PDF
ePub
Citation
Print
Abstract
Purpose
The purpose of this study was to investigate resilience and its mediating effect on the association between symptom distress and depression among recurrent gynecologic cancer patients undergoing chemotherapy.
Methods
A purposive sample of 113 patients diagnosed with recurrent gynecologic cancer was recruited. A cross-sectional survey design was used. The data were collected through a structured questionnaire from September to November 2014.
Results
There was a positive correlation between symptom distress and depression. Negative correlational relationships were found between symptom distress and resilience and between resilience and depression. Resilience showed a partial mediating effect between symptom distress and depression (Z=2.34, p=.019).
Conclusion
The results suggest that the negative effects of symptom distress on depression can be reduced by improving the resilience. Further, it is necessary to explore the multidimensional constructs of resilience and develop intervention programs that can improve the resilience among recurrent gynecologic cancer patients.
REFERENCES
1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015; 136(5):E359–86. https://doi.org/10.1002/ijc.29210.
2. National Cancer Center, Korea Central Cancer Registry. Annual report of cancer statistics in Korea in 2015 [Internet]. Goyang: Korea Central Cancer Registry;2017. [cited 2018 November 24]. Available from:. http://ncc.re.kr/cancerStatsView.ncc?bbsnum=438&searchKey=total&searchValue=&pageNum=1.
3. Korean Society of Gynecologic Oncology. Practice guideline for gynecologic cancer version 3.0 [Internet]. Seoul: Korean Society of Gynecologic Oncology;2016. [cited 2018 September 1]. Available from:. http://mdon.co.kr/news/download.html?no=7745&atno=17901.
4. Song M, Kumaran MN, Gounder M, Gibbon DG, Nieves-Neira W, Vaidya A, et al. Phase I trial of selenium plus chemotherapy in gynecologic cancers. Gynecologic Oncology. 2018; 150(3):478–86. https://doi.org/10.1016/j.ygyno.2018.07.001.
5. Oh PJ, Lim SY. Change of cancer symptom, depression and quality of life based on phases of chemotherapy in patients with colorectal or stomach cancer: a prospective study. Korean Journal of Adult Nursing. 2017; 29(3):313–22. https://doi.org/10.7475/kjan.2017.29.3.313.
6. Oh PJ, Lee JR. Effect of cancer symptoms and fatigue on chemotherapy-related cognitive impairment and depression in people with gastrointestinal cancer. Journal of Korean Academy of Nursing. 2016; 46(3):420–30. https://doi.org/10.4040/jkan.2016.46.3.420.
7. Lee SY, Kim LH, Kim SY, Kim S, Yang HJ, Lee KM, et al. Comparison of depression and quality of life according to nutritional status in elderly cancer patients receiving chemotherapy. Asian Oncology Nursing. 2018; 18(2):55–65. https://doi.org/10.5388/aon.2018.18.2.55.
8. Nho J-H, Kim SR, Kang GS, Kwon YS. Relationships among malnutrition, depression and quality of life in patients with gynecologic cancer receiving chemotherapy. Korean Journal of Women Health Nursing. 2014; 20(2):117–25. https://doi.org/10.4069/kjwhn.2014.20.2.117.
9. Suzuki N, Ninomiya M, Maruta S, Hosonuma S, Nishigaya Y, Kobayashi Y, et al. Psychological characteristics of Japanese gynecologic cancer patients after learning the diagnosis according to the hospital anxiety and depression scale. Journal of Obstetrics and Gynaecology Research. 2011; 37(7):800–8. https://doi.org/10.1111/j.1447-0756.2010.01437.x.
10. Kim Y-H, Lee J-H. Relationships between side effects, depression and quality of sleep in gynecological cancer patients undergoing chemotherapy. Korean Journal of Women Health Nursing. 2010; 16(3):276–87. https://doi.org/10.4069/kjwhn.2010.16.3.276.
11. Chun N, Noh GO, Song HJ, Kim SH. Frequency, intensity and daily life distress of urinary dysfunction in women with cervical cancer after radical hysterectomy. Journal of Korean Academy of Nursing. 2016; 46(3):400–8. https://doi.org/10.4040/jkan.2016.46.3.400.
12. Waugh CE, Fredrickson BL, Taylor SF. Adapting to life's slings and arrows: individual differences in resilience when recovering from an anticipated threat. Journal of Research in Personality. 2008; 42(4):1031–46. https://doi.org/10.1016/j.jrp.2008.02.005.
13. Kim I, Kim SY. Stigma and quality of life in patients with lung cancer: the mediating effect of resilience. Journal of the Korean Data & Information Science Society. 2017; 28(6):1371–82.
