Psychological distress in cancer from survivorship to end of life care: prevalence, associated factors and clinical implications

Aims: Understanding how psychological distress changes over the cancer trajectory is essential to target interventions and care, but is little researched because of difficulties in conducting longitudinal studies. We aimed to determine the prevalence of psychological distress, its associated factors and clinical implications at three different stages in the cancer trajectory.

Data and methods: Cancer patients from cancer outpatients (n=200), the general community (n=364) and specialist palliative care (n=150) were included. Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12). Associated factors and clinical prognostic value were investigated using logistic regression and Cox regression.

Results: Overall prevalence of psychological distress was 24.5% (95% CI: 18.5-30.5%) in cancer outpatients during or soon after treatment, 16.5% (95%CI: 12.7-20.3%) in the general community and rose to 59.3% (95%CI: 51.4-67.2%) in specialist palliative care. Cancer type was the best predictor for psychological distress in both specialist palliative care (PR(prostate cancer versus other cancers)=5.61; 95%CI: 1.21-26.04; p=0.008) and general community samples (PR(lung cancer versus other cancers)=3.64; 95%CI: 1.08-12.35; p=0.003). Higher scores on GHQ-12 items predicted shorter survival in palliative care patients and showed weak protective or no association with survival in cancer outpatients.

Conclusion: Patients undergoing oncological treatment and then again as they approaching death have increased levels of psychological distress. Assessing psychological distress through survivorship and especially at these times may identify unmet psychological needs and allow targeted psychological support.