Distress and Quality of Life among Elderly Patients with Gastric Cancer: The Mediating Effect of Social Support

Yoon Sun Kim; Young Sook Tae; Gum Hee Nam

doi:10.7475/kjan.2017.29.5.536

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Kim, Tae, and Nam: Distress and Quality of Life among Elderly Patients with Gastric Cancer: The Mediating Effect of Social Support

Original Article

Korean J Adult Nurs 2017;29(5):536-546.

Published online: 9 October 2017

DOI: https://doi.org/10.7475/kjan.2017.29.5.536

Distress and Quality of Life among Elderly Patients with Gastric Cancer: The Mediating Effect of Social Support

Yoon Sun Kim, MSN, APN¹, Young Sook Tae, Ph.D., RN^2,, Gum Hee Nam, MSN, APN³

¹Dongnam Institute of Radiological • Medical Sciences, Busan, Korea

²College of Nursing, Kosin University, Busan, Korea

³Research Institute of Holistic Nursing Science, Kosin University, Busan, Korea

Corresponding author: Tae, Young Sook College of Nursing, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-3954, Fax: +82-51-990-3031, E-mail: taehope@kosin.ac.kr

- This study was supported by the research fund of Kosin University in 2016.

Received 16 August 201712 October 2017 Accepted 19 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to describe the mediating effect of social support and its relationship between distress and quality of life (QoL) of elderly patients with gastric cancer.

Methods

186 elderly patients who visited an inpatient/outpatient at two cancer hospitals were recruited from May 30 to July 26, 2017. Distress, social support, and QoL were measured using structured questionnaires such as Distress Thermometer and Problem list, Perceived Social Support scale, and QoL scale for Korean patients with cancer. The mediating effects were analyzed by a multiple hierarchical regression.

Results

Distress was found to have significant negative correlations with social support (r=-.47, p<.001) and QoL (r=-.58, p<.001). There was a positive correlation between social support and QoL (r=.72, p<.001). The influencing factors on QoL were education, recurrence, sleep, dietary problem, distress, and social support. These variables were explained 66% of the variance in QoL. The direct effect of distress on QoL was significant (β=-.24, p<.001) and the indirect effect of distress on QoL via social support was significant (z=-4.14, p<.001).

Conclusion

Based on this study findings, intervention programs directed at re-ducing distress by focusing on bolstering social support is recommended to improve QoL in elderly patients with gastric cancer.

Keywords: Aged, Stomach neoplasms, Social support, Quality of life

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Figure 1.

Model for mediating effect of social support between distress and quality of life.

Table 1.

Differences in Quality of Life according to General Characteristics (N=186)

Variables	Categories		n (%)	M± SD	t or F (p) Scheffé
Gender	Male		116 (62.4)	67.41±11.21	2.69 (.008)
Gender	Female		70 (37.6)	62.86±11.07
Age(year)	65~69		69 (37.1)	68.20±11.27	2.34 (.067)
	70~79		91 (48.9)	64.16±11.50
	≥80		26 (14.0)	64.38±10.14
Religion	None		61 (32.8)	64.26±10.87	1.47 (.225)
	Christian		53 (28.5)	65.15±12.78
	Buddhist		62 (33.3)	66.58±10.94
	Catholic, Others		10 (5.4)	71.80±6.36
Education	None ^a		14 (7.5)	60.14±7.82	5.93 (＜.001)
	Elementary school ^b		58 (31.2)	63.45±9.41	e＞ a, b, c
	Junior high school ^c ^d		44 (23.7)	64.27±10.97
	High school ^d		61 (32.8)	68.18±12.28
	≥ College/university ^e		9 (4.8)	78.89±11.10
Occupation	Yes		86 (46.2)	66.57±11.91	0.98 (.330)
Occupation	No		100 (53.8)	64.94±10.84
Marital status	Married ^a		138 (74.2)	67.04±11.50	4.43 (.013)
	Divorced, Separated ^b		9 (4.8)	65.33±11.85	a＞ c
	Widowed ^c		39 (21.0)	61.03±9.54
Caregiver	Spouse ^a		129 (69.4)	67.04±11.71	3.29 (.039)
	Children or daughter-in-law ^b		44 (23.7)	62.07±9.57	a＞ b
	Others ^c		13 (6.9)	64.62±11.21
Economic status	Independent ^a		85 (45.7)	71.16±10.77	24.37 (＜.001)
	Partially dependent on their children ^b		63 (33.9)	62.48±9.89	a＞ b, c
	Totally dependent on their children, etc ^c		38 (20.4)	58.99±8.99
Months since diagnosed	0~6 ^a		45 (24.2)	64.67±11.42	0.49 (.687)
	7~12 ^b		18 (9.7)	68.50±12.45
	13~24 ^c		39 (21)	65.44±11.99
	≥25 ^d		84 (45.2)	65.76±10.86
Type of treatment	Operation		81 (43.5)	67.49±11.21	2.15 (.119)
	Operation and chemotherapy		83 (44.6)	64.76±11.69
	Chemotherapy, ect		22 (11.8)	62.59±9.81
Recurrence of disease	Yes		12 (6.5)	57.75±14.56	-2.55 (.012)
Recurrence of disease	No		174 (93.5)	66.24±10.93
The list of basic physical assessments for the elderly	Sleeping	Yes	122 (65.0)	61.89±9.84	-7.10 (＜.001)
		No	64 (35.0)	72.94±10.53
	Eating	Yes	105 (56.5)	60.10±8.28	-8.95 (＜.001)
		No	81 (43.5)	72.95±10.68
	Confusion or delirium	Yes	7 (3.8)	64.43±11.63	-3.00 (.765)
		No	179 (96.2)	65.74±11.36
	Previous falls	Yes	9 (4.8)	60.67±9.31	-1.37 (.174)
		No	177 (95.2)	65.95±11.40
	Skin	Yes	148 (79.6)	64.23±10.77	-3.59 (＜.001)
		No	38 (20.4)	71.39±11.87

