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Relationship between Psychological States and Coping in Reproductive Cancer Patients in the Context of the Pandemic
CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(03): 233-241
DOI: DOI: 10.1055/s-0043-1766132
Abstract
Introduction Cancer is known as a disease caused by an uncontrolled division of abnormal cells with the potential to proliferate and destroy body tissues. While it is not uncommon to observe changes in psychological states among patients with cancer, the pandemic situation has been reported to have an impact more severely.
Objective This study attempts to understand the psychological problems of cancer patients, and the process of coping adopted by reproductive cancer patients during the period of the pandemic.
Materials and Methods This study uses a correlation research design and the tools used for assessment were the four-dimensional symptom questionnaire and Brief COPE inventory. Through nonrandom sampling, a sample of 120 cancer patients diagnosed with reproductive cancer, both male and female from the regional cancer center and private cancer hospitals in Hyderabad, was recruited for the pandemic period from May 2020 to September 2021. Descriptive statistics, correlation, and regression statistical analysis methods were implemented.
Results Significant negative correlation was observed between psychological states and coping. Using multiple linear regression analysis, it was found that distress and depression predict problem-solving coping, distress and anxiety predict emotion-solving coping, and distress predicts adaptive coping.
Conclusion This study examines the psychological factors and coping methods in adapting to the dual challenges of illness and potential risk of infection transmission, and emphasizes designing an effective intervention. During the coronavirus disease 2019 crisis, the lack of support through psychological counseling to address their coping mechanisms to face the challenges is also glaring.
Ethical Approval
The study fulfills research ethics and the Helsinki declaration, and approval was taken from the Institutional ethics committee, the University of Hyderabad on 24–2-2022 (UH/IEC/2020/257). Informed consent and participation informed sheet were provided to the participants and complete confidentiality was assured for the study.
Publication History
Article published online:
17 May 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Abstract
Introduction Cancer is known as a disease caused by an uncontrolled division of abnormal cells with the potential to proliferate and destroy body tissues. While it is not uncommon to observe changes in psychological states among patients with cancer, the pandemic situation has been reported to have an impact more severely.
Objective This study attempts to understand the psychological problems of cancer patients, and the process of coping adopted by reproductive cancer patients during the period of the pandemic.
Materials and Methods This study uses a correlation research design and the tools used for assessment were the four-dimensional symptom questionnaire and Brief COPE inventory. Through nonrandom sampling, a sample of 120 cancer patients diagnosed with reproductive cancer, both male and female from the regional cancer center and private cancer hospitals in Hyderabad, was recruited for the pandemic period from May 2020 to September 2021. Descriptive statistics, correlation, and regression statistical analysis methods were implemented.
Results Significant negative correlation was observed between psychological states and coping. Using multiple linear regression analysis, it was found that distress and depression predict problem-solving coping, distress and anxiety predict emotion-solving coping, and distress predicts adaptive coping.
Conclusion This study examines the psychological factors and coping methods in adapting to the dual challenges of illness and potential risk of infection transmission, and emphasizes designing an effective intervention. During the coronavirus disease 2019 crisis, the lack of support through psychological counseling to address their coping mechanisms to face the challenges is also glaring.
Introduction
A chronic illness like cancer has multiple effects that cross the physiological framework and manifest themselves in psychosocial aspects.[1] [2] Many cancer patients suffer from psychological distress, psychosomatic disorders, and psychological crisis during the stages of cancer diagnosis and different phases of treatment.[3] [4] Adding to this, the outbreak of coronavirus disease 2019 (COVID-19) has disrupted health services,[5] caused a delay in medical procedures,[6] [7] and led to medical complications[8] and cumulative disease burden.[9] As known when compared with the general population, the immune-suppressed status of cancer patients due to advanced stage of malignancy or cancer treatments increases the risk of COVID-19 infection transmission.[10] Thus, COVID-19 is experienced as a “syndemic”—a co-occurring, synergistic pandemic that interacts with and exacerbates their existing noncommunicable disease and social conditions.[11] A syndemic exists when risk factors or comorbidities are interwined, interactive, and cumulative-aggravating the disease burden and additively increasing the adverse effects.
