Demoralization and Associated Factors in Palliative Oncology Outpatients: A Cross-Sectional Study

Demoralization is common in palliative psycho-oncology settings. Although its relationship with other psycho-existential conditions has been scrutinized, its co-occurrence with adjustment disorder, as measured by the Adjustment Disorder New Module-20 (ADNM-20), remains unexamined.

Estimate frequency and co-occurrence of demoralization and adjustment disorder symptom domains among palliative outpatients and examine sociodemographic and psycho-existential factors.

A single-site, cross-sectional survey at an academic cancer center used self-reported web-based screening questionnaires. Analyses included descriptive statistics, association tests, and hierarchical logistic regression models.

Moderate-to-severe demoralization symptoms occurred in 43.3% (90% CI: 36.9-49.7) of the 164 outpatients. Among these, co-occurrence with high-risk adjustment disorder symptoms reached 77.6% (90% CI: 69.5-85.8) versus 54.9% (90% CI: 45.2-64.6) for moderate-to-severe depression symptoms (p < 0.001). High-risk adjustment disorder was also frequent (44.1%, 90% CI: 34.4-53.8.3) and, along with moderate-to-severe depression (OR 7.23 and 8.67, p < 0.01), was independently associated with moderate-to-severe demoralization.

Approximately half of oncology outpatients screened positive for demoralization or adjustment disorder, with substantial co-occurrence reflecting their conceptually defined shared disruption of adaptive capacities. Demoralization demonstrates incomplete overlap at the symptom-domain level and appears to capture a distinct existential dimension of distress. This pattern supports consideration of routine screening and further empirical evaluation of its potential diagnostic positioning. Clinician-administered longitudinal studies incorporating item-level analyses are warranted to clarify temporal relationships, refine discriminant validity, and further evaluate demoralization as a distinct diagnostic entity. Such work may enhance recognition of existential suffering and inform targeted integrative interventions.