Perceived Dignity of Advanced Cancer Patients and Its Relationship to Sociodemographic, Clinical, and Psychological Factors

Abstract

ObjectiveLoss of dignity is one of the main reasons for wishing for an early death in patients with incurable diseases such as cancer and is strongly associated with psychological distress and loss of quality of life. The present study aims to analyze the perceived dignity of patients with advanced cancer undergoing systemic treatment and their relationship with sociodemographic, clinical, and psychological factors.MethodsA prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and Palliative Patients’ Dignity Scale, Brief Symptom Inventory, Mental Adjustment to Cancer, Functional Social Support Questionnaire, and Illness Uncertainty.ResultsA total of 508 patients were recruited between February 2020 and October 2021. Most were male, aged > 65 years, with digestive tumors (41%), and metastatic disease at diagnosis. Subjects were classified as having low (56%, N = 283) or high (44%, N = 225) perceived dignity. Patients ≥ 65 years, with worse baseline status (ECOG ≥ 1), and worse estimated 18-month survival had lower levels of perceived dignity. People with lower perceived dignity scored higher for anxious preoccupation and hopelessness and lower for positive attitude. They also displayed higher levels of anxiety, depression, and somatic symptoms, greater uncertainty, and less social support.ConclusionSelf-perceived dignity in advancer cancer patients is significantly associated with psychological factors, psychological distress, uncertainty, less social support. Knowledge of these specific interactions is importance for adequate, comprehensive palliative care.

Dignity and psychosocial related variables in elderly advanced cancer patients

“…Other studies have also found that dignity helps patients maintain the highest level of independence and control over their own lives [39]. In our series and in a recent study in people with advanced cancer, patients with poorer functional status and worse estimated survival have low levels of perceived dignity [40,41]). Hence the importance of developing programs to address the issue of sense of dignity by considering factors that can help preserve dignity such as maintaining good performance status and good social support.…”

Sex Differences in Anxiety and Depression Conditions among Cancer Patients: A Systematic Review and Meta-Analysis

“…In this scenario, the progression of depression and anxiety generally seemed to be more inclined to females and commonly underestimated in males [ 54 ]. In this scenario, it would be necessary for healthcare professionals to improve effective measures purposed at assessing and mitigating depressive symptoms in cases of advanced cancer, thereby improving their mental health, given the high rates of depression in advanced cancer patients [ 55 , 56 , 57 ], due to the difficulty level in performing their daily living activities [ 58 ], which deteriorate further over time [ 59 ].…”

Mental Adjustment, Functional Status, and Depression in Advanced Cancer Patients

“…Individuals with advanced cancer generally experience a variety of symptoms, impaired functional status, and the possibility of death [ 36 , 40 , 41 ]. In this study population, we have found that physical symptoms correlated negatively with functional status, in line with earlier findings [ 17 , 42 ].…”