relationship status and distress after cancer

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Relationship status influences type of problems, distress and wish for professional care after cancer

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relationship status and distress after cancer

  1. 1. IPOS, October 20. 2011 Relationship status affects response on the Distress Thermometer, problem list and referral wishMarrit TuinmanMariët HagedoornStacey Gazendam-DonofrioJosette Hoekstra-WeebersComprehensive Cancer Centre, the NetherlandsDutch Cancer SocietyUniversity Medical Centre Groningen, the Netherlands V i 11 a B e e l d | K o p t e k s t
  2. 2. Research interests• Finding a new partner after treatment for cancer - AYAs often single - middle-aged may be divorced or widowed• Obstacles single survivors face when looking for a partner - How do singles function after cancer? 2
  3. 3. Cancer and well-being• Cancer related distress - The overall burden of diagnosis and treatment• 30%?• Risk factors for elevated distress - Being female - Being younger - Being unmarried
  4. 4. Marital status and well-being after cancer• Being unmarried related to: - Serious psychological distress, also in the long term - Highest rates of clinically elevated distress (up to 61%) - Highest rates of clinical depression (up to 16%) - But: functioning is less well in the general population also…
  5. 5. Marital status and well-being after cancer (2)• Relationship between being unmarried and distress is - lowest for healthy people - then: for people with a serious illness - strongest for people who had cancer• Being unmarried and having a cancer history raises unique isues• What type of problems elevates distress in unmarried cancer patients?
  6. 6. Detecting problems & distress: screening
  7. 7. Dutch version• Distress thermometer & problem list• 5 problem domains - practical, social, emotional, spiritual, and physical• 47 items (additional 12 items after focus group meetings) - for every problem ticked as „yes‟: rate burden from 1-10• Added question - „would you like to talk to a professional about your problems?‟
  8. 8. Validated in the Netherlands in 2008• cut-off > 5• More a ruling-out tool: 95% of low scoring patients are indeed not distressed (negative predictive value)• 57% of patients with elevated distress do not desire a referral Tuinman, Gazendam-Donofrio, Hoekstra-Weebers, Cancer (2008)
  9. 9. Modern relationship forms• Very often studies include a dichotomous variable: married vs not married• Divorced, cohabiting, living-apart-together (LAT), never-marriedthe Netherlands: - 33% of people living alone in the Netherlands do have a steady partner - 30% divorce rate overall, at mean age of 44
  10. 10. Research questions• does cancer related distress differ according to relationship status?• does the desire for additional care differ according to relationship status?• does the desire for additional care in high distressed patients differ according to relationship status?• what type of problems are related to relationship status?
  11. 11. Method• questionnaires• 22 hospitals mainly in the north-eastern region of the Netherlands• cross-sectional: during treatment or follow-up• inclusion criteria: - >18 years - aware of diagnosis and treatment plan - sufficient command of the Dutch language - physically fit to fill in the questionnaire
  12. 12. Response• 22 Hospitals received 2600 packages• Number handed out: ?• 1327 Questionnaires were sent back to the CCCN• 51% (estimated) response rate• Response rate varied between 32%-72%
  13. 13. Respondents: disease characteristics Total group n = 1315 %Married 75Cohabiting 6LAT 2Divorced 3Widowed 7Single 6Type of cancerBreast 43Digestive 11Urologic 15Lung 7Gynaecologic 7Other 17Missing n=12Treatment receivedSurgery only 24Radiotherapy only 6Chemotherapy only 8Combination therapy 62Missing n=78In follow-up 74time since diagnosis in years m (sd) 2.1 (3.1)Range .02-33.7
  14. 14. Respondents: sociodemographics Total group n=1315Age (yrs)*** 60.9 (11.6) F= 21.1, p <.001 widowed, married, divorced,Range 21-89 LAT, single, cohabitingMissing 14Gender Chi2=24.3, p<.001Male### 491 (37%) divorced, widowed, cohabiting,Female 823 (63%) single, married, LATMissing 1
  15. 15. Does cancer related distress differ between groups? mean thermometer score 6 5 4,5 4,6 4 4 3,8 3,6 3,3 3 2 Married Cohabiting LAT Divorced Widowed Single F=2.5, p=.02 Bonferroni: widowed vs singles 95% CI 0.03 – 2.52, p=.03
  16. 16. Does clinical distress differ between groups? % above cut-off 58% 58% 60% 50% 42% 44% 39% 40% 40% 30% 20% 10% 0% Married Cohabiting LAT Divorced Widowed Single Chi2=12.9, p=.02
  17. 17. Does the desire for additional care differ betweengroups? Yes/ Maybe 60% 51% 48% 50% 40% 38% 40% 32% 25% 30% 20% 10% 0% Married Cohabiting LAT Divorced Widowed Single Chi2=21.1, p=.001
  18. 18. Accordance high distress & referral wish >5 ánd wanting a referral 80% 71% 70% 70% 61% 53% 60% 45% 50% 41% 40% 30% 20% 10% 0% Married Cohabiting LAT Divorced Widowed Single Chi2=35.3, p=.001
  19. 19. What type of problems are related to relationship status?“Yes, this bothered me in the past week”Groups differed on these items (20/47):Practical problems Social problems Emotional problems Physical problemsHousing Dealing with partner Self esteem AppearanceHousekeeping Dealing with friends & Family Anxiety SexualityTransportation Loneliness EatingWork/ education Concentration Daily activitiesFinances Guilt FatigueInsurance Loss of control Strength
  20. 20. Problems addressed most often• Married, cohabiting and widowed patients never addressed specific problems most often• Problems most often adressed per group: Singles LAT Divorced Housekeeping 45% Work/education 40% Housing 20% Transportation 21% Finances 28% Insurance 12% Dealing with friends & family 24% Dealing with partner 20% Anxiety 49% Self-esteem 40% Loss of control 26% Loneliness 28% Sexuality 36% Concentration 46% Fatigue 80% Guilt 17% Strength 60% Appearance 33% Eating 30% Daily activities 40%
  21. 21. Differences in problem burden• Only burden in the practical domain differs between groups* - LAT, single, cohabiting, divorced, married, widowed• Only 2 items differ in burden between groups: transportation** & sexuality*** ANCOVAs Controlled for age and gender * F=2.5, P=.03 ** F=2.9, p=.02 *** F=2.2, p=.04
  22. 22. In sum• It‟s not just having a partner or not• Singles & LATs - experience most distress - most often report clinical distress - most often desire additional care• Cohabiting patients‟ reactions more similar to divorced patients than to married ones• Widowed patients, followed by married patients experience least distress and wish for help
  23. 23. Discussion• Accordance between clinical distress and referral wish is higher for singles & LATs - “I don‟t want to handle this by myself”• singles, LATs and divorced patients report the most problems, but the burden is not higher than in other groups (except for practical problems) - life after cancer is most problematic for these three groups
  24. 24. Discussion (2)• Elevated distress in singles & LATs reflects a desire for additonal care• Help is most wanted for - practical problems (housekeeping & work) - emotional problems (concentration, loneliness & self esteem) - physical fitness problems (fatigue, strength, daily activities) - sexuality
  25. 25. Additional help• Referral to social worker, psychologist or physical rehabilitation program would be the choice• May improve well-being - benificial when looking for a partner
  26. 26. Thank youAny questions or comments?
  27. 27. Referral wish differs (p<.001) % yes / maybe 60 50 13 40 28 18 30 12 24 10 38 20 20 22 20 10 14 15 0 Married Cohabiting LAT Divorced Widowed Single maybe yes

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