Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients
Article first published online: 8 NOV 2010
Copyright © 2010 John Wiley & Sons, Ltd.
Volume 21, Issue 1, pages 54–63, January 2012
How to Cite
Vehling, S., Lehmann, C., Oechsle, K., Bokemeyer, C., Krüll, A., Koch, U. and Mehnert, A. (2012), Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients. Psycho-Oncology, 21: 54–63. doi: 10.1002/pon.1866
- Issue published online: 3 JAN 2012
- Article first published online: 8 NOV 2010
- Manuscript Accepted: 13 SEP 2010
- Manuscript Revised: 29 JUL 2010
- Manuscript Received: 23 APR 2010
- advanced cancer;
- physical functioning;
- global meaning;
- existential distress
Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients.
Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self-report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found.
Conclusions: Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning. Copyright © 2010 John Wiley & Sons, Ltd.