Predictors of meaning and purpose among patients with cancer and with elevated psychological distress.

Abstract

e24123 Background: Patients with cancer frequently experience psychological distress and existential concerns. Meaning and purpose are often emphasized in oncologic end-of-life settings. But many patients don’t find meaning and purpose during the cancer trajectory. Studies have not described clinical and demographic features associated with meaning and purpose. Methods: We conducted a retrospective analysis of 96 patients at a single-institution dedicated cancer center undergoing psychosocial evaluation. Demographics, disease characteristics, and psychiatric diagnoses were collected. PROMIS short forms measured emotional distress (anxiety, depression, social isolation), meaning and purpose, and concern for death and dying. PROMIS measures are standardized using a T-score metric with a mean of 50 and standard deviation of 10, based on the U.S. general population. Linear regression models were used to assess predictors of meaning and purpose. Results: The cohort had a mean age of 60.2 years (SD = 16.9), and 53.8% were female. Most patients had localized cancer (65.6%) and were receiving cancer treatment (89.3%). Mean PROMIS scores indicated lower-than-average meaning and purpose (46.2, SD 9.0), elevated concern for death and dying (55.1, SD = 8.9) and anxiety (58.6, SD = 8.6) and depression (55.9, SD = 7.7), with average social isolation (50.3 SD = 7.8). In univariate analysis, metastatic disease (t = 2.35, p = .02), anxiety (t = -3.2, p = .05), depression (t = -0.37), and social isolation (t = -4.2, p = 0.03), were significantly associated with meaning and purpose. The multivariable regression model below predicted 32% of meaning and purpose variance. Adjusted R 2 = .32. Conclusions: Although meaning and purpose is lower for this standard cohort of patients with localized and metastatic cancer than the general population, patients with metastatic disease were more likely to express meaning and purpose while social and depression were independently associated with lower meaning and purpose. Addressing depression and social isolation and meaning and purpose in patients with localized cancer may increase quality of life for patients with cancer and warrants further research. Variables Mean (SD) β Coefficient 95% CI P -value PROMIS forms Anxiety 58.6 (8.6) -0.189 -.042, .044 0.11 Depression 55.9 (7.7) -0.307 -0.63, -0.14 0.003* Social Isolation 50.3 (7.9) -0.311 -0.60, -0.13 0.003* Demographics/Clinical Metastatic (yes) N=34 0.189 0.08,7.50 0.05*