Journal List > Korean J Adult Nurs > v.31(1) > 1116798

Yang and Ryu: Symptom Distress and Depression in Patients with Recurrent Gynecologic Cancer Undergoing Chemotherapy: Mediating Effect of Resilience

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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
24. McCorkle R, Young K. Development of a symptom distress scale. Cancer Nursing. 1978; 1(5):373–8.
crossref
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.
crossref
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.
crossref
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.
crossref

Figure 1.
Model for mediating effect of resilience in the relationship between symptom distress and depression.
kjan-31-28f1.tif
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

Peritoneal, vaginal cancer;

Scheffé test.

Table 2.
Degree of Symptom Distress, Resilience, and Depression of Participants (N=113)
Variables M± SD Item number (scoring) Range n (%)
Possible Actual
Symptom distress 46.01±9.34 18 (1~5) 18~90 26~67
Resilience 85.71±10.19 25 (1~5) 25~125 60~117
Depression 19.30±19.31 21 (0~3) 0~63 3~46
 Minimal (0~13) 35 (31.0)
 Mild (14~19) 28 (24.8)
 Moderate (20~28) 34 (30.1)
 Severe (29~63) 16 (14.1)
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

Adj. R

2 =Adjusted R

2 ; CI=confidence interval; SE=standard error;

Occupation=no;

Monthly income=>300 (10,000 won);

§ Elapsed time since diagnosis=2.1~4.0 (year);

Elapsed time since diagnosis=>4.0 (year);

Elapsed time since recurrence=0.6~2.0 (year);

# Elapsed time since recurrence=>2.0 (year).

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