Psychological Distress and Problems Among Young and Middle-Aged Cancer Patients Undergoing Treatment in China
Shuman Wang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorWenjie Xu
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorAoxing Sun
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorZeling Zhang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorYanhong Zhang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorYu Zhu
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorCorresponding Author
Hongwei Wan
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Correspondence: Hongwei Wan
Search for more papers by this authorShuman Wang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorWenjie Xu
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorAoxing Sun
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorZeling Zhang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorYanhong Zhang
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorYu Zhu
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Search for more papers by this authorCorresponding Author
Hongwei Wan
Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
Correspondence: Hongwei Wan
Search for more papers by this authorFunding: This study was supported in part by the CSC scholarship program (202306100227) and the Shanghai Shenkang Hospital Development Center (Grant numbers SHDC12022620 and 2023SKMR-36).
ABSTRACT
Objective
Influenced by their life stage and socio-cultural background, young and middle-aged cancer patients in China may experience unique psychological distress. Therefore, this study investigated the severity, problems, and associated factors of psychological distress among young and middle-aged cancer patients.
Methods
We conducted a cross-sectional study on young and middle-aged cancer patients aged 18–59 who were treated at a radiotherapy center from February 2022 to September 2023. Participants' psychological distress severity and problems were measured using the Distress Thermometer and the Problem List. Binary logistic regression was used to identify sociodemographic and clinical factors, as well as PL items, associated with clinically significant psychological distress in young and middle-aged cancer patients.
Results
Among the 510 participants, 102 (20.0%) had DT scores ≥ 4, reported an average of 3.36 ± 3.78 problems, and 360 (70.6%) reported at least one problem. The five most frequently reported problems were worry, no time and energy to take care of children/elderly people, memory loss/lack of concentration, appearance/shape, and work/school. Annual household income, self-reported loneliness, nervousness, loss of interest in daily activities, eating, and nausea were associated with DT scores ≥ 4.
Conclusions
One-fifth of young and middle-aged cancer patients experienced clinically significant psychological distress. Greater attention should be paid to patients with lower household incomes and those who self-report loneliness, nervousness, loss of interest in daily activities, eating, and nausea, providing targeted support to alleviate psychological distress.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data supporting the findings of this study are accessible from the first author upon request, subject to reasonable conditions.
Supporting Information
| Filename | Description |
|---|---|
| pon70062-sup-0001-fig_s1.docx24.1 KB | Figure S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1R. S. Zheng, R. Chen, B. F. Han, et al., “[Cancer Incidence and Mortality in China, 2022],” Zhonghua Zhongliu Zazhi 46, no. 3 (2024): 221–231, https://doi.org/10.3760/cma.j.cn112152-20240119-00035.
- 2L. Lu, B. Zhang, W. Li, and L. Li, “Prevalence and Risk Factors of Psychological Distress in Patients With Early-Stage Lung Cancer During Preoperative Period: A Cross-Sectional Study,” Journal of Clinical Nursing (2024), https://doi.org/10.1111/jocn.17501.
10.1111/jocn.17501 Google Scholar
- 3A. Hunt, E. Handorf, M. Blau, et al., “Psychological Distress in Patients With Metastatic Cancer Enrolling on Phase I Clinical Trials,” Journal of Cancer Survivorship: Research and Practice 15, no. 3 (2021): 398–402, https://doi.org/10.1007/s11764-021-01014-w.
- 4M. Seland, K. Skrede, K. Lindemann, et al., “Distress, Problems and Unmet Rehabilitation Needs After Treatment for Gynecological Cancer,” Acta Obstetricia et Gynecologica Scandinavica 101, no. 3 (2022): 313–322, https://doi.org/10.1111/aogs.14310.
- 5M. B. Riba, K. A. Donovan, B. Andersen, et al., “Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology,” Journal of the National Comprehensive Cancer Network 17, no. 10 (2019): 1229–1249, https://doi.org/10.6004/jnccn.2019.0048.