14. Ha BY, Jung EJ, Choi SY. Effects of resilience, post-traumatic stress disorder on the quality of life in patients with breast cancer. Korean Journal of Women Health Nursing. 2014; 20(1):83–91. https://doi.org/10.4069/kjwhn.2014.20.1.83.
15. Cha K, Kim K. Impact of uncertainty on resilience in cancer patients. Asian Oncology Nursing. 2012; 12(2):139–46. https://doi.org/10.5388/aon.2012.12.2.139.
16. Wu W-W, Tsai S-Y, Liang S-Y, Liu C-Y, Jou S-T, Berry DL. The mediating role of resilience on quality of life and cancer symptom distress in adolescent patients with cancer. Journal of Pediatric Oncology Nursing. 2015; 32(5):304–13. https://doi.org/10.1177/1043454214563758.
17. Silva SM, Crespo C, Canavarro MC. Pathways for psychological adjustment in breast cancer: a longitudinal study on coping strategies and posttraumatic growth. Psychology & Health. 2012; 27(11):1323–41. https://doi.org/10.1080/08870446.2012.676644.
18. Kurtz ED. Effects of parental alcoholism and trauma exposure on depressive symptoms: a path model with resilience, social support, and family satisfaction [dissertation]. Norfolk. Old Dominion University;2014.
19. Kwak SY, Byeon YS. Factors influencing resilience of patients with hematologic malignancy. Korean Journal of Adult Nursing. 2013; 25(1):95–104. https://doi.org/10.7475/kjan.2013.25.1.95.
20. Shin JH, So HS, Kim EA. Influence of post-traumatic stress disorders on quality of life among patients with ostomy: focused on the mediating effect of resilience. Korean Journal of Adult Nursing. 2017; 29(6):657–66. https://doi.org/10.7475/kjan.2017.29.6.657.
21. Kong K-R, Lee E-N. The mediating effects of resilience between symptom experience and depression in patients with chronic obstructive pulmonary disease. Korean Journal of Adult Nursing. 2015; 27(4):375–83. https://doi.org/10.7475/kjan.2015.27.4.375.
22. Kim YS, Tae YS, Nam GH. Distress and quality of life among elderly patients with gastric cancer: the mediating effect of social support. Korean Journal of Adult Nursing. 2017; 29(5):536–46. https://doi.org/10.7475/kjan.2017.29.5.536.
23. Lee JR, Oh PJ. Cognitive decline and quality of life among patients with breast cancer undergoing chemotherapy: the mediating effect of health promotion behavior. Korean Journal of Adult Nursing. 2016; 28(2):202–12. https://doi.org/10.7475/kjan.2016.28.2.202.
24. McCorkle R, Young K. Development of a symptom distress scale. Cancer Nursing. 1978; 1(5):373–8.
25. Uhm DC. Exploratory study on factors related to depression and symptom distress of cancer patients [master's thesis]. Seoul: Seoul National University;1986.
26. Wagnild GM, Young HM. Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement. 1993; 1(2):165–78.
27. Song YS. Determinants of resilience of the physically disabled at home [master's thesis]. Busan: Kosin University;2004.
28. Kim JH, Lee EH, Hwang ST, Hong SH. The manual of K-BDI-II [Internet]. Daegu: Korea Psychology;2015. [cited 2018 September 1]. Available from:. http://www.koreapsy.co.kr/TM_bbs/view.php?zipEn-code==0tB152x552BTvMCLnMjLbxEu5wzW9wpLvhBHz3xZnxzJ9MCWzspLrxydrMCH9MyMCvrjzvpLbxEun2ybrMCH9MyMaJm90wDU91DLLMDM0dzSvwAMLxzRzspL1wyULxzRzszSLMzF1ev9qusKjxyVjMj9u3zMetpLDwyWD3BUzcCObNl0nxAS9YCIj2xnr1l9WMC19fDZLgB.
29. Baron RM, Kenny DA. The moderator-mediator variable dis-tinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51(6):1173–82.
30. Song MS, Kim HL. Service improving the subjective happiness in cancer patient receiving radiation therapy. Journal of Service Research and Studies. 2016; 6(2):51–64. https://doi.org/10.18807/jsrs.2016.6.2.051.
31. Lee EJ, Yoon JH, Park D, Park D. Performance status and resilience in patients with colorectal cancer. Asian Oncology Nursing. 2013; 13(4):273–9. https://doi.org/10.5388/aon.2013.13.4.273.
32. Park J, Kim N. Factors influencing rehabilitation among cancer survivors. Korean Journal of Adult Nursing. 2017; 29(5):463–71. https://doi.org/10.7475/kjan.2017.29.5.463.
Figure 1.
