investigated whether death anxiety added to the variance over and above these variables. Correlational analyses demonstrated that death anxiety is more strongly associated with FOP than FCR. The hierarchical regression including the theoretical variables described above predicted 62-66% of variance in FCR and FOP. In both models, death anxiety predicted a small but statistically significant unique variance in FCR and FOP. These findings draw attention to the importance of death anxiety in understanding FCR and FOP in people with a diagnosis of ovarian cancer. They also suggest that elements of exposure and existentialist therapies may be relevant in treating FCR and FOP.

Effects of online-offline integrated death education on patients with advanced cancer: A before-and-after study

PURPOSE

To evaluate the effectiveness of the constructed OOIDE intervention in patients with advanced cancer.

METHOD

In this study, patients were invited to participate in a 4-week OOIDE intervention. The assessment of patients' ability to cope with death was conducted using a scale in conjunction with interviews. Additionally, patients' 'readiness to die' was assessed.

RESULTS

Thirty-two patients with advanced cancer participated in this study. Our intervention significantly enhanced their perspective on life and spirituality, while also reducing their fear of death (P < 0.01). Furthermore, it facilitated their acceptance of death, encouraged a more rational approach to their illness, and fostered an understanding of hospice care, thereby reinforcing their sense of self-worth. Additionally, the intervention improved the relationship between the patient and their families, fostering greater mutual understanding and respect for the patient's perspectives. Comparing the results to the pre-intervention period, there was a significant increase in the number of patients who discussed death with their families and contemplated the place of their passing (P < 0.05).

CONCLUSION

OOIDE improves participants' ability to confront death, while also assisting patients' families in the physical and psychological preparations for the loss of their relative.

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China

OBJECTIVE

This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.

METHODS

Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.

RESULTS

Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R ² ​= ​0.335, F ​= ​20.072, P ​< ​0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F ​= ​5.892, P ​= ​0.003). Multivariate analysis revealed no significant association between family function and death anxiety.

CONCLUSIONS

Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Does Spiritual Well-Being Affect Death Anxiety and Psychological Resilience in Cancer Patients?

This study was conducted to research the effects of spiritual well-being on death anxiety and psychological resilience in cancer patients. This cross-sectional, descriptive and correlational study was carried out with 260 cancer patients who were admitted to oncology and haematology outpatient clinic of a university hospital in east of Turkey between October 2021 and April 2022. The data were collected by using "Personal Information Form", "Spiritual Well-being Scale (FACIT-sp), Death Anxiety Scale (DAS) and The Brief Resilience Scale (BRS). It was found that mean DAS total score of cancer patients was 12.51 ± 3.39, while their mean FACIT-sp total score was 26.10 ± 6.93 and their mean BRS total score was 16.1 ± 7.05. It was found that FACIT-sp total score affected DAS and BRS total score positively, while DAS total score affected BRS total score negatively (p < .001). It was found that cancer patients had moderate level of spiritual well-being and psychological resilience and high level of death anxiety. It was also found that death anxiety and psychological resilience of cancer patients increased as their spiritual well-being levels increased. Psychological resilience was found to decrease as death anxiety increased.

Fear and death anxiety in the shadow of COVID-19 among the Lebanese population: A cross-sectional study

Background

The COVID-19 pandemic was one of the most devastating health crises the world has seen. One of its mental health consequences includes fear of being infected, which could lead to anxiety. This study aimed to assess the fear related to the COVID-19 pandemic and its associated factors among the adult population in Lebanon.

Methods

A cross-sectional study was conducted in Lebanon between February 26^th and April 29^th, 2021. Data was collected through an online survey among adults aged 18 years and older. Information on sociodemographic and clinical characteristics of the participants, fear and death anxiety related to the COVID-19 pandemic, depression, and anxiety were collected. Multivariable linear regression analyses were carried out to identify the predictors of fear related to the COVID-19 pandemic.