- 6R. D. Nipp, A. El-Jawahri, S. M. Moran, et al., “The Relationship Between Physical and Psychological Symptoms and Health Care Utilization in Hospitalized Patients With Advanced Cancer,” Cancer 123, no. 23 (2017): 4720–4727, https://doi.org/10.1002/cncr.30912.
- 7Y. H. Wang, J. Q. Li, J. F. Shi, et al., “Depression and Anxiety in Relation to Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies,” Molecular Psychiatry 25, no. 7 (2020): 1487–1499, https://doi.org/10.1038/s41380-019-0595-x.
- 8W. W. Rao, M. J. Yang, B. N. Cao, et al., “Psychological Distress in Cancer Patients in a Large Chinese Cross-Sectional Study,” Journal of Affective Disorders 245 (2019): 950–956, https://doi.org/10.1016/j.jad.2018.11.089.
- 9J. Gao, X. Wang, L. Zhang, et al., “Prevalence and Predictors of Psychological Distress Among Patients With Thyroid Cancer During Transitional Period in China: A Cross-Sectional Study,” Supportive Care in Cancer 30, no. 10 (2022): 7903–7911, https://doi.org/10.1007/s00520-022-07225-w.
- 10S. J. Lee, L. J. Katona, S. E. De Bono, and K. L. Lewis, “Routine Screening for Psychological Distress on an Australian Inpatient Haematology and Oncology Ward: Impact on Use of Psychosocial Services,” Medical Journal of Australia 193, no. S5 (2010): S74–S78, https://doi.org/10.5694/j.1326-5377.2010.tb03933.x.
- 11S. Y. Park, Y. Kim, and H. Hong, “Patient-Reported Distress and Problems Among Elderly Patients With Hematological Malignancy in Korea,” Supportive Care in Cancer 30, no. 11 (2022): 9019–9027, https://doi.org/10.1007/s00520-022-07315-9.
- 12W. Z. Tang, E. Mangantig, Y. H. P. Iskandar, Sl Cheng, A. Yusuf, and K. Jia, “Prevalence and Associated Factors of Psychological Distress Among Patients With Breast Cancer: A Systematic Review and Meta-Analysis,” BMJ Open 14, no. 9 (2024): e077067, https://doi.org/10.1136/bmjopen-2023-077067.
- 13M. J. Burgoyne, K. Bingen, J. Leuck, M. Dasgupta, P. Ryan, and R. G. Hoffmann, “Cancer-Related Distress in Young Adults Compared to Middle-Aged and Senior Adults,” Journal of Adolescent and Young Adult Oncology 4, no. 2 (2015): 56–63, https://doi.org/10.1089/jayao.2014.0005.
- 14J. Hamilton, H. Kruse, L. Holcomb, and R. Freche, “Distress and Psychosocial Needs: Demographic Predictors of Clinical Distress After a Diagnosis of Cancer,” Clinical Journal of Oncology Nursing 22, no. 4 (2018): 390–397, https://doi.org/10.1188/18.Cjon.390-397.
- 15X. Ma, Q. Wang, and D. N. S. Chan, “Women's Experience and Management of Cancer-Related Fatigue and Psychological Distress During Treatment for Gynaecological Cancer: A Qualitative Study,” Journal of Advanced Nursing (2024), https://doi.org/10.1111/jan.16527.
10.1111/jan.16527 Google Scholar
- 16N. Itzep and M. Roth, “Psychosocial Distress Due to Interference of Normal Developmental Milestones in AYAs With Cancer,” Children 9, no. 3 (2022): 309, https://doi.org/10.3390/children9030309.
- 17D. Chopra, R. De La Garza, 2nd, and T. E. Lacourt, “Clinical Relevance of a Body Image Scale Cut Point of 10 as an Indicator of Psychological Distress in Cancer Patients: Results From a Psychiatric Oncology Clinic,” Supportive Care in Cancer 29, no. 1 (2021): 231–237, https://doi.org/10.1007/s00520-020-05491-0.
