Appraisal of illness, symptom distress, self-care burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer.

Cancer recurrence may present unique stressors for patients receiving chemotherapy. The objectives of this exploratory study were to (1) describe perceptions of symptom distress, self-care burden, appraisal of illness, and mood in patients undergoing chemotherapy, (2) identify differences in these perceptions according to stage of illness (new versus recurrent cancer), and (3) test a theoretical model of the mediating effects of appraisal. Subjects completed a modified Symptom Distress Scale, the Self-Care Burden Scale, the Family Hardiness Index, the Appraisal of Illness Scale, the short form of the Profile of Mood States, and a self-report form that included personal and illness characteristics and questions about the subjects' current situation. The 60 subjects were outpatients being treated for initial cancer (n = 28) or recurrent cancer (n = 32). Those with recurrence had higher symptom distress and health deviation self-care burden scores and more stressful appraisals; mood scores were low and did not differ between groups. Appraisal, symptom distress, and perceived seriousness predicted 36% of variance in affective mood, with appraisal partially mediating the effects of symptom distress. Somatic mood (36%) was best predicted by symptom distress and universal self-care burden (USCB). Economic status, symptom distress, and recurrence status predicted 49% of appraisal variance. Symptom distress was predicted best by recurrence and symptom control; USCB was predicted best by economic status and perceived dependency. Results suggest the need for different nursing interventions for the two groups. Further model testing is recommended.