Demoralization and depression in patients with advanced cancer: Prevalence and related symptoms

The concept of demoralization (DS) has been widely used to describe states of “nonspecific“ distress, a self-perceived incapacity to deal effectively with a specific stressful situation or a combination of distress and feelings of subjective incompetence. Particularly emphasis has been placed on the distinction between DS, anhedonia and symptoms of depression, which seem phenomenologically closely related. Aim of this study was to explore prevalence of demoralization and depression in patients with advanced cancer. Patients with heterogeneous tumor sites (UICC cancer stages III/IV or cancer recurrence) were recruited in several treatment facilities and completed measures such as the Demoralization Scale, PHQ–9 and GAD–7. The mean age of the 516 participants was 58 years (SD 12); 53% were male. The total mean DS score was M=29.8 (SD=10.4). Among all patients, 24% were classified as having depression. On the basis of the cutoff value of >30, 202 patients (39%) had high levels of DS. We identified 101 cases with high scores on DS but low scores on depression. Using the cutoff value based on the mean value (±1 SD), 81 patients (16%) were classified as having high levels of DS and 377 patients (73%) as having moderate levels of DS. The study provides evidence that DS is a frequent syndrome among patients with advanced cancer. Despite of a partial overlap with depression findings indicate that DS is a distinct concept of high clinical relevance in this population.

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cancer - demoralization - palliative care - psycho-oncology