This study observes psychological states and different coping strategies in patients diagnosed with cancer during the period of a pandemic. A psychological state is a mental condition in which the quality of the state is relatively constant, even though the state itself may be dynamic. Terluin et al identified four dimensions that describe psychological states: distress, depression, anxiety, and somatization.[12] In simple terms, psychological distress is described as a state of emotional suffering associated with stressors and demands that are difficult to cope with, which is indicative of physical, mental, or emotional exhaustion. Depression causes feelings of sadness, and or loss of interest in activities that one enjoyed before. Anxiety is the body's natural response to stress such as feelings of fear or apprehension about what's to happen; somatization is the expression of psychological or emotional factors as physical (somatic) symptoms. A coping strategy is defined as “a response aimed at diminishing the physical, emotional, and psychological burden linked to stressful life events and daily hassles.”[13]
A detailed literature review has been conducted for the study. Cancer is one of the most widely studied diseases that cause significant psychological distress.[14] [15] [16] [17] According to Oncology care, NCCN Guidelines (2019), “Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disability such as depression, anxiety, panic attacks, social isolation, and existential and spiritual crisis.”[18] This is seen in greater magnitude in the current syndemic situation. Different studies emphasize the role of factors such as a change in lifestyle,[19] [20] lack of social support or social interaction,[21] employment issues,[22] and others in the manifestation of certain mental health issues.[23] [24]
A systematic review revealed that COVID-19 adversely affected the psychological health of cancer patients. Fear of COVID-19, fear of disease progression, disruption of oncology services, cancer stage, and immune-compromised status were the most common causes of psychological distress in cancer patients, which can influence patients' decisions about treatment as reported in the study.[25] A systematically reviewed community-based studies estimate the prevalence of depression during COVID-19 from 7.45 to 48.30%.[26] Another cross-sectional study observed anxiety and depression are very common and employment loss during a pandemic is positively associated with greater depressive symptoms.[27] An Indian study analyzed COVID-19 induced work stress and found that role overload, family distraction, changes in lifestyle choices, and occupational discomfort were significant predictors of distress during a lockdown.[28]
Research indicates that the potential mental health effects of COVID-19 might be associated with the primary effects of epidemic disease outbreaks and secondary effects of economic recessions/depression, loneliness, quarantine, and social isolation.[29] Important to mention here is the “process of stress amplification,” which explains the cumulative burden when two stressors combine and cause multiplicative effects on mental health.[30] Research studies have attempted to explore coping in cancer patients.[31] [32] Psychological and coping responses were analyzed in a review-research in the context of the COVID-19 situation, comprising a narrative synthesis of 24 papers and the common themes that emerged in psychological responses are not only anxiety, fear, depression, anger, guilt, grief, loss, posttraumatic stress, and stigmatization, but also a greater sense of empowerment and compassion toward others. A comprehensive systematic review strengthened the evidence for an association between psychological coping and cancer outcome.[33] Research throws light on an individual's coping style and explains that fighting spirit has improved survival rates even in the advanced stage of leukemia.[34] Another study observed that individual coping style determines the intensity of trauma-related symptoms in cancer, where destructive coping style and emotional reactivity account for 55% of the variance of general post-traumatic stress symptoms.[35] Similarly, Laskowska reported with the study findings that a destructive style of coping with stress is less beneficial for the adaptation to cancerous disease and may influence the development of post-traumatic symptoms in persons diagnosed with cancer.[36] [37] As mentioned above, research studies related to stress and coping in cancer patients are widely reported across the countries. However, there seems to be a need to explore the psychological states of patients with cancer and their coping mechanism during the challenging phases of the pandemic, especially in the Indian scenario.