Model for mediating effect of resilience in the relationship between symptom distress and depression.
Table 1.
Differences in Symptom Distress, Resilience, and Depression according to the Characteristics of Participants(N=113)
| Variables | Categories | n (%) | Symptom distress | Resilience | Depression | |||
|---|---|---|---|---|---|---|---|---|
| M± SD | t or F (p) | M± SD | t or F (p) | M± SD | t or F (p) | |||
| Age (year) | 50 | 34 (30.1) | 44.74±9.54 | 0.5 | 84.29±11.10 | 0.48 | 19.47±9.73 | 0.26 |
| 50~59 | 50 (44.2) | 47.00±8.82 | (.550) | 86.46±10.75 | (.622) | 18.66±9.14 | (.773) | |
| ≥60 | 29 (25.7) | 45.79±10.06 | 86.07±8.04 | 20.21±9.36 | ||||
| Marital status | Married | 101 (89.4) | 45.51±9.05 | 1.68 | 85.31±9.61 | 1.22 | 19.31±9.06 | -0.02 |
| Single | 12 (10.6) | 50.25±10.99 | (.096) | 89.08±14.28 | (.227) | 19.25±11.70 | (.984) | |
| Religion | Yes | 80 (70.8) | 45.99±9.68 | -0.04 | 86.00±9.60 | 0.47 | 19.29±8.70 | -0.02 |
| No | 33 (29.2) | 46.06±8.57 | (.970) | 85.00±11.64 | (.637) | 19.33±10.80 | (.981) | |
| Education | Elementary school | 13 (11.5) | 51.15±12.34 | 1.82 | 85.77±8.81 | 0.40 | 23.69±11.46 | 1.40 |
| Middle school | 23 (20.3) | 43.78±7.96 | (.147) | 87.65±9.73 | (.752) | 18.61±9.64 | (.246) | |
| High school | 55 (48.7) | 45.96±8.16 | 85.38±10.38 | 19.40±8.82 | ||||
| ≥ College | 22 (19.5) | 45.41±10.86 | 84.45±11.29 | 17.18±8.55 | ||||
| Occupation | Yes | 10 (8.8) | 45.76±9.35 | 0.92 | 85.92±10.01 | -0.72 | 18.70±9.08 | 2.32 |
| No | 103 (91.2) | 48.60±9.26 | (.360) | 83.50±12.29 | (.476) | 25.70±9.70 | (.022) | |
| Number of family members | Alone | 5 (4.4) | 44.80±6.06 | 1.57 | 90.00±13.77 | 0.46 | 16.40±7.44 | 2.22 |
| Two | 35 (31.0) | 47.54±10.18 | (.202) | 85.31±10.34 | (.708) | 21.26±9.89 | (.090) | |
| Three | 37 (32.7) | 47.30±9.21 | 86.41±10.80 | 20.70±9.83 | ||||
| ≥ Four | 36 (31.9) | 43.36±8.68 | 84.78±9.10 | 16.36±7.80 | ||||
| Monthly income (10,000 won) | ≤300 | 65 (57.5) | 47.80±9.53 | 2.43 | 85.95±11.16 | 0.30 | 20.83±9.77 | 2.06 |
| ＞300 | 48 (42.5) | 43.58±8.57 | (.017) | 85.38±8.81 | (.767) | 17.23±8.32 | (.042) | |
| Types of gynecologic cancer | Cervix cancer | 26 (23.0) | 45.50±8.52 | 0.54 | 85.31±12.17 | 0.90 | 19.12±9.37 | 0.45 |
| Ovary cancer | 66 (58.4) | 46.39±9.54 | (.653) | 85.03±79.38 | (.446) | 19.26±9.58 | (.987) | |
| Endometrial cancer | 13 (11.5) | 47.31±9.89 | 86.62±7.40 | 20.15±8.08 | ||||
| Etc† | 8 (7.1) | 42.38±10.11 | 91.13±13.47 | 18.88±10.41 | ||||
| Elapsed time since diagnosis (year) | ≤2.0 a | 30 (26.6) | 43.77±10.08 | 3.69 | 89.57±8.22 | 3.42 | 17.97±9.17 | 1.96 |
| 2.1~4.0 b | 39 (34.5) | 44.46±9.49 | (.028) | 85.31±10.25 | (.036) | 17.90±9.70 | (.146) | |
| ＞4.0 c | 44 (38.9) | 48.91±8.03 | a=b=c‡ | 83.43±10.78 | a＞ c‡ | 21.45±8.85 | ||
| Elapsed time since recurrence (year) | ≤0.5 a | 36 (31.9) | 43.78±10.39 | 3.22 | 89.39±10.35 | 4.22 | 18.72±10.10 | 3.48 |
| 0.6~2.0 b | 36 (31.9) | 45.03±8.77 | (.044) | 85.28±9.65 | (.017) | 16.69±7.85 | (.034) | |
| ＞2.0 c | 41 (36.2) | 48.83±8.29 | a=b=c‡ | 82.85±9.75 | a＞ c‡ | 22.10±9.24 | b＜ c‡ | |
Table 2.