Table 2.

Descriptive Statistics of Distress, Social Support, and Quality of Life (N=186)

Variables	Categories	n (%)	M± SD	Range	Minimum	Maximum
Distress thermometer			4.96±1.59	0~10	1	10
Score	＜4	38 (20.4)
Score	≥4	148 (79.6)
Distress level	Total		12.12±5.09	0~35	0	24
	Emotional problem		0.59±0.37	0~1
	Physical problem		0.35±0.14
	Spiritual problem		0.18±0.38
	Family problem		0.30±0.55
	Practical problem		0.14±0.16
Social support	Total		2.98±0.67	1~5	1	5
	Family support		3.43±0.59
	Medical team support		2.53±0.50
Quality of life	Total		3.28±0.57	1~5	2	5
	Physical		3.89±0.62
	Emotional		3.47±0.73
	Social		2.33±0.91
	Coping		2.87±0.81

Table 3.

Influencing Factors on QoL among Elderly Patients with Gastric Cancer (N=186)

Variables	Step 1					Step 2
Variables	B	SE	β	t	p	B	SE	β	t	p
Gender^†	-.05	.08	-.04	-0.65	.515	-.03	.06	-.02	-0.47	.641
Education level^†	-.11	.08	-.09	-1.47	.144	-.15	.06	-.12	-2.59	.011
Marital status^†	.23	.11	.18	2.07	.040	.14	.09	.11	1.58	.117
Caregiver^†	.08	.12	.06	0.67	.502	.04	.09	.03	0.41	.682
Economic status^†	-.10	.07	-.08	-1.36	.176	-.06	.06	-.05	-1.13	.259
Recurrence^†	.24	.13	.10	1.79	.075	.21	.10	.09	2.09	.038
Sleeping^†	-.32	.08	-.27	-4.24	＜.001	-.12	.06	-.10	-2.02	.045
Eating^†	-.45	.08	-.40	-5.92	＜.001	-.21	.06	-.18	-3.36	＜.001
Skin^†	-.04	.09	-.03	-0.44	.663	.00	.07	.00	0.05	.996
Distress						-.08	.02	-.24	-4.77	＜.001
Social support						.03	.00	.41	8.14	＜.001
	R²=.44, Adjusted R²=.41, F=15.18, p＜.001					R²=.68, Adjusted R²=.66, F=33.43, p＜.001

QoL=Quality of life;

^† Dummy variables: gender (male=1, female=0), education level (high school and ≥ college/university=1, others=0), Marital status (marrried=1, divorced, separated and widowed=0), caregiver (spouse and children=1, others=0), Ecomonic status (independent=1, dependent and others=0), recurrence (yes=1, no=0), sleeping (yes=1, no=0), Eating (yes=1, no=0), skin (yes=1, no=0).

Table 4.

The Mediating Effect of Social Support on the Relationship between Distress and Quality of life (N=186)

Step		Path		B	SE	β	R²	p
Step 1	Distress	→	Social support	-1.82	.40	-.30	.07	＜.001
Step 2	Distress	→	QOL	-0.12	.02	-.36	.10	＜.001
Step 3	Distress	→	QOL	-0.08	.02	-.24	.19	＜.001
	Social support			0.02	.00	.41		＜.001

QOL=quality of life.

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