Assessment of Psychosocial Distress in Cancer Patients and its Association with Quality of Life -A Cross-Sectional Study
Keywords:
Psychological Distress, Quality of LifeAbstract
Background: The psychosocial impact of cancer remains unexplored despite its profound influence on patient outcomes. Advances in early detection and treatment have transformed cancer into a chronic, life-threatening condition, increasing the psychosocial burden on patients. Prolonged survival is often accompanied by uncertainty, treatment - related side effects, financial strain, and disruption of social and family roles. Psychosocial distress can impair quality of life (QoL), lower symptom tolerance, reduce treatment adherence and increase health care utilisation. It may adversely affect clinical outcomes, including disease progression and survival through mechanisms such as immune dysregulation. Despite its importance, distress remains under recognised due to stigma and limited access to supportive care, particularly in resource limited settings. The National Comprehensive Cancer Network (NCCN) recognises distress as the “sixth vital sign” and recommends its routine assessment across the cancer trajectory. Understanding psychosocial distress and its impact on QoL is essential for holistic patient centered care. QoL in cancer patients, is a multidimensional concept encompassing global health, functional status and symptom burden.
Objectives: To determine the prevalence of psychosocial distress among cancer patients, assess its association with QoL, and identify sociodemographic and disease related factors associated with distress.
Methods: A cross-sectional study was conducted among 113 adult cancer patients at a tertiary care center. Data were collected using a pretested, interviewer administered questionnaire capturing sociodemographic and disease related factors. Psychosocial distress was assessed using NCCN Distress Thermometer and QoL using the EORTC QLQ-C30 questionnaire. Statistical analysis included chi-square tests, logistic regression, and Pearson correlation, with p<0.05 considered significant.
Results: Clinically significant distress(score≥4) was observed in 63.7% of patients (mean score 4.74 ± 2.91). Pain and impaired physical functioning were the strongest physical correlates. Emotional factors, particularly fear, showed the strongest association, along with sadness, anger and feelings of worthlessness. Social, practical and spiritual concerns were also significant.
Advanced cancer stage(p<0.001) and treatment modality(p=0.011) were strongly associated with distress with higher prevalence among patients receiving chemotherapy and surgery. Symptom severity showed strong association; all patients with moderate to severe symptoms reported clinically significant distress(p=0.003). Although higher distress was observed among females, younger patients, unemployed individuals, those separated or widowed, sole bread winners, rural residents, those with longer disease duration, those receiving active or palliative treatment and certain cancer types, these associations were not statistically significant.
QoL was significantly lower among distressed patients(p<0.001) and showed a moderate negative correlation with distress (r= -0.481). Nearly half (46.9%) had severe QoL impairment. Functional domains were significantly associated with distress(p<0.01) and global health status strongly correlated with QoL(r=0.881)
Conclusion: Psychosocial distress is highly prevalent and significantly affects QoL in cancer patients. It is closely associated with symptom burden, especially pain and functional impairment, as well as emotional, social, and practical challenges. Distress is inversely related to QoL and is higher in advanced disease and certain treatments. Integrating psychosocial care into oncology practice and addressing stigma, limited awareness and inadequate resources through scalable, cost-effective models is essential for equitable, culturally sensitive care and improved outcomes.
Downloads
Published
How to Cite
License
Copyright (c) 2026 PARVATHI SUDHA HARI, Ciniraj Raveendran, Sudha Padmam, Libu G K
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
