Vital Signs: Recognizing and Managing Distress

Recognizing & managing distress can lead to better outcomes.

BY LAURA BEIL
PUBLISHED: JUNE 18, 2013
The National Comprehensive Cancer Network (NCCN) describes distress as "an unpleasant emotional experience of a psychological, social and/or spiritual nature that extends on a continuum from normal feelings of vulnerability, sadness and fears to problems that become disabling, such as depression, anxiety, panic, social isolation and existential and spiritual crises."

Yet it's a spectrum—there’s no distinct borderline that separates normal worry from distress, says Barbara Andersen, a psychology professor at The Ohio State University in Columbus, Ohio. Generally speaking, people with distress have trouble carrying on with everyday life. "The issue is when the level of distress gets so high it causes other impairments in your life," she says, such as trouble sleeping, loss of appetite, lack of interest and irritability.

Zabora began to focus on distress almost three decades ago. When he started talking to patients about how they were feeling, he says, "a gentleman came up to me and said, 'I want to thank you. You were the only one to ask me about me.' I think most people who are distressed know they are distressed."

"We know from numerous research studies that if we do not offer these patients appropriate treatment, they will suffer psychologically from their illness," he adds.

It's not unusual to experience distress after a cancer diagnosis, but distress becomes a prevailing life force for some patients more than others. The vulnerability to distress is as individual as each patient and each cancer type. In a 2001 study in the journal Psycho-Oncology, Zabora and his colleagues from The Johns Hopkins University School of Medicine in Baltimore reported that among a sample of about 4,500 patients, the overall presence of distress was about 35 percent. But among those with lung cancer, approximately 43 percent experienced distress. And a study published in 2012 in the same journal suggested that among various types of cancer, men with prostate cancer appeared to be the least likely to suffer from distress. Demographics can make a difference, too. One study in the journal BMC Cancer found that single, young women with cancer appeared to be the most prone to psychosocial difficulties.

Moreover, patients' mental health before cancer contributes a great deal to their mental health after, Andersen says.

"The individuals most at risk are those most at risk for depression in general," she says. Depression affects nearly one in 10 adults. "In cancer patients, at least half who become clinically depressed after diagnosis have had a prior episode [of depression] before they had cancer." She also says that some of the people who are of concern include those who are alone or socially isolated, or who are coping with other stressful circumstances in their lives, such as losing a job or having a poor marital relationship.

Distress is not limited to patients alone. Researchers from Indiana University-Purdue University Indianapolis recently reported results of a study of 91 caregivers of people with lung cancer. More than half of those surveyed reported "negative emotional effects." (The psychological aftershocks of cancer are not all bad, though. About 40 percent of caregivers said their family relationships had improved.)

Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.
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