Results

A total of 1840 participants were included in the analysis of which 62.9% were females and 62.2% were single. The age of the participants ranged from 18 to 70 years with a mean of 26.6 ±8.8 years. Of the total participants, 41.9% felt uncomfortable thinking about the novel Coronavirus and 35.4% of candidates became nervous/anxious when watching the news about COVID-19 on social media. About one-third of the participants (33.7%) were afraid of COVID-19 and 23.8% were afraid of losing their life because of the disease. Concerning somatic symptoms of fear, 7.9% reported increased heart races or palpitations whenever they thought about getting infected with COVID-19, 3.7% complained about sleep disturbances while 2.5% developed tremors or sweating in their hands when they thought about Coronavirus. In addition, Death anxiety related to the COVID-19 pandemic was one of the most fear-related factors (B = 0.191, 95% CI (0.172 to 0.211), P-value < 0.0001).

Conclusion

This study provides insights on the impact of COVID-19 on individuals at the level of fear in Lebanon. Death anxiety was identified as the most significant predictor of fear related to the COVID-19 pandemic. Considering the negative psychological effects of fear, it is necessary to educate the adults on how to deal with death anxiety and implement psychological interventions and counseling programs to relieve fear and improve the mental health of Lebanese adults.

Spiritual distress of patients living with cancer in Northern Vietnam

BACKGROUND

Literature on the spirituality of cancer patients has been mainly focused on the experiences of western patients. Few studies explore the experience of Asian cancer patients, while no spiritual study on cancer patients has been conducted in Vietnam.

PURPOSE

The purpose of this study was to survey the spiritual distress of cancer patients at two general hospitals in northern Vietnam.

METHODS

This was a quantitative survey with a cross-sectional design. This study used purposive sampling with a fitting the inclusion criteria, alongside the Spiritual Distress Scale-Vietnam version (SDS-V). The data was collected by an investigator in two general hospitals in northern Vietnam. The study received approval from two research councils.

RESULTS

The results demonstrated that the demographics of cancer patients in the study reflected the national data of Vietnam. Regarding the four exploratory dimensions, more than 50% of cancer patients expressed feeling hardship and sorrow, most did not feel loneliness, most patients reported a good relationship with others and God, while the majority of were afraid to discuss death.

CONCLUSIONS

Due to impact of aging and poverty on the sample patients, further studies into the interconnectivity between economics and the spiritual health status of patients is recommended. Additionally, since the 132 Vietnamese cancer patients reported a positive relationship with others and God, healthcare professionals should study effective strategies to apply the above strengths in easing hardships for future cancer patients.

The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study

OBJECTIVE

Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors.

METHODS

In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years).

RESULTS

Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner.

CONCLUSIONS

The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.

'Who would even want to talk about death?' A qualitative study on nursing students' experiences of talking about death with terminally ill patients with cancer

OBJECTIVES

This study aimed to describe nursing students' experiences of talking about death with terminally ill patients with cancer.

METHODS

The study adopted a qualitative design, and participants (n = 28) were final-year undergraduate nursing students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The researchers followed a systematic data analysis procedure which is an appropriate method of analysis when aiming to create knowledge based on experiences and meanings from cross-case analysis.

RESULTS

The responses of the nursing students were subsumed under the following three themes: (1) 'balance on the rope', (2) 'who would even want to talk about death' and (3) 'need to talk but …'. The findings suggest that many nursing students do not believe that they are competent enough to talk about death with terminally ill patients with cancer, even though they believe it is essential to end-of-life care.

CONCLUSION

The findings underscore the importance of examining students' perspectives on death, which not only shapes their experiences of caring for terminally ill patients but also influences the quality of care. Further, students feel unprepared for talking to terminally ill patients with cancer and require support to avoid ignoring calls to speak about death.

Gender difference about death anxiety among older adults: Structural Equation Model

BACKGROUND

Older adults may be more prone to death anxiety than their younger counterparts. This study explores factors affecting death anxiety based on gender differences.

METHODS

In this correlational study, 450 older adults referred to the health centres in the city of Bukan, Iran were recruited by using a randomised sampling method. Next, data were collected about the demographic questionnaire, anxiety about ageing, death anxiety, mental well-being, perceived social support, and quality of life questionnaire. The Spearman correlation coefficient was used to determine the correlation between variables, and the predictors of death anxiety were evaluated using quintile regression. Relationship between death anxiety and other variables was evaluated by the Structural Equation Model (SEM). The study was approved by the Tabriz University of Medical Sciences Ethics Committee (Ethics Code: IR.TBZMED.REC.1397.304).

