Mood, quality of life worse in newly diagnosed incurable cancer

Awareness of prognosis appeared associated with worse mood and quality of life among patients newly diagnosed with incurable cancer, study data showed.

Researchers suggested including coping strategies in future efforts to improve patients’ adaptive coping strategies.

“After a diagnosis of incurable cancer, patients must cope with numerous stressors, including the need to make urgent treatment decisions, manage adverse effects of the diagnosis and treatment, and tolerate uncertainty regarding their future,” Ryan D. Nipp, MD, gastrointestinal oncologist and health services researcher at Massachusetts General Hospital in Boston, and colleagues wrote. “The manner in which patients cope with their life-threatening illness likely influences their prognostic awareness and experience with their illness. However, little is known about the interaction between patients’ use of coping strategies and their prognostic awareness, quality of life and mood.”

The researchers assessed the self-reported mood, coping, quality of life and health status of 350 patients (92.3% white; 54% men) who had been diagnosed with incurable lung or gastrointestinal cancer within the previous 8 weeks. Nipp and colleagues administered the Prognosis and Treatment Perceptions Questionnaire, Brief COPE, Functional Assessment of Cancer Therapy-General and Hospital Anxiety and Depression Scale questionnaires to evaluate the interactions between health status, treatment goals, coping strategies, quality of life and mood.

Most patients (69.7%) were married, and more than half (54.6%) had lung cancer.

Patients with terminal illness showed worse quality of life (P < .001), anxiety (P = .007) and depression (P < .001), whereas those who reported their oncologist’s goal as to “cure” their disease had less anxiety (P = .007) and better quality of life (P = .03).

Subgroup analysis showed that greater use of positive framing appeared associated with less depression and better quality of life (P < .001 for both).

Among patients who reported that their oncologist’s goal was “’not’ to cure my cancer,” active coping conferred association with less depression and better quality of life (P < .001 for both).

“We discovered interaction effects with patients’ use of certain coping strategies on these relationships, which underscores the importance of promoting the use of more adaptive coping strategies, particularly among patients with accurate prognostic understanding,” the researchers wrote. “Future research is needed to develop and test interventions to enhance patients’ prognostic awareness and to support effective end-of-life decision-making. Such efforts would ideally address patients’ quality of life and psychosocial needs while facilitating the use of more adaptive coping behaviors.” – by Andy Polhamus

Disclosure: Nipp reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.