Meaning, distress, and desire for hastened death in homebound adults with advanced cancer: A cluster analysis.

Abstract

12071 Background: Patients with advanced cancer experience significant anxiety and depression exacerbating existential distress, which is often defined as a loss of meaning and dignity, desire for death, hopelessness, and/or demoralization. Such distress is even more pronounced for homebound adults with cancer who are isolated and engage less in enjoyable activities. While meaning in life, affective distress, and existential distress are related, discrepancies exist in the literature which may reflect the presence of distinct psychosocial profiles as opposed to inconsistencies in the literature. Methods: Patients with advanced cancer ( N = 64) who had recently completed an episode of home care and completed baseline assessments in a pilot randomized controlled trial (RCT) of Meaning-Centered Psychotherapy for Hospitals, Hospice, and Home (MCP-H) served as the study sample. Baseline assessments included measures of meaning in life, anxiety, depression, and desire for hastened death. A hierarchical agglomerative cluster analysis was conducted to identify naturally occurring subgroups of participants. Subgroup differences in predictor variables, physical symptom burden, and demographic variables were explored. Results: A 2-cluster solution emerged from the data: Low Meaning, High Distress and DHD ( n = 29; 45.3%) and High Meaning, Low Distress and DHD ( n = 35; 54.7%). Subgroups were statistically discrepant on measures of meaning in life ( d = 0.57), anxiety ( d = 3.07), depression ( d = 2.57), and DHD ( d = 2.76), with medium to large effect sizes. Subgroups were also significantly different in physical quality of life ( d = 16.50). No significant differences were noted demographically between subgroups. Conclusions: To our knowledge, this is the first cluster analysis investigating affective and existential distress in a population of homebound adults with advanced cancer. Results suggest the possibility of 2 distinct subgroups of homebound cancer patients, the first of which is prone to clinically significant anxiety, depression, and moderate DHD, possibly due to a subtle difference in meaning in life. Results also point to physical symptom burden and quality of life being exponentially impacted by affective and existential distress. This study provides valuable information which can aid assessment and treatment for vulnerable homebound adults with advanced cancer.