Psychological distress among Indigenous Australian cancer survivors
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The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis.
The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress.
The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35%; n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/divorced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21–7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08–0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08–0.68, p = 0.008).
Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.
KeywordsIndigenous Australian Psychological distress Cancer Cancer survivor Aboriginal
The authors thank the staff and Indigenous patients of the participating hospitals for their assistance and cooperation in carrying out this study, Christina Bernardes for her role in project management, and Stuart Leske for the editorial assistance.
GG was funded by the Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (no. 1105399). JC was funded by the NHMRC Research Fellowship (no. 1058244). VH was supported by the University Postgraduate Research Scholarship by Charles Darwin University. PCV and MJ were funded by separate NHMRC Career Development Fellowships (no. 1083090 and no. 1045247, respectively).
This work was supported by the Australian National Health and Medical Research Council (Grant no. 552414). It was conducted under the auspices of the Centre for Research Excellence in Discovering Indigenous Strategies to improve Cancer Outcomes via Engagement, Research Translation and Training (DISCOVER-TT CRE, funded by the NHMRC no. 1041111), and the Strategic Research Partnership to improve cancer control for Indigenous Australians (STREP Ca-CIndA, funded through Cancer Council NSW [SRP 13-01]). We also acknowledge the ongoing support of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies.
Compliance with ethical standards
Ethics approval was obtained from the Human Research Ethics Committees of Charles Darwin University, Northern Territory Department of Health, Menzies School of Health Research, QIMR Berghofer Medical Research Institute, and the four participating hospitals. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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