When social support rises above all: determinants of end-of-life-treatment and long-term anxiety and depression for Chinese female cancer survivors

Abstract

AIMS: Anxiety and depression afflicts 21–36% of female cancer patients in Hong Kong. The two studies being presented aim to first explore the predictors of prolonged high anxiety and depression among post-treatment female survivors, and subsequently to examine the specific needs of patients upon treatment completion – a crossroad where patients rely less on medical care and more on personal and social resources. Findings inform targeted post-treatment psychosocial care to prevent the development of prolonged distress. METHODS: In Study 1, Chinese female survivors (n = 144) completed instruments on psychological well-being (anxiety, depression, stress), coping and resilience (posttraumatic growth, cancer adjustment, emotional control), physical well-being and social support 4 times across one year. Predictors of prolonged high anxiety and depression (being consistently above the median on the Hospital Anxiety and Depression Scale, HADS), were identified with multivariate logistic regression. Study 2 subsequently recruited female patients (n = 110) upon treatment completion. Based on Study 1 findings, Study 2 participants completed the HADS and instruments to examine specific physical symptoms (fatigue, sleep, pain) and items on their family and friends’ support. Multilevel regression identified the interplay between support and physical discomforts on anxiety and depression at treatment completion. RESULTS: Findings showed that prolonged anxiety among survivors was predicted by negative support network (p = 0.02; C.I. = 1.06–1.96) with poor physical well-being (p = 0.05; C.I. = 0.87–1.00). Lower interpersonal growth predicted sustained high depression (p = 0.00; C.I. = 0.71–0.94). At treatment completion, anxiety was associated with the daily interferences of fatigue (p = 0.00; C.I. = 0.05–0.18) and pain (p = 0.02; C.I. = 0.01–0.13) whereas depression was related to distancing from friends (p = 0.00; C.I. = 0.65–2.01). CONCLUSION: While anxiety at post-treatment is associated with physical discomfort, the benefits of social support eventually fall into place to prevent it from developing into prolonged anxiety. Depression, post-treatment and prolonged, bears little connection with physical discomfort and is solely related to support. Culturally-informed meaning of social support and implications for mind-body interventions are discussed.