Goal disturbance and emotional symptoms in patients with cancer

Cancer is a major stressor leading to a wide range of emotions. Emotions, also negative emotions, are essentially adaptive, in the sense that they help patients cope with cancer. Emotions can also be maladaptive, if they are disproportionately severe or persistent, or interfere with functioning. Our overall goal was to explore whether disturbance of life goals provides a fruitful framework for developing indicators that can distinguish between adaptive and maladaptive emotions.

To test the hypotheses that (1) goal disturbance and emotional symptoms are reciprocally and positively associated to each other; and (2) the association between goal disturbance and emotional symptoms is stronger in patients with maladaptive emotions as compared to patients with adaptive emotions.

Patients with (non)metastasized disease who recently started systemic treatment (n = 132) filled out Ecological Momentary Assessments 5 times per day for 14 consecutive days in which emotional symptoms and activities related to life goals were documented. The importance of life goals in six domains was assessed with an interview (work/study, disease-related health, lifestyle health, social activities, religious, spiritual and intellectual activities, and leisure). Patients were grouped as having adaptive or maladaptive emotions based on a reference standard (a psychiatric diagnostic assessment, or the subjective need for professional mental healthcare). Linear mixed models were built in R, with either goal disturbance or negative emotional symptoms as dependent variable.

Goal disturbance for social activities and leisure activities was significantly associated with more emotional symptoms. Goal disturbance for disease-related health activities was significantly associated with less emotional symptoms. No significant association was found for other activities (with one exception). With negative emotions as outcome variable, goal disturbance was more strongly associated with more emotional symptoms in patients with maladaptive emotions than patients with adaptive emotions for social, leisure and lifestyle health activities.

Further research is warranted to develop an indicator of maladaptive emotions in patients with cancer based on the extent of goal disturbance of social, leisure and lifestyle health activities.