The Role of Social Support in Mediating Levels of Distress Among Cancer Patients

Introduction: Distress in cancer patients is associated with mental health conditions, such as depressive and anxiety. The importance of identifying distress in cancer patients was highlighted by the 2012 American College of Surgeons’ Commission on Cancer (CoC) guidelines, which set into motion the requirement that all accredited treatment centers integrate distress screening into standard care by 2015. Distress screening is an evidenced-based practice that is useful in identifying issues that influence patients’ abilities to cope with their illnesses and manage treatment. Evidence also indicates that social support is a consistent protective factor in the emotional well-being of cancer patients. This study explored the role of social support and self-reported distress levels in a national sample of cancer patients.

Methods:  Level of distress was collected as part of an electronic intake assessment, administered to 1,148 patients (366 males and 782 females) at 19 cancer centers across the United States. The NCCN Distress Thermometer, one of the most commonly used screening instruments, was used to measure distress. This measure includes a single item zero-to-ten self-report measure of distress and has the advantage of being easily and quickly administered (Rohan, 2012). Patients were also asked seven questions with ordered responses representing various domains of social support.  Participants ranged in age from 18 to 93, with a mean age of 60 (SD=14.99), and more than a dozen distinct cancer types were represented. Analyses were conducted to determine the effect of social support on clients’ reported levels of psychological distress.

Results:  More than half of those surveyed reported a distress level of four or higher – the traditional cut score indicating significant levels of distress.  Results of the regression model indicated that the predictors explained 21% of the total variation in distress scores (R²=.207, F(6, 1141)=49.607, p<.001).  In five of seven domains, increased levels of social support were shown to be directly related to significant change in psychological distress.  Specifically, patients who reported having friends or family that could help financially (β=-.253, p=.001), having friends or family to help with everyday responsibilities (β=-.355, p=.001), receiving direct emotional support from others (β=-.357, p=.001), and those with more people in their lives who could be trusted to help in difficult times reported lower levels of distress (β=-.465, p<.001).  Additionally, age was related to lower distress scores, as older participants reported less distress (β=-.018, p<.001).  Conversely, those who reported that they were more frequently receiving advice from others reported higher levels of distress (β=.627, p<.001).  There were no statistically significant differences in distress scores relating to gender.

Implications:  Distress in cancer patients can complicate treatment and lead to negative psychosocial outcomes, including posttraumatic stress. Understanding the dynamics that influence distress is an important step toward improving the quality of life for cancer patients and equipping social workers to deliver targeted and timely care.

References

Rohan, E. A. (2012). Removing the stress from selecting instruments: Arming social workers to take leadership in routine distress screening implementation. Journal of psychosocial oncology, 30(6), 667-678.