RESULTS

The results showed that death anxiety in men had a significant relationship with the level of literacy (P = 0.047), body self-imaging (P = 0.031), and perceived social activity (P = 0.033). Among women, death anxiety had a significant relationship with physical activity (P = 0.007) and perceived social activity (P = 0.002). Additionally, quintile regression analysis was calculated: among men, anxiety about ageing was related to death anxiety (β = 0.182, P = 0.05), while in women, only perceived social support was associated to death anxiety (β = -0.376, P = 0.05). Finally, according to SEM, a significantly different level of predictability of mental well-being was found for death anxiety among older men and women.

CONCLUSION

Understanding the gender differences about death anxiety by the healthcare system might be useful in controlling and reducing a variety of concerns among elders who experience high levels of anxiety of death.

Death anxiety in patients with cancer: A systematic review and meta-analysis

PURPOSE

The present study was designed to estimate the rate of death anxiety and the factors influencing its occurrence in cancer patients using a systematic review and meta-analysis approach.

METHOD

Five academic databases, including Scopus, PubMed, Science Direct, Embase, and ProQuest, were searched systematically from inception until the end of January 2020. Observational studies that reported mean score of death anxiety in cancer patients, regardless of language restriction, were eligible to be included. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. A meta-analysis was performed using a random effect model with the DerSimonian and Laird weighted method. Publication bias was assessed using the funnel plot and Begg's and Egger's tests.

RESULTS

The estimated pooled mean for death anxiety among cancer patients was 6.84 (CI_95% = [5.98, 7.69]). Publication bias and small study effects were not detected. Subgroup analysis and a meta-regression showed that the estimated pooled mean was higher in Asian studies (M = 7.57) compared to European (M = 6.47) and North American studies (M = 5.57); in breast cancer patients (M = 9.68) compared to studies examining different types of cancers; in female only participants (M = 7.37) compared to studies with both genders (M = 6.60); and in married participants compared to non-married participants.

CONCLUSIONS

The findings suggest that death anxiety in patients with cancer is moderate and is influenced by socio-demographic factors such as region, type of cancer, sex, and marital status.

The Effect of Positive Psychotherapy on the Meaning of Life in Patients with Cancer: A Randomized Clinical Trial

Background and Aim:

Cancer, as a social phenomenon, disrupts the daily functions and social activities of a person and changes his ability to perform roles and responsibilities and reach the meaning of life. The purpose of this study was to investigate the effect of positive psychotherapy on understanding the meaning of life in patients with cancer.

Materials and Methods:

This was a randomized clinical trial study. Sixty-one patients with cancer were selected by convenience sampling method and were assigned randomly into two positive psychotherapeutic (n = 30) and control (n = 31) groups. Positive psychotherapy included eight 90-min sessions held weekly in group form. The life attitude profile-Gary Reker was completed before and after the intervention.

Results:

The results showed that there was no significant difference between the mean scores of meaning of life and all its dimensions (purposes, existential vacuum, death acceptance, goal seeking, coherence and responsibility choice) before intervention, but there was a significant difference between the two groups after intervention (P < 0.05). Also in the control group, the mean score was reduced after the intervention.

Conclusion:

The positive psychotherapy is effective in increasing the level of meaningful life, enjoyable and committed life of people with cancer. Therefore, based on the results of this study, health-care managers can plan to train and increase the empowerment of nurses in providing these interventions to patients in need.

Fear of cancer recurrence and death anxiety

In 2013, 3 systematic reviews of fear of cancer recurrence (FCR) and its predictors were published. All 3 concurred that FCR is a highly prevalent problem and amongst the largest unmet needs of cancer survivors, even 5 or more years after treatment. However, between them they identified only 1 study that had investigated the relationship between death anxiety and FCR. This is surprising because it is well acknowledged that a diagnosis of cancer, a potentially life-threatening illness, is associated with a number of existential issues that give rise to psychological sequelae such as intrusive thoughts about death and other post-traumatic symptoms. Outside the cancer literature, there has recently been a call to identify death anxiety as a transdiagnostic construct that underlies many anxiety disorders even in healthy people. And yet, the relevance of death anxiety to FCR has not been studied. We explore the barriers to the study of death anxiety and FCR and the reasons that a potential link between the 2 might have important theoretical and clinical implications. We conclude that establishing the relationship between death anxiety, FCR and other existential issues is essential in order to fully understand FCR, particularly in the context of advanced disease. We further conclude that whether death anxiety underlies FCR has important clinical implications which would potentially allow us to optimise currently available evidence-based treatments.