Research Objective
Based on the above review findings, the following objectives have been formed concerning the person diagnosed with reproductive cancer with special reference to the pandemic situation.
To examine the psychological states of patients diagnosed with reproductive cancer.
To examine coping adopted by patients diagnosed with reproductive cancer.
To know the relationship between psychological states and coping in patients diagnosed with reproductive cancer.
To find out predictors of coping among patients diagnosed with reproductive cancer
Materials and Methods
Research Design—This study is retrospective, and uses a corelational design to understand the relationship between psychological states and coping among reproductive cancer patients. The data was collected from regional cancer hospitals and private cancer hospitals in the twin cities of Hyderabad in Telangana state, from May 2020 to September 2021.
Participants: Nonrandom sampling, more specifically convenient sampling, was done; 120 patients diagnosed with reproductive cancer were recruited from hospitals in Hyderabad for the study. Both males and females were diagnosed with reproductive cancer (cancer in the testes, prostate, and penis in males; cancer of the uterus, cervix, ovary, vagina, and fallopian tube in females) of stages 1, 2, and 3, and aged between 18 and 65 years were included in the study.
However, patients with uncontrolled or recurrence of cancer, patients with advanced stages of cancer (stage 4), and patients with a history of other types of malignancies, or known with psychological morbidity (schizophrenia, paranoid disorder, bipolar mood disorder) were excluded from the study. It was ensured by the patients and caregivers that they have not been diagnosed with any psychiatric illness.
Instruments: The psychological instruments used for the study were well-researched tools. The description of tools is as follows.
Four-dimensional symptom questionnaire (4DSQ) makes an assessment of distress, anxiety, depression, and somatization in cancer patients. 4DSQ subscales show excellent reliability and validity and Cronbach's α for the four subscales ranged from 0.79 to 0.90.
Brief COPE was developed by Carver, a four-point Likert scale consisting of 28 items. It assesses 14 subscales, two items each, which deal with ways a person is coping with stress in his/her life. It shows good reliability and validity. Carver reported and established the reliability and validity of the Brief COPE scale in the original scale (Cronbach's α: 0.570.90).[38]
The psychometric properties of the Brief COPE scale are studied in different contexts.[39] [40] A study has categorized these into four-domain problem: focused coping (active coping, planning, and seeking instrumental support), emotion-focused coping (seeking emotional support, positive reframing, and religion), adaptive coping (acceptance and humor), and maladaptive coping (venting, behavioral disengagement, self-distraction, substance use, self-blame, and denial).
Procedure: Data collection has been done after obtaining ethics approval from the parent university and necessary permission from hospital authorities. After obtaining consent from each patient, the measure was administered individually by the researcher. Any doubts or queries from patients were clarified. For the benefit of those who are not comfortable with English, the measures were translated into the vernacular languages (Telugu and Hindi).
Ethical guidelines have been followed for the study. The participants were primarily approached and rapport was generated when the researchers introduced themselves and, the research work's purpose, and other necessary details were told to them. With their consent, psychological instruments were provided and their responses were recorded and complete confidentiality was ensured. Debriefing was done after the procedure.
Statistical Analysis
Descriptive statistics, correlation, and regression statistical analysis methods were implemented. This study used a correlational design to find associations and predictions between psychological states and coping among reproductive cancer patients.
Ethics
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
An approval was taken by Institutional Ethics committee board, School of Medical Sciences, University of Hyderabad, bearing No- UH/IEC/2020/257 for the study.
Results
The following figures portray the analysis of the results starting with descriptive statistics.
[Fig. 1] displays the diagrammatic representation of the study's distribution of types of reproductive cancer patients. The percentage distribution of types of reproductive cancer patients in this study is as follows. The distribution (n = 120) is as follows: Cervix cancer 60 (50%), Breast cancer 27 (22.5%), Ovarian cancer16 (13.33%), Prostate cancer 5 (4.16%), Endometrial cancer 5 (4.16%), Penis cancer 3 (2.5%), Cancer in vulva 2 (1.6%), Cancer in scrotum 2 (1,6%).
