Our results from 2006 on psychosocial aspects of cancer in hospitalized adult patients in Romania showed that 16.9% of Romanian cancer patients are not aware of their oncologic diagnosis, 47.5% are clinically depressed, 46.7% experience anxiety disorders and 28.1% report critically low quality of life. 85.4% of those suffering from clinical depression and 90.7% of persons with low quality of life are patients with malignant cancer diseases. 75.9% of cancer patients who report low quality of life are also facing clinically relevant depression symptoms. Moreover, almost two–thirds of cancer patients to whom cancer diagnosis was not disclosed are highly or severely depressed.
In 2006 almost every fifth hospitalized Romanian cancer patient was not informed about his/her cancer diagnosis. Furthermore, patients who were not informed about their cancer diagnosis were significantly more depressed, hopeless and with lower levels of problem–focused coping compared to patients who were informed. Also, patients who were not told about their cancer diagnosis tended to be older, with a mandatory education or less and living in small communities.
Prevalence of clinical depression in Romanian cancer patients was high in 2006. Almost half of hospitalized cancer patients involved in our study were clinically depressed most likely requiring treatment. Among clinically depressed cancer patients, the proportion of respondents over 65 years, with mandatory or less education, widowed and who were not informed about their cancer diagnosis, was significantly higher compared to patients without clinical depression. Increasing clinical depression was significantly associated with advanced disease stage; worsening state of health, lack of physical activity, cancer diagnosis non-disclosure and passive-negative reactions to cancer diagnosis. Also, our results show significant negative correlation between clinical depression and quality of life, and strong positive correlation between moderate-to-severe depression, hopelessness and anxiety.
In clinically depressed cancer patients, we found significantly higher hopelessness, higher anxiety, higher vital exhaustion scores, more lack of social support, and higher levels of emotion-focused coping, behavior inhibition, and dysfunctional attitude, more prevalent external locus of control and significantly lower self-efficacy and sense of coherence. Furthermore, differences in relation to quality of life and particularly physical and functional well-being were of clinically significant importance.
The odds of clinical depression were fivefold higher for female cancer patients, more than fourfold higher for cancer patients with high levels of emotion-focused coping and hopelessness, threefold higher for cancer patients with low quality of life and high vital exhaustion, dysfunctional attitude and anxiety and almost twofold higher for cancer patients who experienced high illness intrusiveness, social-behavior inhibition and low self-efficacy, sense of coherence and also who were negatively assessing their childhood.
In 2006 we have found that negative trend in quality of life of Romanian cancer patients was significantly related to low education, widowhood, small-town residence, absence of religious practice, malignant cancer, advanced disease stage, helpless-control lacking reactions to cancer diagnosis, poor/very poor health status, physical inactivity, and severe depression. Positive trend in quality of life was significantly associated with high education, married family status, regular religious practice in church, benign tumor, initial stage of disease, hopeful reactions to cancer diagnosis – faith in God, determination of healing and denial of disease, very good health, weekly/daily physical activity and the absence of depression. Not only statistically, but also clinically significant differences in quality of life scores were found related to education, practice of religion, health status and depression.
APSCO believes that psychosocial cancer care can be one of the comprehensive support sources in Romania, which can lessen patient and family distress and burdens by employing the existing family networks to provide better care and enrich quality of life.