Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer.
Journal of pain and symptom management
oregon; portland; chiles
CONTEXT: Older adults with advanced cancer face uncertainty related to their disease and treatment.
OBJECTIVES: To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer.
METHODS: Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP
RESULTS: We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8).
CONCLUSION: Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.
Earle A. Chiles Research Institute
Verduzco-Aguirre, Haydee C; Babu, Dilip; Mohile, Supriya G; Bautista, Javier; Xu, Huiwen; Culakova, Eva; Canin, Beverly; Zhang, Yingzi; Wells, Megan; Epstein, Ronald M; Duberstein, Paul; McHugh, Colin; Dale, William; Conlin, Alison; Bearden, James; Berenberg, Jeffrey; Tejani, Mohamedtaki; and Loh, Kah Poh, "Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer." (2021). Articles, Abstracts, and Reports. 4495.