Fig 1:Pie chart showing distribution of reproductive cancer patients in the sample (n = 120). Ca Breast, breast cancer; Ca Cervix, cervical cancer; Ca Endometrium, endometrial cancer; Ca Ovary, ovarian cancer; Ca Penis, cancer in penis; Ca Prost, prostrate cancer; Ca Scrotum, scrotal cancer; Ca Vulva, cancer in vulva.
[Fig. 2] describes that majority of participants in the study are diagnosed with reproductive cancer stages 3 and 2. Very few cases diagnosed with stage 4, recurrence, and metastasis are included.
Fig 2:Bar graph showing the distribution of stages of different types of reproductive cancer in the study. Participants in the study are majorly of reproductive cancer stages 3 and 2.
[Fig. 3] displays the normal distribution curve and shows the mean age of reproductive cancer patients is 46.67 years with a standard deviation of 9.33 in the sample (n = 120) taken for the study.
Fig 3:Bar graph showing age of reproductive cancer patients. Mean age of reproductive cancer patients in the study (n=120).
The following paragraphs explain the results using statistical analysis.
Objective 1 examined the psychological states of patients diagnosed with reproductive cancer. Accordingly, the psychological states measured using a 4DSQ are distress, depression, anxiety, and somatization.
[Table 1] demonstrates the mean score of psychological states of patients diagnosed with reproductive cancer. The mean score of distress is 22, somatization is 14, followed by an anxiety score of 9 and the mean depression score of 6. An interpretation of scores is done based on the following description as per the manual. Distress score more than 20 indicates strong elevation; depression score more than 5 indicates strong elevation; anxiety more than 8 indicates moderate elevation; and somatization score more than 10 indicates moderate elevation in psychological states, respectively.
|
Mean |
SD |
|
|---|---|---|
|
DSQ distress |
21.79 |
5.60 |
|
DSQ depression |
6.33 |
3.46 |
|
DSQ anxiety |
8.82 |
4.62 |
|
DSQ somatization |
14.43 |
6.45 |
According to the Brief COPE scale, the dimensions are active coping (M = 3.86), planning (M = 3.30), instrumental support (M = 4.73), emotional support (M = 6.05), and positive reframing (M = 2.53), religion (M = 4.10), acceptance (M = 3.78), humor (M = 1.89), venting (M = 5.06), behavioral disengagement (M = 4.06), self-distraction (M = 4.99), substance use (M = 1.98), self-blame (M = 3.19), and denial (M = 3.49).
The Brief COPE measures fourteen different coping strategies that are broadly grouped into four coping types: problem-focused, emotion-focused, adaptive and maladaptive coping. In this study, the maladaptive coping measure is the most common, and adaptive coping is very less seen among reproductive cancer patients ([Table 3]).
