Effect of sex on psychological distress and fatigue over time in a prospective cohort of cancer survivors

Gabriella Rondanina1,2, Giacomo Siri1, Domenico Marra1, Andrea DeCensi1,2,3,4
1E. O. Ospedali Galliera, Genoa, Italy
2Villa Serena Hospital, GVM, Genoa, Italy
3Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
4European Institute of Oncology, IRCCS, Milan, Italy

Tóm tắt

Studies indicate a higher level of distress in women than men with cancer, but whether this difference is retained over time is unknown. We studied the frequency and level of distress and fatigue during time according to gender in a cohort of cancer survivors. In this prospective study, cancer survivors were invited to undergo a psychological session immediately before the medical visit. Distress was assessed by the distress thermometer, and fatigue was assessed by the ESAS-r scale. Patients underwent follow-up visits to assess changes over time. A total of 305 patients and 568 visits were performed with a median follow-up of 15.8 months. At baseline, females, young age, and breast cancer patients had significantly higher distress. However, there was an increase in distress of 0.29 points every 6 months in males (95% CI, 0.09–0.50) versus no change in females (0.03 points, 95% CI, − 0.09–0.15; p-interaction = 0.01). The different behavior of cancer distress during time according to gender was more evident in subjects aged 68 or older due to increasing physical problems in men (p-interaction = 0.005). There was no change in fatigue with time according to sex. Women, younger age, and breast cancer patients had increased cancer distress at the initial visit. However, women tend to stabilize during follow-up, whereas men tend to worsen their distress, especially because of physical and emotional problems, suggesting different coping capabilities. The study is registered at ClinicalTrials.gov NCT05122052. Interventions aimed at improving recognition of emotions related to disease experience in male cancer survivors appear necessary.

