Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer

Abstract

Background Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. Purpose The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). Methods Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress. Results Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type. Conclusions Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

“…These findings not only suggested the different protective mechanisms for quality of life dimensions but also mirrored previous suggestions as to the variabilities in the effect of a given coping strategy in various situations, especially during the course of cancer ( Reddick et al, 2005 ; Ahlstedt Karlsson et al, 2020 ). In terms of behavioral disengagement, some studies suggested that when aggregated with denial to form disengagement coping, behavioral disengagement could contribute to heightening emotional distress and physical wellbeing, respectively, in higher states of functional impairment ( Merluzzi et al, 2021 ) and lifetime stressful events ( Langford et al, 2017 ; Merluzzi et al, 2019 ). Some other studies also suggested venting to be a function of maladaptive mental processes of pessimism in evoking cancer distress ( David et al, 2006 ), which also showed its lower levels to be functional in terms of arm subscale in the current patients with mastectomy ( n = 153).…”

Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness

“…It is also important to know comorbidities and complications associated with the indexed disease; in this study, e.g., the selected diagnoses, type 2 diabetes and severe osteoarthritis, are both known as disorders that are accompanied with a high level of comorbidity and disability (48, 49). In addition, as indicated by the knowledge gained so far, the level of adaptation to chronic disease (in association with providing an adequate social and service support) could be of the utmost importance for avoiding negative emotions and achieving a satisfactory level of psychological resilience and well-being (13,16,50,51). Education of older individuals with chronic diseases in changing unproductive into productive coping with stress mechanisms, is considered the right intervention approach to improving adaptation to chronic diseases (51,52).…”

“…Unsuccessful coping with chronic diseases may cause emotional distress, which in turn may diminish internal psychological resources (resilience) and change the one`s perception of the stressful situation and of the availability of social support, thus maintaining and/or aggravating the feeling of loneliness (13,15). Such course of aging can lead to the development of the "loneliness trait", characterized by the set of psychosocial characteristics and speci c comorbidity patterns, that an individual having this trait possesses.…”

“…It is not only that loneliness accelerates deterioration of health of older individuals, but also poor health may potentiate the feelings of loneliness. In this regard, it is known that adaptation to life burdened with chronic diseases and disabilities, is di cult (13). Having a chronic disease diminishes functional capabilities of an older individual, and an opportunity to achieve the level of social activities that one had before the onset of chronic disease (14).…”

Discerning critical stressors and resources in the lives of cancer patients: A multivariate analysis of targets of intervention for enhancing cancer care and quality of life

“…2 In addition, there are mindfulness 3,4 and exercise-based 5 interventions as well as those that foster social support, 6 coping, 7 self-efficacy 8 and problem-solving 9 in order to improve some aspect of quality of life. However, cancer patients' lives are not only defined by stress that is closely related to cancer care such as managing symptoms and other comorbid diseases, 10 but also current life problems (e.g., financial, insurance, workrelated, home life), [11][12][13] and major life events 14 (e.g., accident, death of someone, job loss). Importantly, many such issues may be exacerbated by a cancer diagnosis and its treatment, which may impact engagement in cancer care and quality of life.…”