- 18B. E. Lane, S. N. Garland, K. Chalifour, et al., “Prevalence and Factors Associated With Fear of Recurrence in a Mixed Sample of Young Adults With Cancer,” Journal of Cancer Survivorship 13, no. 6 (2019): 842–851, https://doi.org/10.1007/s11764-019-00802-9.
- 19R. Zheng, J. Wang, Y. Wang, et al., “‘Let Them Be’: Family Members' Perspectives on the Participation of Advanced Cancer Patients in Nursing Research: A Qualitative Descriptive Study,” International Journal of Nursing Studies 155 (2024): 104772, https://doi.org/10.1016/j.ijnurstu.2024.104772.
- 20L. L. Ji, W. Tsai, X. L. Sun, et al., “The Detrimental Effects of Ambivalence Over Emotional Expression on Well-Being Among Mainland Chinese Breast Cancer Patients: Mediating Role of Perceived Social Support,” Psycho-Oncology 28, no. 5 (2019): 1142–1148, https://doi.org/10.1002/pon.5069.
- 21X. Chen, J. Giles, Y. Yao, et al., “The Path to Healthy Ageing in China: A Peking University-Lancet Commission,” Lancet 400, no. 10367 (2022): 1967–2006, https://doi.org/10.1016/s0140-6736(22)01546-x.
- 22E. Von Elm, D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbroucke, “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies,” Annals of Internal Medicine 147, no. 8 (2007): 573–577, https://doi.org/10.7326/0003-4819-147-8-200710160-00010.
- 23 Population and Employment Statistics Division NSO 2024-03-22. “Is There Any Other Distinction Between the Age Range of Our Young People, the Age Range of Our Middle-Aged Population, and the Age Range of Our Elderly Population, Updated for 2024?[EB/OL]: [2024-11-05],” https://www.stats.gov.cn/hd/lyzx/zxgk/202405/t20240524_1954105.html.
- 24L. L. Tang, Y. N. Zhang, Y. Pang, Hw Zhang, and Ll Song, “Validation and Reliability of Distress Thermometer in Chinese Cancer Patients,” Chinese Journal of Cancer Research 23, no. 1 (2011): 54–58, https://doi.org/10.1007/s11670-011-0054-y.
- 25R. Jin, T. Xie, L. Zhang, N. Gong, and J. Zhang, “Stigma and Its Influencing Factors Among Breast Cancer Survivors in China: A Cross-Sectional Study,” European Journal of Oncology Nursing 52 (2021): 101972, https://doi.org/10.1016/j.ejon.2021.101972.
- 26F. Yang, B. X. Yang, T. E. Stone, et al., “Stigma towards Depression in a Community-Based Sample in China,” Comprehensive Psychiatry 97 (2020): 152152, https://doi.org/10.1016/j.comppsych.2019.152152.
- 27A. Al-Shaaobi, M. Alahdal, S. Yu, and H. Pan, “The Efficiency of Distress Thermometer in the Determination of Supporting Needs for Cancer Inpatients,” Libyan Journal of Medicine 16, no. 1 (2021): 1957199, https://doi.org/10.1080/19932820.2021.1957199.
- 28M. Nishiura, A. Tamura, H. Nagai, and E. Matsushima, “Assessment of Sleep Disturbance in Lung Cancer Patients: Relationship Between Sleep Disturbance and Pain, Fatigue, Quality of Life, and Psychological Distress,” Palliative & Supportive Care 13, no. 3 (2015): 575–581, https://doi.org/10.1017/s1478951513001119.
- 29K. L. Kwekkeboom, C. H. Cherwin, J. W. Lee, and B. Wanta, “Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Persons With Cancer,” Journal of Pain and Symptom Management 39, no. 1 (2010): 126–138, https://doi.org/10.1016/j.jpainsymman.2009.05.022.
