Patient perception of disease control and psychological distress

Abstract

Eva Mazzotti,1 Claudia Sebastiani,1 Paolo Marchetti1,21Division of Oncology and Dermatological Oncology, Istituto Dermopatico dell’Immacolata, Istituto di Ricerca e Cura a Carattere Scientifico, 2Faculty of Medicine and Psychology, Saint Andrew Hospital, “Sapienza” University of Rome, Rome, ItalyBackground: Risk perception and efficacy beliefs affect health behavior. The aim of this study was to measure cancer severity and curability (as proxy for risk perception and efficacy beliefs, respectively) and their association with clinical and psychosocial variables. Methods: A consecutive sample of cancer patients were recruited and assessed for sociodemographic and medical data, patient perception of cancer severity and curability, and quality of life. The main outcome measures were the depression and anxiety components as measured by the Hospital Anxiety and Depression Scale (HADS). Results: Subjective and objective measures of severity and curability were found to be associated. The perception of one’s own disease as severe and difficult to cure, as opposed to severe but curable, was strongly associated with depression (OR = 6.93; P = 0.048) when adjusted for potential confounding factors. Factors independently associated with anxiety were the perception of difficulty to cure (OR = 15.73; P = 0.018), having religious beliefs (OR = 49.74; P = 0.013), and metastasis (OR = 18.42; P = 0.015), when adjusted for sex, marital status, site of cancer, and time from diagnosis. Differences in curability beliefs did not affect any quality of life domain.Conclusion: Patients and clinicians may have different perceptions of disease and treatment. The perception of control and curability must be taken into account to identify cancer patients who are suffering most and require special medical care, as these factors have an effect on depression and anxiety.Keywords: cancer, curability, patient perception, perceived control, psychological distress