title: Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer.
abstract: BACKGROUND
  Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase.
  
  
  METHODS
  A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted.
  
  
  RESULTS
  We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02): the effect of age on demoralization was negative for women receiving palliative treatment (b = -.26, P = .02) and positive for men receiving palliative treatment (b = .25, P = .03). Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001) and social support (b = -3.17, P<.001).
  
  
  CONCLUSIONS
  Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential distress in subgroups of cancer patients.
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. s.vehling@uke.de
authors.forename: Sigrun
authors.initials: S
authors.lastname: Vehling
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.forename: Uwe
authors.initials: U
authors.lastname: Koch
authors.forename: Anja
authors.initials: A
authors.lastname: Mehnert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D010166:Palliative Care; D012044:Regression Analysis; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
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