Association of sense of coherence and supernatural beliefs with death anxiety and death depression among Romanian cancer patients

The aim of this cross-sectional study was to examine the association of supernatural beliefs and sense of coherence with death anxiety and death depression in a Romanian sample of cancer patients. We found support for the terror management theory worldview defence hypothesis postulating the presence of a curvilinear relation between death anxiety and supernatural beliefs among cancer patients. Results conformed to an inverted U-shape quadratic regression, indicating that cancer patients who scored moderately on supernatural beliefs were afraid of death the most, while death anxiety was lowest for the extreme atheists and extreme believers in supernatural entities.

A time to be born and a time to die: Exploring the determinants of death anxiety among university students in a western Canadian city

Using data collected from a questionnaire survey of 501 university students in a western Canadian city, this article explores the death anxiety among young adults and the factors influencing their levels of death anxiety. Results demonstrated that respondents displayed a moderate level of death anxiety. Multiple regression analysis further revealed that females, non-Caucasians and those who demonstrated to be less religious, indicated a higher level of loneliness, scored lower on the purpose in life scale, expressed dissatisfaction with their self-image, and reported a higher socio-economic status were found to exhibit a higher level of death anxiety.

Resilience Style Questionnaire: Development and Validation Among College Students and Cardiac Patients in Hong Kong

The present research aims to develop and validate a measure of resilience that reflects the influence of Confucian philosophies and Chinese cultural lay beliefs. Based on a representative sample of 1,419 college students from universities and a clinical sample of 214 cardiac patients in Hong Kong, reliability, construct validity, and criterion validity of the Resilience Style Questionnaire (RSQ) were examined. A two-factor structure of the RSQ was explored and validated in both samples. Results showed that the two factors of the RSQ (i.e., perseverance and optimistic approach to life) were significantly associated with a variety of mental health indicators in both samples. Furthermore, the RSQ explained additional variances above and beyond those explained by the Ego-Resiliency Scale, the Sense of Coherence Scale (SOC), and the Connor-Davidson Resilience Scale in multiple mental health indicators among college students and cardiac patients. These findings showed that the RSQ is a reliable and valid tool in assessing resilience among Chinese and other groups influenced by Confucianism.

Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors

OBJECTIVE

Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence (FOR), and one of the most salient facets is the worry that a recurrence of cancer could cause one's death. The primary goal of the present study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR, positing pursuit of meaningful goals as a theoretically driven putative mediator. To replicate published tests of similar gratitude-eliciting interventions, positive affect (PA) was also considered as an outcome.

METHOD

Sixty-seven women with early stage breast cancer were randomly assigned to either a 6-week online gratitude intervention or a 6-week online control condition. Outcomes were assessed at pre- and posttreatment, as well as 1 month and 3 months after the end of treatment. The mediator, meaningful goal pursuit, was measured via assessments over the 6-week intervention period.

RESULTS

Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition. Moreover, this effect was significantly mediated by meaningful goal pursuit (and not by PA). The gratitude intervention was also found to prevent declines in PA observed in the control condition.

CONCLUSIONS

Overall, findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR. (PsycINFO Database Record

Race and Gender Differences in Correlates of Death Anxiety Among Elderly in the United States

BACKGROUND

Death anxiety among elderly is a major public health concern. Few studies, however, have been conducted on factors associated with death anxiety.

OBJECTIVES

This study investigated race and gender differences in psychosocial correlates of death anxiety among elderly in the US.

MATERIALS AND METHODS

With a cross-sectional design, we used data of the Religion, Aging, and Health survey. 1,074 White and Black elderly (age > 65 years, 615 women, 359 men) were entered to this study. Demographic (age, gender, and race), socio-economic (family income, perceived financial difficulty), health (number of chronic medical conditions and self-rated health), and psychological (perceived control over life) factors were measured. Death anxiety was measured using four items. We used linear regressions to determine factors associated with death anxiety based on race and gender.

RESULTS

Although race and gender did not have main effects on death anxiety (P > 0.05), they altered correlates of death anxiety. Age was a predictor of death anxiety among women (B = 0.165, P = 0.002) but not men (B = 0.082, P = 0.196). Self-rated health was associated with death anxiety among Whites (B = - 0.120, P = 0.050) but not Blacks (B = - 0.077, P = 0.268). Total family income was only associated with death anxiety among White men.