Tài liệu tham khảo

Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90:2297–304. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10:19–28. Bultz BD, Carlson LE. Emotional distress: the sixth vital sign–future directions in cancer care. Psychooncology. 2006;15(2):93. Boyes A, Newell S, Girgis A, McElduff P, Sanson-Fisher R. Does routine assessment and real-time feedback improve cancer patients’ psychosocial well-being? Eur J Cancer Care (Engl). 2006;15(2):163–71. https://doi.org/10.1111/j.1365-2354.2005.00633.x. Kim GM, Kim SJ, Song SK, Kim HR, Kang BD, Noh SH, Chung HC, Kim KR, Rha SY. Prevalence and prognostic implications of psychological distress in patients with gastric cancer. BMC Cancer. 2017;17(1):283. https://doi.org/10.1186/s12885-017-3260-2. Leung B, Shokoohi A, Bates A, Ho C. Patient-reported psychosocial needs and psychological distress predict survival in geriatric oncology patients. J Geriatr Oncol. 2020;12(4):612–7. https://doi.org/10.1016/j.jgo.2020.10.001. Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer. 2001;84(8):1011–5. https://doi.org/10.1054/bjoc.2001.1724. van Scheppingen C, Schroevers MJ, Smink A, van der Linden YM, Mul VE, Langendijk JA, Coyne JC, Sanderman R. Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psychooncology. 2011;20(6):655–63. https://doi.org/10.1002/pon.1939. Faller H, Weis J, Koch U, et al. Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. J Psychosom Res. 2016;81:24–30. https://doi.org/10.1016/j.jpsychores.2015.12.004. Hamama-Raz Y. Does psychological adjustment of melanoma survivors differs between genders? Psychooncology. 2012;21(3):255–63. https://doi.org/10.1002/pon.1889. Nicholas DR. Men, masculinity, and cancer: risk-factor behaviors, early detection, and psychosocial adaptation. J Am Coll Health. 2000;49(1):27–33. https://doi.org/10.1080/07448480009596279. Maliski SL, Rivera S, Connor S, Lopez G, Litwin MS. Renegotiating masculine identity after prostate cancer treatment. Qual Health Res. 2008;18(12):1609–20. https://doi.org/10.1177/1049732308326813. Hoyt MA. Gender role conflict and emotional approach coping in men with cancer. Psychol Health. 2009;24(8):981–96. https://doi.org/10.1080/08870440802311330. Lennon J, Hevey D, Kinsella L. Gender role conflict, emotional approach coping, self-compassion, and distress in prostate cancer patients: a model of direct and moderating effects. Psychooncology. 2018;27(8):2009–15. https://doi.org/10.1002/pon.4762. Vogelzang NJ, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: result of a tripart assessment survey. Semin Hematol. 1997;34:4–12. Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K, Ripamonti CI. ESMO guidelines committee. Electronic address: [email protected]. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Ann Onco. 2020;31(6):713–23. https://doi.org/10.1016/j.annonc.2020.02.016. Ptacek JT, Pierce GR, Ptacek JJ. Coping, distress, and marital adjustment in couples with cancer: an examination of the personal and social context. J Psychosoc Oncol. 2007;25(2):37–58. https://doi.org/10.1300/J077v25n02_03. DonovanKA Grassi L, McGinty HL, Jacobsen PB. Validation of the distress thermometer worldwide: state of the science. Psychooncology. 2014;23(3):241–50. https://doi.org/10.1002/pon.3430. Moro C, Brunelli C, Miccinesi G, Fallai M, Morino P, Piazza M, Labianca R, Ripamonti C. Edmonton symptom assessment scale: Italian validation in two palliative care settings. Support Care Cancer. 2006;14(1):30–7. https://doi.org/10.1007/s00520-005-0834-3. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: distress management Version1. 2013 Grassi L, Johansen C, Annunziata MA, Capovilla E, Costantini A, Gritti P, Torta R, Bellani M. Italian Society of Psycho-Oncology Distress Thermometer Study Group. Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer. 2013;119(9):1714–21. https://doi.org/10.1002/cncr.27902. Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health. 2005;4:11. https://doi.org/10.1186/1475-9276-4-11. Mehnert A. Predictors of early retirement after cancer rehabilitation—a longitudinal study. Eur J Cancer Care. 2006. https://doi.org/10.1111/ecc.12528. Tan CJ, Yip SYC, Chan RJ, Chew L, Chan A. Investigating how cancer-related symptoms influence work outcomes among cancer survivors: a systematic review. J Cancer Surviv. 2021. https://doi.org/10.1007/s11764-021-01097-5. Loge JH, Abrahamsen AF, Ekeberg O, Hannisdal E, Kaasa S. Psychological distress after cancer cure: a survey of 459 Hodgkin’s disease survivors. Br J Cancer. 1997;76:791–6. Rohrbaugh MJ, Cranford JA, Shoham V, Nicklas JM, Sonnega JS, Coyne JC. Couples coping with congestive heart failure: role and gender differences in psycho- logical distress. J Fam Psychol. 2002;16:3–13. McDonough P, Walters V. Gender and health: reassessing patterns and explanations. Soc Sci Med. 2001;52:547–59. Keller M, Henrich G. Illness-related distress: does it mean the same for men and women? Gender aspects in cancer patients’ distress and adjustment. Acta Oncol. 1999;38(6):747–55. https://doi.org/10.1080/028418699432905. Johnson BS, Shepard S, Torgeson T, Johnson A, McMurray M, Vassar M. Using Google Trends and Twitter for prostate cancer awareness: a comparative analysis of prostate cancer awareness month and breast cancer awareness month. Cureu. 2021;13(2):e13325. https://doi.org/10.7759/cureus.13325. Chaplin TM. Gender and emotion expression: a developmental contextual perspective. Emot Rev. 2015;7(1):14–21. https://doi.org/10.1177/1754073914544408. Liss-Levinson WS. Clinical observations on the emotional responses of males to cancer. Psychotherapy Theory, Res & Prac. 1982;19(3):325–30. Wan Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open. 2013;3(8):e003320. https://doi.org/10.1136/bmjopen-2013-003320. Aznar A, Tenenbaum HR. Gender and age differences in parent-child emotion talk. Br J Dev Psychol. 2015;33(1):148–55. https://doi.org/10.1111/bjdp.12069. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/crude-suicide-rates-(per-100-000-population) Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219–21. https://doi.org/10.1503/jpn.150205. Suarez-Almazor ME, Newman C, Hanson J, Bruera E. Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. J Clin Oncol. 2002;20(8):2134–41. https://doi.org/10.1200/JCO.2002.08.025 (PMID: 11956275). Peleg-Oren N, Sherer M, Soskolne V. Effect of gender on the social and psychological adjustment of cancer patients. Soc Work Health Care. 2003;37(3):17–34. https://doi.org/10.1300/J010v37n03_02. Hoyt MA, Stanton AL, Irwin MR, Thomas KS. Cancer-related masculine threat, emotional approach coping, and physical functioning following treatment for prostate cancer. Health Psychol. 2013;32(1):66–74. https://doi.org/10.1037/a0030020. Clocchiatti A, Cora E, Zhang Y, Dotto GP. Sexual dimorphism in cancer. Nat Rev Cancer. 2016;16(5):330–9. https://doi.org/10.1038/nrc.2016.30. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626–38. https://doi.org/10.1038/nri.2016.90. Hwang WJ, Lee TY, Kim NS, Kwon JS. The role of estrogen receptors and their signaling across psychiatric disorders. Int J Mol Sci. 2020;22(1):373. https://doi.org/10.3390/ijms22010373. Azcoitia I, Barreto GE, Garcia-Segura LM. Molecular mechanisms and cellular events involved in the neuroprotective actions of estradiol. Anal Sex Differences Front Neuroendocrino. 2019;55:100787. https://doi.org/10.1016/j.yfrne.2019.100787. Torta R, Ieraci V, Zizzi FA. Review of the emotional aspects of neuropathic pain: from comorbidity to co-pathogenesis. Pain Ther. 2017;6(Suppl 1):11–7. https://doi.org/10.1007/s40122-017-0088-z.