Psychosocial contributors to psychological and physical health-related outcomes in adults with poor prognosis cancer and their caregivers

Background: Psychosocial correlates of mental and physical health related outcomes in poor-prognosis cancers are relatively understudied in comparison more favorable prognosis cancers. Relevant theory in stress and coping and social cognitive processes posit associations among cognitive appraisals, coping processes and adjustment to stressors and that these processes occur in a social context. Diagnosis of poor-prognosis cancer represents a profound health threat and activates cancer-related appraisals, including assessments of treatment goals and survival, as well as coping processes in attempts to mitigate the impact of the stressor. A cancer diagnosis typically involves additional individuals that serve in a supportive role, termed caregivers. Two studies were designed to examine facets of illness perceptions, coping, and mental and physical health-related outcomes to inform theoretical understanding of these constructs and to identify potentially malleable treatment targets in adults diagnosed with poor-prognosis cancer and their caregivers. Method: Adults diagnosed with lung (n = 52) or pancreatic (n = 36) cancer and their primary caregivers (n = 48) were enrolled from 2017 to 2020 in two separate studies focused on the experience of each respective cancer. Patients and caregivers in both studies reported sociodemographic and medical characteristics as well as completed measures of depressive symptoms, anxiety, life disruption from pain, and approach- and avoidance-oriented coping processes. In Study 1, patients completed a measure of prognosis and treatment perceptions. Study 1 examined the association of prognosis and treatment perceptions with depressive symptoms, anxiety, and life disruption from pain as and the moderating capacity of coping processes in these hypothesized associations using multiple regression analysis. Study 2 examined the interdependence of patient and caregiver coping processes and depressive symptoms, anxiety, and life disruption from pain using Actor Partner Interdependence Modeling. Results: Participants were adults who were diagnosed lung (n = 52) or pancreatic (n = 36) and their primary caregivers (lung n = 20, pancreatic n = 28). Both patients and caregivers were mostly older adults (patient M age = 66, caregiver M age = 62) who were white, well-educated, and financially secure. Nearly two-thirds of caregivers were women (n = 30, 62.5%), while about half the patients were women (n = 48, 54.5%). The overall sample was nearly 3 years post-initial diagnosis. Average depressive symptoms and anxiety were below clinical cutoffs, and average life disruption from pain was “within normal limits,” for both patients and caregivers. Rates of clinically elevated depressive symptoms in patients were lower than other advanced cancer samples and comparable to rates found in people with more favorable prognosis cancers. Patients diagnosed with pancreatic cancer reported clinically elevated anxiety at rates comparable to more favorable prognosis cancers, and lung cancer patients reported anxiety comparable with the general population. Caregivers reported levels of clinically elevated depressive symptoms and anxiety that were comparable to other advanced cancer samples and substantially greater than rates in the general population. Caregivers reported significantly higher rates of anxiety than patients, and patients diagnosed with pancreatic cancer and their caregivers reported greater anxiety than those diagnosed with lung cancer. Depressive symptoms, anxiety, and life disruption from pain did not differ as a function of gender. About one-third of patients reported a terminal illness perception, and there was discordance between perceived prognosis and treatment intent in about half the sample. Terminal (vs non-terminal) illness perception was associated with greater depressive symptoms and anxiety, but not with life disruption from pain. In patients, greater use of active coping was associated with lower depressive symptoms and buffered the association between terminal prognosis perception and greater depressive symptoms. Greater use of emotional processing coping was also associated with lower anxiety symptoms and buffered the association between terminal prognosis perception and greater anxiety symptoms. Greater acceptance coping was also associated with lower depressive symptoms. In caregivers, greater emotional expression coping was associated with lower depressive symptoms and less life disruption from pain. In both patients and caregivers, greater avoidance-oriented coping was associated with greater depressive symptoms and life disruption from pain and was also associated with greater anxiety in caregivers. Interdependence was observed between patient avoidance and caregiver depressive symptoms, though no other evidence of interdependence between patient and caregiver coping and outcomes was observed. Conclusions: Both patients and caregivers reported clinically elevated depressive symptoms and anxiety at higher rates than the general population. Patients diagnosed with pancreatic cancer and their caregivers were particularly vulnerable to psychological distress. Approach-oriented coping processes related to the cancer experience of active coping, emotional processing, and acceptance coping were associated with favorable outcomes in patients, and active coping and emotional processing buffered the impact of terminal prognosis perception on depressive symptoms and anxiety, respectively. Emotional expression coping was beneficial in caregivers. Avoidance-oriented coping was maladaptive in both patients and caregivers and was interdependent between patients’ avoidance and caregivers’ depressive symptoms. Interventions may promote emotional expression in caregivers, and promote active coping, emotional processing, and acceptance in patients, and reduce experiential avoidance in patients in caregivers. Future research should focus on differential effects of prognosis perceptions and coping on mental and physical health-related outcomes at distinct points along the cancer trajectory, incorporate cultural considerations, and focus on adapting existing interventions to use in the context of poor-prognosis cancer