Psychosocial factors influencing distress among cancer patients in South India

Abstract Background: The increase of cancer rates in India over the last decade has placed a significant psychosocial burden on patients and their families. To address the psychosocial issues, cancer centers in India have integrated psychosocial services into cancer care by routinely measuring the distress of patients and responding to their distress. In this study, we sought to determine the association between self-reported distress and patient demographic and clinical variables and awareness of their diagnosis and prognosis. Methods: The Department of Psycho-oncology conducted a cross-sectional, cohort study of patients who were being treated for a variety of cancers in a comprehensive cancer center in Chennai, India. Cancer patients (N = 2019) completed a standardized measure of distress and participated in a clinical interview during their admission to a ward or at the time of referral to psycho-oncology. The level of distress was measured by the NCCN Distress Thermometer and problem list. Chi-square tests were used to examine variations in overall distress. Multi-nominal logistic regression analyses were used to assess the level of patients’ reported distress as a function of clinical characteristics (stage of cancer, awareness of diagnosis and prognosis, physical symptoms). Results: The majority (60.3%) of the sample reported a moderate to high level of emotional distress. There were significant associations (P < .05) of younger age, awareness of diagnosis, prognosis, sleep issues, and physical pain with higher levels of distress. Patients who were aware of their diagnoses were more likely to report moderate (P < .01) or severe distress (P < .05) than those who were unaware. Patients who were aware of their prognoses were less likely to report moderate distress (P < .001) and severe distress (P < .001. Implications for Practice and Research: Given that a majority of patients rated at or above the clinical cut-off for distress, oncology centers in India need to provide training for professional psycho-oncology clinicians and incorporate psycho-oncology services to adequately address patients’ distress. Qualitative research may be needed to advance our understanding of specific social and cultural factors that may influence the psychosocial challenges faced by patients. Further investigation of patient distress related to diagnostic disclosure may be helpful in informing practice.