DURHAM, NC – Cancer patients often suffer psychological distress, but the condition often is an underrecognized and burdensome adverse effect of cancer diagnosis and treatment, according to a new study.
“Left unaddressed, psychological distress can further exacerbate poor mental health, negatively influence health management behaviors, and lead to a worsening quality of life,” according to researchers from Duke University Medical Center and the Durham, NC, VA Healthcare System.
Their multimethod study primarily focused on understanding veterans’ psychological distress and personal experiences living with lung cancer, which is an underrepresented patient population.
The study published in Psychological Services focused on a sample of 60 veterans diagnosed with either non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). The researchers said they “found that distress is common across clinical psychology measures of depression (37% [using the Patient Health Questionnaire, PHQ-9 measure]), anxiety (35% [using the Generalized Anxiety Disorder, GAD-7 measure]), and cancer-related posttraumatic stress (13% [using the Posttraumatic Stress Symptom Checklist measure]).”
The study noted that 23% of the sample endorsed distress scores on two or more mental health screeners.
“Using a broader cancer-specific distress measure (National Comprehensive Cancer Network), 67% of our sample scored above the clinical cutoff (i.e., ≥ 3), and in the follow-up symptom checklist of the National Comprehensive Cancer Network measure, a majority endorsed feeling sadness (75%), worry (73%), and depression (60%),” the authors pointed out.
Meanwhile, qualitative analysis with a subset of 25 veterans demonstrated that psychological distress is common, variable in nature, and quite bothersome.
The study team called for future research to identify veterans at risk for distress while living with lung cancer and to test supportive mental health interventions to target psychological distress among this vulnerable veteran population.
A study last year from Columbia University and Rutgers University pointed out that more than 1.6 million pulmonary nodules are diagnosed in the United States each year.
“Although the majority of nodules are found to be benign, nodule detection and the process of ruling out malignancy can cause patients psychological harm to varying degrees,” the authors wrote in Respiratory Medicine & Research.2
Their scoping review of the literature investigated pulmonary nodule-related psychological harm as a primary or secondary outcome. Online databases were systematically searched to identify papers published through June 30, 2023, from which 19 publications were reviewed. Prevalence was examined by type, measurement, associated factors, and behavioral or clinical consequences. Of the 19 studies reviewed, 11 studies investigated distress, anxiety (n = 6), and anxiety and depression (n = 4). Prevalence of distress was 24.0 %-56.7 %; anxiety 9.9 %-42.1 %, and 14.6 %-27.0 % for depression.
“A wide range of demographic and social characteristics and clinical factors were associated with nodule-related psychological harm,” according to the report. “Outcomes of nodule-related harms included experiencing conflict when deciding about treatment or surveillance, decreased adherence to surveillance, adoption of more aggressive treatment, and lower health-related quality of life.”
The authors pointed out that the scoping review demonstrated that nodule-related psychological harm is common, adding, “Findings provide evidence that nodule-related psychological harm can influence clinical decisions and adherence to treatment recommendations. Future research should focus on discerning between nodule-related distress and anxiety; identifying patients at risk; ascertaining the extent of psychological harm on patient behavior and clinical decisions; and developing interventions to assist patients in managing psychological harm for better health-related quality of life and treatment outcomes.”
- Ramos K, King HA, Gladney MN, Woolson SL, Coffman C, Bosworth HB, Porter LS, Hastings SN. Understanding veterans’ experiences with lung cancer and psychological distress: A multimethod approach. Psychol Serv. 2024 Nov;21(4):773-783. doi: 10.1037/ser0000839. Epub 2024 Mar 4. PMID: 38436646; PMCID: PMC11371941.
- Hillyer GC, Milano N, Bulman WA. Pulmonary nodules and the psychological harm they can cause: A scoping review. Respir Med Res. 2024 Nov;86:101121. doi: 10.1016/j.resmer.2024.101121. Epub 2024 Jul 3. PMID: 38964266.
