Associations of uncertainty with psychological health and quality of life in older adults with advanced cancer

Context: Older adults with advanced cancer face uncertainty related to their disease and treatment.

Objective: To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer.

Methods: Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients ≥70 years with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using a modified 9-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (Distress Thermometer), QoL ([Functional Assessment of Cancer Therapy-General (FACT-G)], and emotional well-being (FACT-G subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a Partial Least Squares (PLS) analysis with a Variable Importance in Projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential.

Results: We included 527 patients (median age: 76 years, range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β=0.11, SE=0.04), depression (β=0.09, SE=0.02), and distress (β=0.12, SE=0.02), and lower QoL (β=-1.08, SE=0.11) and emotional well-being (β=-0.29, SE=0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP > 0.8).

Conclusions: Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.

Keywords: Uncertainty; older adults; oncologists; psychological health; quality of life.