Psychological Distress and Perceived Change in Self-Reported Quality of Life during Cancer Survivorship: Exploring Sociodemographic, Clinical, and Relational Factors

Background and Purpose. Psychological distress is a highly-prevalent, “multifactorial unpleasant experience” (NCC, 2019) that can interfere with cancer patients’ adherence to treatment, treatment decision-making, and quality of life. Among survivors, untreated distress reduces compliance with surveillance screenings and healthy behaviors. With 26 million cancer survivors predicted to live in the nation by 2040, there is a critical need to investigate the interplay of sociodemographic, clinical, and relational factors affecting psychological distress in cancer survivorship and how this ultimately contributes to quality of life (QoL). The present study was aimed at examining sociodemographic, clinical, and relational predictors of psychological distress and self-reported change in QoL among a national sample of cancer survivors.

Methods: A survey questionnaire about the impact of cancer on survivors’ QoL was completed by a sample of 504 survivors. Positive and negative changes in close relationships resulted from an exploratory factor analysis on fourteen items assessing communication, closeness, stability, and caregiving burden. Psychological distress was measured with a 5-point Likert scale ranging from "not at all" (1) to "extremely" (5) distressed, with change in QoL assessed by comparing variations in physical, emotional, financial, social, and spiritual well-being before and after diagnosis. Descriptive statistics and bivariate analysis were used to describe the sample; a path analysis was conducted to examine predictors of distress and QoL. Mplus version 7.31 was utilized for data management and data analysis.

Results: Participants were mostly male, middle-aged, non-Hispanic white and 4 years or more since diagnosis. Factors significantly associated with distress were: younger age (<65 vs ≥65 yrs.; z=-7.776; p < .001); being Black/African American versus Non-Hispanic White, (z=4.03, p < .001); and reporting a more negative effect of cancer on close relationships (z= 8.651; p < .0001). Distress was significantly and positively correlated to change in QoL (z=8.835; p < .0001). In addition, older respondents and those who received a single treatment type reported lower change in QoL than younger survivors (z=-3.736; p < .001) and those who received multiple treatments (z=1.994; p = 0.046). Finally, joint significance test results suggest that distress mediated the relationship between positive and negative interaction factors on change in QoL.

Conclusions and Implications: The present work illustrates that there are groups of cancer survivors more vulnerable to affected psychological distress and impaired quality of life. Younger survivors, those who identify as Black/African American, and those facing more negative effects on close relationships were more likely to experience greater distress. Similarly, worse quality of life was reported by younger survivors and those who received multiple treatments. Finally, the present work also demonstrates that the effect of close relationships on QoL is indirect, via their influence on distress. Results emphasize the need to enhance psychological distress screening programs able to timely connect survivors with psychosocial services, especially for younger and minority groups. The study also highlights that changes in close relationships play a critical role in mental health outcomes of cancer survivors, with the need for psychosocial interventions to be inclusive of survivors and their supportive networks.