Haydee C Verduzco-Aguirre1, Dilip Babu2, Supriya G Mohile3, Javier Bautista3, Huiwen Xu3, Eva Culakova3, Beverly Canin3, Yingzi Zhang4, Megan Wells3, Ronald M Epstein5, Paul Duberstein6, Colin McHugh3, William Dale7, Alison Conlin8, James Bearden9, Jeffrey Berenberg10, Mohamedtaki Tejani11, Kah Poh Loh12. 1. Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. 2. Kaiser Permanente, Portland, Oregon, USA. 3. James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA. 4. University of Rochester School of Nursing, Rochester, New York, USA. 5. James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. 6. Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA. 7. Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA. 8. Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington, USA. 9. Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA. 10. Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii, USA. 11. AdventHealth, Orlando, Florida, USA. 12. James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA. Electronic address: kahpoh_loh@urmc.rochester.edu.
Abstract
CONTEXT: Older adults with advanced cancer face uncertainty related to their disease and treatment. OBJECTIVES: To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer. METHODS: Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential. RESULTS: We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8). CONCLUSION: Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.
CONTEXT: Older adults with advanced cancer face uncertainty related to their disease and treatment. OBJECTIVES: To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer. METHODS: Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential. RESULTS: We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8). CONCLUSION: Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.
Authors: Patricia A Parker; Frances Alba; Bryan Fellman; Diana L Urbauer; Yisheng Li; Jose A Karam; Nizar Tannir; Eric Jonasch; Christopher G Wood; Surena F Matin Journal: Eur Urol Date: 2013-02-09 Impact factor: 20.096
Authors: Patricia A Parker; John W Davis; David M Latini; George Baum; Xuemei Wang; John F Ward; Deborah Kuban; Steven J Frank; Andrew K Lee; Christopher J Logothetis; Jeri Kim Journal: BJU Int Date: 2015-04-21 Impact factor: 5.588
Authors: Erin B Moth; Belinda E Kiely; Andrew Martin; Vasi Naganathan; Stephen Della-Fiorentina; Florian Honeyball; Rob Zielinski; Christopher Steer; Hiren Mandaliya; Abiramy Ragunathan; Prunella Blinman Journal: J Geriatr Oncol Date: 2019-08-19 Impact factor: 3.599
Authors: Mackenzi Pergolotti; Allison M Deal; Grant R Williams; Ashley L Bryant; Jeannette T Bensen; Hyman B Muss; Bryce B Reeve Journal: J Geriatr Oncol Date: 2017-03-09 Impact factor: 3.599
Authors: Kah Poh Loh; Supriya G Mohile; Jennifer L Lund; Ronald Epstein; Lianlian Lei; Eva Culakova; Colin McHugh; Megan Wells; Nikesha Gilmore; Mostafa R Mohamed; Charles Kamen; Valerie Aarne; Alison Conlin; James Bearden; Adedayo Onitilo; Marsha Wittink; William Dale; Arti Hurria; Paul Duberstein Journal: Oncologist Date: 2019-04-23
Authors: Supriya G Mohile; Ronald M Epstein; Arti Hurria; Charles E Heckler; Beverly Canin; Eva Culakova; Paul Duberstein; Nikesha Gilmore; Huiwen Xu; Sandy Plumb; Megan Wells; Lisa M Lowenstein; Marie A Flannery; Michelle Janelsins; Allison Magnuson; Kah Poh Loh; Amber S Kleckner; Karen M Mustian; Judith O Hopkins; Jane Jijun Liu; Jodi Geer; Rita Gorawara-Bhat; Gary R Morrow; William Dale Journal: JAMA Oncol Date: 2020-02-01 Impact factor: 31.777
Authors: Siobhan C McKay; Hanns Lembach; Angus Hann; Kelvin Okoth; Joy Anderton; Krishnarajah Nirantharakumar; Laura Magill; Barbara Torlinska; Matthew Armstrong; Jorge Mascaro; Nicholas Inston; Thomas Pinkney; Aaron Ranasinghe; Richard Borrows; James Ferguson; John Isaac; Melanie Calvert; M Thamara P R Perera; Hermien Hartog Journal: Transpl Int Date: 2021-09-16 Impact factor: 3.842
Authors: K L Luu; F E Witkamp; D Nieboer; E M Bakker; L W Kranenburg; C C D van der Rijt; K Lorig; A van der Heide; J A C Rietjens Journal: BMC Palliat Care Date: 2022-06-13 Impact factor: 3.113
Authors: Yingzi Zhang; Supriya Mohile; Eva Culakova; Sally Norton; Kah Poh Loh; Sindhuja Kadambi; Lee Kehoe; Valerie Aarne Grossman; Victor G Vogel; Brian L Burnette; Thomas P Bradley; Marie Flannery Journal: Psychooncology Date: 2022-02-20 Impact factor: 3.955
Authors: Paul K J Han; Elizabeth Scharnetzki; Eric Anderson; John DiPalazzo; Tania D Strout; Caitlin Gutheil; F Lee Lucas; Emily Edelman; Jens Rueter Journal: J Pain Symptom Manage Date: 2021-12-22 Impact factor: 3.612