Poorer Quality of Life Outcomes Are Associated with Higher Levels of Stress, Lower Levels of Resilience, and Poorer Adjustment to Cancer in Outpatients Receiving Chemotherapy.

Abstract

Objectives: The purposes were to identify subgroups of patients (n = 1324) with distinct quality of life (QOL) profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as levels of global, cancer-related, and cumulative life stress; resilience; and mental adjustment to cancer.

Methods: Prior to their second or third cycle of chemotherapy, patients completed a demographic questionnaire, measures of stress (Perceived Stress Scale, global stress), Impact of Event Scale-Revised (IES-R, cancer-related distress), Life Stressor Checklist-Revised (LSC-R, cumulative life stress); resilience (Connor-Davidson Resilience Scale [CDRS]), and mental adjustment (Mental Adjustment to Cancer Scale [MAC]). In addition, they completed the Multidimensional QOL Scale-Patient Version six times over two cycles of chemotherapy. Latent profile analysis was used to identify the distinct QOL profiles. Parametric and nonparametric tests were used to evaluate for differences in risk factors among the QOL profiles.

Results: Three distinct QOL profiles were identified (Low, 26.9%; Moderate, 44.7%; and High, 28.4%). Compared to the High QOL class, the other two classes were younger and more likely to be female and had a higher comorbidity burden and lower functional status. Differences among the QOL classes in PSS, IES-R, and LSC-R scores followed a similar pattern (Low > Moderate > High). Differences were found among the QOL classes in CDRS (Low < Moderate < High) and MAC (Low > Moderate > High) scores.

Conclusions: This study is the first to describe interindividual variability in QOL outcomes among patients receiving chemotherapy. Levels of cancer-related stress reported by Low and Moderate QOL classes suggest that these patients meet the diagnostic criteria for posttraumatic stress and have levels of resilience below the normative score for the general population.

Implications for nursing practice: Given that stress and resilience are modifiable risk factors, this information can be used by clinicians to design tailored interventions to improve patients' QOL.