|
Types of coping |
Mean (M) |
Standard deviation (SD) |
|---|---|---|
|
Problem focused coping |
11.88 |
4.77 |
|
Emotion focused coping |
12.69 |
4.46 |
|
Adaptive coping |
5.70 |
1.95 |
|
Maladaptive coping |
22.98 |
6.04 |
|
4DSQ Ds |
4DSQDp |
4DSQAx |
4DSQSo |
BCIPF |
BCIEF |
BCIA |
BCIMA |
|
|---|---|---|---|---|---|---|---|---|
|
4DSQDs |
1 |
|||||||
|
4DSQDp |
0.736** |
1 |
||||||
|
4DSQAx |
0.632** |
0.646** |
1 |
|||||
|
4DSQSo |
0.466** |
0.529** |
0.634** |
1 |
||||
|
BCIPF |
−0.518** |
−0.526** |
−0.359** |
−0.330** |
1 |
|||
|
BCIEF |
−0.339** |
−0.268** |
−0.088 |
−0.069 |
0.785** |
1 |
||
|
BCIA |
−0.314** |
−0.341** |
−0.333** |
−0.223* |
0.700** |
0.609** |
1 |
|
|
BCIMA |
−0.043 |
0.079 |
0.068 |
0.086 |
0.568** |
0.746** |
0.446** |
1 |
|
Model and predictor variables |
B |
SE B |
Β |
t |
R 2 |
∆R 2 |
|---|---|---|---|---|---|---|
|
Model 1 |
||||||
|
DSQ Ds |
−0.44 |
.07 |
−0.52 |
−6.57 |
0.27 |
0.27 |
|
Model 2 |
||||||
|
DSQ Ds |
−0.24 |
0.10 |
−0.28 |
−2.52 |
||
|
DSQ Dp |
−0.43 |
0.16 |
−0.32 |
−2.80 |
0.31 |
0.05 |
|
Model 3 |
||||||
|
DSQ Ds |
−0.25 |
0.10 |
−0.30 |
−2.52 |
||
|
DSQ Dp |
−0.46 |
0.17 |
−0.33 |
−2.77 |
||
|
DSQ Ax |
−0.05 |
0.11 |
0.05 |
0.45 |
0.31 |
0.00 |
|
Model and predictor variables |
B |
SE B |
β |
t |
R 2 |
∆R 2 |
|---|---|---|---|---|---|---|
|
Model 1 |
||||||
|
DSQ Ds |
−0.27 |
0.07 |
−0.34 |
−3.92 |
0.115 |
0.115 |
|
Model 2 |
||||||
|
DSQ Ds |
−0.25 |
0.10 |
−0.31 |
−0.24 |
0.116 |
0.00 |
|
DSQ Dp |
−0.05 |
0.16 |
−0.04 |
−0.31 |
||
|
Model 3 |
||||||
|
DSQ Ds |
−0.31 |
0.11 |
−0.40 |
−2.98 |
0.150 |
0.034 |
|
DSQ Dp |
−0.18 |
0.17 |
−0.14 |
−1.04 |
||
|
DSQ Ax |
−0.24 |
0.11 |
0.25 |
2.15 |
|
Model and predictor variables |
B |
SEB |
Β |
t |
R2 |
∆R2 |
|---|---|---|---|---|---|---|
|
Model 1 |
||||||
|
DSQ Ds |
−0.11 |
0.03 |
−0.31 |
−3.60 |
0.09 |
0.09 |
|
Model 2 |
||||||
|
DSQ Ds |
−0.05 |
0.04 |
−0.14 |
−1.08 |
0.11 |
0.03 |
|
DSQ Dp |
−0.13 |
0.07 |
−0.24 |
−1.87 |
||
|
Model 3 |
||||||
|
DSQ Ds |
−0.03 |
0.05 |
−0.08 |
−0.59 |
0.12 |
0.02 |
|
DSQ Dp |
−0.10 |
0.08 |
−0.17 |
−1.26 |
||
|
DSQ Ax |
−0.07 |
0.05 |
−0.17 |
−1.46 |
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Publication History
Article published online:
17 May 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Fig 1:Pie chart showing distribution of reproductive cancer patients in the sample (n = 120). Ca Breast, breast cancer; Ca Cervix, cervical cancer; Ca Endometrium, endometrial cancer; Ca Ovary, ovarian cancer; Ca Penis, cancer in penis; Ca Prost, prostrate cancer; Ca Scrotum, scrotal cancer; Ca Vulva, cancer in vulva.
Fig 2:Bar graph showing the distribution of stages of different types of reproductive cancer in the study. Participants in the study are majorly of reproductive cancer stages 3 and 2.
Fig 3:Bar graph showing age of reproductive cancer patients. Mean age of reproductive cancer patients in the study (n=120).
References
- Tsamakis K, Gavriatopoulou M, Schizas D. et al. Oncology during the COVID-19 pandemic: challenges, dilemmas and the psychosocial impact on cancer patients. Oncol Lett 2020; 20 (01) 441-447
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