Degree of Symptom Distress, Resilience, and Depression of Participants (N=113)
Table 3.
Correlations among Symptom Distress, Resilience, and Depression of Participants (N=113)
| Variables | Symptom distress | Resilience | Depression |
|---|---|---|---|
| r (p) | r (p) | r (p) | |
| Symptom distress | 1 | ||
| Resilience | -.28 (.002) | 1 | |
| Depression | .56 (＜.001) | -.45 (＜.001) | 1 |
Table 4.
Mediating Effects of Resilience on the Relationship between Symptom Distress and Depression of Participants (N=113)
| Step | Independent variables | Dependent variables | B | SE | β | t | p | 95% CI | Adj. R2 | F | p |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Symptom distress | -0.29 | 0.11 | -0.27 | -2.74 | .007 | -0.50~-0.08 | .08 | 2.43 | .024 | |
| Occupation† | 0.29 | 3.33 | 0.01 | 0.09 | .931 | -6.31~6.89 | |||||
| Monthly income‡ | -1.93 | 1.93 | -0.09 | -1.00 | .319 | -5.74~1.89 | |||||
| Elapsed time since diagnosis§ | -2.15 | 2.89 | -0.10 | -0.74 | .458 | -7.89~3.59 | |||||
| Elapsed time since diagnosis‖ | Resilience | -0.79 | 3.75 | -0.04 | -0.21 | .834 | -8.23~6.65 | ||||
| Elapsed time since recurrence¶ | -2.91 | 2.82 | -0.13 | -1.03 | .305 | -8.50~2.68 | |||||
| Elapsed time since recurrence# | -4.68 | 3.61 | -0.22 | -1.30 | .197 | -11.83~2.47 | |||||
| (Constant) | 103.28 | 6.36 | - | 16.25 | .001 | 90.68~115.88 | |||||
| 2 | Symptom distress | 0.51 | 0.08 | 0.51 | 6.21 | .001 | 0.35~0.68 | .33 | 8.85 | .001 | |
| Occupation | -5.26 | 2.60 | -0.16 | -2.03 | .045 | -10.42~-0.11 | |||||
| Monthly income | -1.69 | 1.50 | -0.09 | -1.13 | .263 | -4.67~1.29 | |||||
| Elapsed time since diagnosis | Depression | 0.04 | 2.26 | 0.00 | 0.02 | .985 | -4.44~4.53 | ||||
| Elapsed time since diagnosis | -0.11 | 2.93 | -0.01 | -0.04 | .971 | -5.92~5.70 | |||||
| Elapsed time since recurrence | -2.79 | 2.20 | -0.14 | -1.27 | .208 | -7.15~1.58 | |||||
| Elapsed time since recurrence | 0.37 | 2.82 | 0.02 | 0.13 | .894 | -5.21~5.96 | |||||
| (Constant) | 1.98 | 4.96 | - | 0.40 | .691 | -7.87~11.82 | |||||
| 3 | Resilience | -0.32 | 0.07 | -0.35 | -4.51 | .001 | -0.45~-0.18 | .43 | 11.72 | .001 | |
| Symptom distress | 0.42 | 0.08 | 0.42 | 5.36 | .001 | 0.27~0.58 | |||||
| Occupation | -5.17 | 2.39 | -0.16 | -2.17 | .033 | -9.91~-0.44 | |||||
| Monthly income | -2.30 | 1.39 | -0.12 | -1.66 | .100 | -5.05~0.45 | |||||
| Elapsed time since diagnosis | Depression | -0.64 | 2.08 | -0.03 | -0.31 | .760 | -4.77~3.49 | ||||
| Elapsed time since diagnosis | -0.36 | 2.69 | -0.02 | -0.13 | .895 | -5.70~4.98 | |||||
| Elapsed time since recurrence | -3.71 | 2.03 | -0.19 | -1.82 | .071 | -7.74~0.33 | |||||
| Elapsed time since recurrence | -1.10 | 2.61 | -0.06 | -0.42 | .673 | -6.28~4.07 | |||||
| (Constant) | 34.61 | 8.55 | - | 4.05 | .001 | 17.66~51.57 | |||||
| Sobel test: Z=2.34, p=.019 | |||||||||||
XML Download