Dataset Information

Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer.

ABSTRACT:

Context

Older adults with advanced cancer face uncertainty related to their disease and treatment.

Objectives

To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer.

Methods

Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential.

Results

We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8).

Conclusion

Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.

SUBMITTER: Verduzco-Aguirre HC

PROVIDER: S-EPMC7854861 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo evaluate the relationships between aging-related domains captured by geriatric assessment (GA) for older patients with advanced cancer and caregivers' emotional health and quality of life (QOL).DesignIn this cross sectional study of baseline data from a nationwide investigation of older patients and their caregivers, patients completed a GA that included validated tests to evaluate eight domains of health (eg, function, cognition).SettingThirty-one community oncology practices throughout the United States.ParticipantsEnrolled patients were aged 70 and older, had one or more GA domain impaired, and had an incurable solid tumor malignancy or lymphoma. Each could choose one caregiver to enroll.MeasurementsCaregivers completed the Generalized Anxiety Disorder-7, Distress Thermometer, Patient Health Questionnaire-2 (depression), and Short Form Health Survey-12 (SF-12 for QOL). Separate multivariate linear or logistic regression models were used to examine the association of the number and type of patient GA impairments with caregiver outcomes, controlling for patient and caregiver covariates.ResultsA total of 541 patients were enrolled, 414 with a caregiver. Almost half (43.5%) of the caregivers screened positive for distress, 24.4% for anxiety, and 18.9% for depression. Higher numbers of patient GA domain impairments were associated with caregiver depression (adjusted odds ratio [aOR] = 1.29; P < .001], caregiver physical health on SF-12 (regression coefficient [β] = -1.24; P < .001), and overall caregiver QOL (β = -1.14; P < .01). Impaired patient function was associated with lower caregiver QOL (β = -4.11; P < .001). Impaired patient nutrition was associated with caregiver depression (aOR = 2.08; P < .01). Lower caregiver age, caregiver comorbidity, and patient distress were also associated with worse caregiver outcomes.ConclusionPatient GA impairments were associated with poorer emotional health and lower QOL of caregivers. J Am Geriatr Soc 67:969-977, 2019.