title: Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator.
abstract: BACKGROUND
  Continuing symptoms and poor health following cancer treatments may alter meaning in life for cancer survivors. Gynecologic cancer survivors are particularly troubled with physical sequelae. In addition, for the most common sites of disease, such as breast and gynecologic cancers, the prevalence of depression is also high.
  
  
  OBJECTIVE
  This study tests meaning in life as a mechanism for the relationship between physical symptoms and depressive symptoms.
  
  
  METHODS
  Gynecologic cancer survivors (N = 260) participated. Measures of physical sequelae (nurse rated symptoms/signs, patient-reported gynecologic symptoms), meaning in life (harmony, life purpose, spirituality, and conversely, confusion and loss), and depressive symptoms were obtained at the time of a routine clinical follow-up visit 2-10 years following the completion of treatment. Latent variables were defined, and structural equation modeling tested a mediator model.
  
  
  RESULTS
  Analyses support partial mediation. That is, survivors with more physical sequelae also reported lower levels of meaning in life, which was associated with higher levels of depressive symptoms.
  
  
  CONCLUSIONS
  Gynecologic cancer patients have been neglected in psychosocial research, and findings highlight the importance of existential issues in their lives. While many adjust well, those with persistent physical functioning deficits may experience depressive symptoms. By appreciating the role of meaning in their experience, we may help survivors foster their own growth and perspectives important for their future.
authors.affiliation: Department of Psychology, The Ohio State University, 1835 Neil Ave., Columbus, OH 43210-1222, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Simonelli
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fowler
authors.forename: G Larry
authors.initials: GL
authors.lastname: Maxwell
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Andersen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000150:complications / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*