- 30M. Miyashita, “Chemotherapy-Related Cognitive Impairment: What we Need to Know and What we can do,” Asia-Pacific Journal of Oncology Nursing. 11, no. 1 (2024): 100334, https://doi.org/10.1016/j.apjon.2023.100334.
- 31M. Lange, F. Joly, J. Vardy, et al., “Cancer-related Cognitive Impairment: An Update on State of the Art, Detection, and Management Strategies in Cancer Survivors,” Annals of Oncology 30, no. 12 (2019): 1925–1940, https://doi.org/10.1093/annonc/mdz410.
- 32M. E. Mcgrady, V. W. Willard, A. M. Williams, and T. M. Brinkman, “Psychological Outcomes in Adolescent and Young Adult Cancer Survivors,” Journal of Clinical Oncology 42, no. 6 (2023): 707–716, https://doi.org/10.1200/JCO.23.01465.
- 33A. Pytel, A. Zielińska, J. Staś, and M. Chabowski, “Quality of Life, Psychological Distress, and Nutritional Status of Polish Patients With Head and Neck Cancer Treated With Radiotherapy,” Journal of Clinical Medicine 12, no. 2 (2023): 659, https://doi.org/10.3390/jcm12020659.
- 34M. Gosak, K. Gradišar, N. Rotovnik Kozjek, and P. Strojan, “Psychological Distress and Nutritional Status in Head and Neck Cancer Patients: A Pilot Study,” European Archives of Oto-Rhino-Laryngology 277, no. 4 (2020): 1211–1217, https://doi.org/10.1007/s00405-020-05798-y.
- 35A. B. Ilyas, R. K. Bahaj, A. A. Shaikh, B. S. Khawandanah, M. Al-Foheidi, and T. Y. Omer, “Breast Cancer Patients' Perceptions of Their Experience With Chemotherapy-Induced Nausea and Vomiting and Its Impact on Quality of Life in Jeddah, Saudi Arabia,” Cureus 12, no. 12 (2020): e12038, https://doi.org/10.7759/cureus.12038.
- 36P. I. Jewett, D. Teoh, S. Petzel, et al., “Cancer-Related Distress: Revisiting the Utility of the National Comprehensive Cancer Network Distress Thermometer Problem List in Women With Gynecologic Cancers,” JCO Oncol Pract 16, no. 8 (2020): e649–e659, https://doi.org/10.1200/jop.19.00471.
- 37A. Dahill, H. Al-Nakishbandi, K. B. Cunningham, G. Humphris, D. Lowe, and S. Rogers, “Loneliness and Quality of Life After Head and Neck Cancer,” British Journal of Oral and Maxillofacial Surgery 58, no. 8 (2020): 959–965, https://doi.org/10.1016/j.bjoms.2020.04.041.
- 38M. Dornan, C. Semple, A. Moorhead, and E. McCaughan, “A Qualitative Systematic Review of the Social Eating and Drinking Experiences of Patients Following Treatment for Head and Neck Cancer,” Supportive Care in Cancer 29, no. 9 (2021): 4899–4909, https://doi.org/10.1007/s00520-021-06062-7.
- 39A. Yan, K. Howden, A. L. Mahar, et al., “Experiences of Adolescent and Young Adult Cancer Survivors During the COVID-19 Pandemic,” Journal of Cancer Survivorship: Research and Practice 17, no. 2 (2023): 370–383, https://doi.org/10.1007/s11764-021-01158-9.
- 40G. K. B. Halkett, E. Lobb, K. Spilsbury, H. Dhillon, and A. K. Nowak, “Brain Cancer Patients' Levels of Distress and Supportive Care Needs Over Time,” Psycho-Oncology 31, no. 12 (2022): 2074–2085, https://doi.org/10.1002/pon.6028.
Citing Literature
