Psychological distress and its associated factors among cancer patients in Nepal: A cross-sectional study

Psychological distress, encompassing depression, anxiety, and stress, is common among individuals with cancer but remains inadequately recognized in many low- and middle-income countries, including Nepal. Despite growing emphasis on holistic cancer care, psychological aspects are often overshadowed by clinical and financial concerns. This study aimed to estimate the prevalence of psychological distress among cancer patients in Nepal and to identify its associated sociodemographic, clinical, and economic factors. A cross-sectional study was conducted among cancer patients in two tertiary level referral hospitals in Nepal. The validated Nepali version of the Depression, Anxiety and Stress Scale (DASS‑21) was used to assess psychological distress. A total of 262 participants were enrolled. SPSS version 27 was used to perform cleaning, coding and analyses. Associations were examined using binary logistic regression, and adjusted odds ratios were estimated using multivariate logistic regression, with p-values <0.05 considered statistically significant. More than two-thirds of cancer patients had depression (66.8%) and anxiety (68.7%) symptoms, and nearly three-fifths had symptoms of stress (58.0%). Higher odds of psychological distress were observed among participants who were older, unemployed, had fewer years of education, and had advanced-stage cancer. Compared with patients diagnosed at stage I, those diagnosed at II, III, and IV had significantly higher odds of depressive symptoms, with crude odds ratios of 2.75 (95% CI: 1.39-5.42), 2.81 (95% CI: 1.40-5.64), and 4.21 (95% CI: 1.39-12.76), respectively. Although households of cancer patients experienced out of pocket expense, catastrophic health expense and impoverishment, no significant association was found between these indicators and psychological distress. Psychological distress is highly prevalent among Nepali cancer patients and is linked primarily to sociodemographic and clinical factors rather than direct economic burden. Integrating routine mental health screening and basic counseling into oncology services is urgently needed to improve patients' overall well-being.