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Symptom reporting in cancer patients: The role of negative affect and experienced social stigma
Author(s) -
Koller Michael,
Kussman Jochen,
Lorenz Wilfried,
Jenkins Melissa,
Voss Maria,
Arens Erich,
Richter Erika,
Rothmund Matthias
Publication year - 1996
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19960301)77:5<983::aid-cncr27>3.0.co;2-z
Subject(s) - medicine , affect (linguistics) , distress , stigma (botany) , quality of life (healthcare) , clinical psychology , social stigma , psychiatry , family medicine , psychology , nursing , communication , human immunodeficiency virus (hiv)
BACKGROUND Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. METHODS Sixty surgical cancer patients who at the time of a routine follow‐up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire‐C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. RESULTS Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. CONCLUSIONS Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor follow‐up programs. Cancer 1996;77:983‐95.