CONCLUSIONS

Demographic, socio-economic, health, and psychological determinants of death anxiety in United States differ based on race, gender, and their intersection. Findings advocate that geriatric psychiatrists and gerontologists who wish to reduce death anxiety among elderly people may need to tailor their interventions to race and gender.

Determinants of long-term quality of life in patients with differentiated thyroid carcinoma - a population-based cohort study in Sweden

BACKGROUND

Although differentiated thyroid cancer (DTC) has an excellent prognosis and a low incidence of recurrence, lifelong follow-up and medication might be needed. The aim of this study was to clarify how living with a cancer diagnosis for many years affects health-related quality of life (HRQoL) in DTC patients in Sweden.

MATERIAL AND METHODS

From the national all-encompassing population-based Swedish Cancer Registry, 353 patients diagnosed with DTC between 1995 and 1998 were identified and invited to answer the HRQoL questionnaire SF-36 and a study-specific questionnaire, 14-17 years after their diagnosis. Data were compared with a reference population as well between subgroups of patients.

RESULTS

Of the patients with DTC, 279 (79%) answered the questionnaires. In all, only 19 (7%) reported a recurrence, however, as many as 134 (48%) stated that they still had concerns about having a recurrence. The HRQoL in those with a recurrence was significantly lower than those without concerns of a recurrence in five of eight domains (p < 0.001-0.049). Similarly, patients with concerns of a recurrence reported poorer HRQoL than those without concerns, with significantly lower values in five domains (p < 0.001-0.008). Those few who stated that their disease had given them a negative view on life reported poor HRQoL in all eight domains (p < 0.001-0.030).

CONCLUSIONS

Even if DTC comes with an excellent prognosis, almost half of the patients, fully 15 years after diagnosis, worried about a recurrence which negatively impacted their HRQoL. Awareness among healthcare practitioners might improve information, supportive care and, in the end, the patient's HRQoL.

Prediction of end-of-life fears in COPD - hoping for the best but preparing for the worst

OBJECTIVE

The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD.

DESIGN

A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted.

MAIN OUTCOME MEASURES

The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity.

RESULTS

Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears.

CONCLUSION

Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.

Initial validation of the Death and Dying Distress Scale for the assessment of death anxiety in patients with advanced cancer

CONTEXT

The experience of death anxiety in patients with advanced cancer has been understudied partly because of the lack of a tailored measure for this population. The Death and Dying Distress Scale (DADDS) was constructed to address this gap. Although an initial version of this instrument has shown promising psychometric properties, validation of the finalized version is needed.

OBJECTIVES

This study aims to validate the recent 15-item DADDS by examining its factor structure and construct validity.

METHODS

Sixty participants with advanced or metastatic cancer were recruited from the Princess Margaret Cancer Centre, University Health Network, Toronto, Canada, into a pilot trial of a psychological intervention. This article analyzes the baseline measures on death anxiety, depressive symptoms (Patient Health Questionnaire-9, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis 1 Disorders), generalized anxiety (Generalized Anxiety Disorder-7), and preparation for end of life (Quality of Life at the End of Life-Cancer Scale). Exploratory factor analysis was conducted. Construct validity was assessed by correlations between measures.

RESULTS

Factor analysis revealed a dominant single factor explaining more than 75% of the shared variation between items. Factor loadings were high, ranging from 0.57 to 0.86. Item communalities were evenly ranged from 0.33 to 0.75 and with the 15:1 variable to factor ratio, suggest the viability of parameter estimates despite the small sample size. Cronbach's alpha was 0.95. Death anxiety was associated with less preparation for end of life (r = -0.68, P < 0.0001), more generalized anxiety (r = 0.63, P < 0.0001), and more depressive symptom severity (r = 0.50, P < 0.0001). Individuals with major depression had greater death anxiety than the nondepressed (mean difference = 17; 95% CI = 1.5-33), as did individuals with minor depression (mean difference = 25; 95% CI = 10-41).

CONCLUSION

The DADDS is a valid measure of death anxiety in patients with advanced cancer. It may provide useful information in the assessment and treatment of distress in patients near the end of life.