TY - JOUR
T1 - Meaning in life in patients with advanced cancer
T2 - a multinational study
AU - Gravier, Anna L.
AU - Shamieh, Omar
AU - Paiva, Carlos Eduardo
AU - Perez-Cruz, Pedro Emilio
AU - Muckaden, Mary Ann
AU - Park, Minjeong
AU - Bruera, Eduardo
AU - Hui, David
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: Few studies have examined meaning in life, a novel existential outcome, in patients with advanced cancer across countries. Objectives: We examined differences in meaning in life across 5 countries and identified factors associated with meaning in life. Methods: This is a pre-planned secondary analysis of a prospective longitudinal multicenter observational study of patients with advanced cancer. Meaning in life was assessed using a validated scale which examined four domains of meaning: values, purpose, goals, and reflection. The total score ranged from 8 to 32, with a higher score indicating greater meaning in life. Results: Among 728 patients, the median meaning in life score was 25/32 (interquartile range 23, 28). There was no significant difference in the total meaning in life score among 5 countries (P = 0.11), though there were differences in domain sub-scores. In the univariate analysis, patients with higher intensity of physical symptoms by ESAS score (pain, fatigue, drowsiness, dyspnea, insomnia), depression, anxiety, spiritual pain, and financial distress had significantly lower meaning in life. However, patients with higher levels of education, who were married, and who had higher optimism had significantly higher meaning in life. In the multivariate analysis, higher total meaning in life scores were significantly associated with greater optimism (multivariate estimate = 0.33, p < 0.001), lower depression (− 0.26, < 0.001), spiritual pain (− 0.19, < 0.001), and financial distress (− 0.16, < 0.001). Conclusion: Country of origin was not a determinant of meaning in life. However, meaning in life was significantly associated with optimism, depression, spiritual pain, and financial distress, underscoring the multidimensional nature of this construct and potential opportunities for improvement in addressing meaning in life of patients with advanced cancer.
AB - Background: Few studies have examined meaning in life, a novel existential outcome, in patients with advanced cancer across countries. Objectives: We examined differences in meaning in life across 5 countries and identified factors associated with meaning in life. Methods: This is a pre-planned secondary analysis of a prospective longitudinal multicenter observational study of patients with advanced cancer. Meaning in life was assessed using a validated scale which examined four domains of meaning: values, purpose, goals, and reflection. The total score ranged from 8 to 32, with a higher score indicating greater meaning in life. Results: Among 728 patients, the median meaning in life score was 25/32 (interquartile range 23, 28). There was no significant difference in the total meaning in life score among 5 countries (P = 0.11), though there were differences in domain sub-scores. In the univariate analysis, patients with higher intensity of physical symptoms by ESAS score (pain, fatigue, drowsiness, dyspnea, insomnia), depression, anxiety, spiritual pain, and financial distress had significantly lower meaning in life. However, patients with higher levels of education, who were married, and who had higher optimism had significantly higher meaning in life. In the multivariate analysis, higher total meaning in life scores were significantly associated with greater optimism (multivariate estimate = 0.33, p < 0.001), lower depression (− 0.26, < 0.001), spiritual pain (− 0.19, < 0.001), and financial distress (− 0.16, < 0.001). Conclusion: Country of origin was not a determinant of meaning in life. However, meaning in life was significantly associated with optimism, depression, spiritual pain, and financial distress, underscoring the multidimensional nature of this construct and potential opportunities for improvement in addressing meaning in life of patients with advanced cancer.
KW - Cultural diversity
KW - Financial support
KW - Neoplasms
KW - Palliative care
KW - Psychological stress
KW - Spirituality
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U2 - 10.1007/s00520-019-05239-5
DO - 10.1007/s00520-019-05239-5
M3 - Article
C2 - 31858248
AN - SCOPUS:85076884017
SN - 0941-4355
VL - 28
SP - 3927
EP - 3934
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 8
ER -