Relationship between Resilience, Psychological Distress and Physical Activity in Cancer Patients: A Cross-Sectional Observation Study

Abstract

Objective: Psychological distress remains a major challenge in cancer care. The complexity of psychological symptoms in cancer patients requires multifaceted symptom management tailored to individual patient characteristics and active patient involvement. We assessed the relationship between resilience, psychological distress and physical activity in cancer patients to elucidate potential moderators of the identified relationships.

Method: A cross-sectional observational study to assess the prevalence of symptoms and supportive care needs of oncology patients undergoing chemotherapy, radiotherapy or chemo-radiation therapy in a tertiary oncology service. Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), social support was evaluated using the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) and both psychological distress and activity level were measured using corresponding subscales of the Rotterdam Symptom Checklist (RSCL). Socio-demographic and medical data were extracted from patient medical records. Correlation analyses were performed and structural equation modeling was employed to assess the associations between resilience, psychological distress and activity level as well as selected socio-demographic variables.

Results: Data from 343 patients were included in the analysis. Our revised model demonstrated an acceptable fit to the data (χ2(163) = 313.76, p = .000, comparative fit index (CFI) = .942, Tucker-Lewis index (TLI) = .923, root mean square error of approximation (RMSEA) = .053, 90% CI [.044.062]). Resilience was negatively associated with psychological distress (β = -.59), and positively associated with activity level (β = .20). The relationship between resilience and psychological distress was moderated by age (β = -0.33) but not social support (β = .10, p = .12).

Conclusion: Cancer patients with higher resilience, particularly older patients, experience lower psychological distress. Patients with higher resilience are physically more active. Evaluating levels of resilience in cancer patients then tailoring targeted interventions to facilitate resilience may help improve the effectiveness of psychological symptom management interventions.

Fig 1. Conceptual diagram.

Proposed relationship between resilience (Connor-Davidson Resilience Scale), psychological distress and activity level (Rotterdam Symptom Checklist), with age and social support as moderators.

Fig 2. Statistical diagram of the revised model.

Relationship between resilience (Connor-Davidson Resilience Scale) psychological distress and activity level (Rotterdam Symptom Checklist). Regression paths for age and social support are also shown, controlling for work status in the analysis. Note. Resilience*Age, Resilience*Social support: the moderating effects of age and social support. Standardized coefficients and standard errors are shown. ^aResidual error in the prediction of the latent variable. **p < 0.01

Fig 3. Moderating effect of age on the relationship between resilience and psychological distress.

The moderator effects by age showing that compared to younger patients, older patients with equivalent levels of resilience (measured by CD-RISC 10) have lower levels of psychological distress (measured by RSCL). Note. The values of age represent the 10^th, 25^th, 50^th, 75^th and 90^th percentiles in the sample distribution of age.