Emotional Distress in Patients With Cancer: A Cross-Sectional Study

Emotional distress has long been a central concern for clinical health care professionals when caring for patients with cancer. Emotional distress evaluation is one of the accreditation criteria for cancer centers. The ability to quickly and effectively assess, identify, and treat emotional distress in patients with cancer has become an essential skill for health care professionals.

The purposes of this study were to explore the related factors of emotional distress and propose emotional distress score cutoff points to identify the presence of psychological problems or psychiatric disorders in patients with cancer.

This cross-sectional study was conducted between August 2021 and April 2022 on 400 patients with cancer. The 5-item Brief Symptom Rating Scale (BSRS-5) was used to measure emotional distress in patients with cancer. Data collection employed a structured questionnaire including demographics, BSRS-5, Patient Dignity Inventory-Mandarin version (PDI-MV), Demoralization Scale-Mandarin version (DS-MV), and Patient Health Questionnaire-9 (PHQ-9). Data analysis was performed using SPSS software version 26.0. Data were analyzed using an independent t test, one-way analysis of variance, Pearson's correlation, and receiver operating characteristic curve.

Emotional distress was found to be significantly related to cancer stage ( F =3.37, p= .019), disease characteristics ( t =2.29, p= .023), and treatment phase ( F =3.12, p= .015), with being in stage IV, receiving a recurrence diagnosis, and receiving chemotherapy associated with a higher likelihood of emotional distress. Sensitivity and specificity of the BSRS-5 with an aggregate score of 3.5 or above were, respectively, 74.0% and 84.8% for low dignity (PDI-MV ≥35), 79.1% and 69.6% for demoralization (DS-MV ≥30), 76.7% and 83.8% for depression (PHQ-9 ≥ 10), and 92.0% and 84.0% for suicidal ideation. The BSRS-5 exhibits excellent discrimination for both psychological problems and psychiatric disorders, for example, low dignity, demoralization, depression, and suicidal ideation, in patients with cancer.

In this study, emotional distress was shown to be significantly related to demographic factors, including cancer stage, disease characteristics, and treatment phase. Thus, health care professionals should be particularly concerned when patients with cancer are in stage IV, diagnosed with recurrence, or undergoing chemotherapy. Health care professionals should regularly employ brief and highly reliable questionnaires to help evaluate the emotional distress of patients with cancer. Regular evaluation can facilitate the early detection of emotional distress, psychological problems, and psychiatric disorders such as low dignity, demoralization, depression, and suicidal ideation in these patients.