The influence of symptom distress, depression, and social support on spiritual well-being among older patients with advanced cancer during treatment


  • Pattamaporn Arsanok The Student of Master of Nursing Science Program in Gerontological Nursing, Faculty of Nursing and Faculty of Graduate Studies, Mahidol University
  • Virapun Wirojratana Department of Fundamental Nursing, Faculty of Nursing, Mahidol University
  • Narirat Jitramontree Independent scholar


elderly with advanced cancer, spiritual well-being, symptom distress, depression, SOCIAL SUPPORT, GUIDED IMAGERY, PREOPERATIVE ANXIETY, HEART SURGERY PATIENTS


The present study was based on descriptive, correlational, and predictive analysis research designs with the aim of exploring the predictive power of depression, symptom distress, and social support on the spiritual well-being of elderly people with advanced cancer during chemotherapy or radiation therapy. The study applied O’Brien’s theory of spiritual well-being in illness. The sample was composed of 85 advanced cancer patients. Data were collected by using questionnaires which consist of demographic data, symptom distress, depression, social support, and spiritual well-being. The data obtained were analyzed by using descriptive statistics, and predictive power was analyzed by using multiple regression analysis.

According to the findings, most of the sample was composed of males with a mean age of 67.81 years (SD = 5.68) and a high level of spiritual well-being (Mean = 99.59 SD = 12.61). Physical symptom distress, depression, and social support were able to co-predict the spiritual well-being of elderly patients with advanced cancer at 30.6% with a statistical significance of 0.05. Physical symptom distress, depression, and social support were all statistically significant predictors of spiritual well-being. (β = .21, β = -.32, and β = .33, p < .05, respectively).

Based on the findings of this study, it is recommended that nurses should assess physical symptom distress, depression, and social support in elderly patients with advanced cancer. In addition, nurses should make nursing care plans to perform nursing activities to promote their spiritual well-being.


World Health Organization. World Cancer Day 2017. 2017 [cited 2017 Oct 1], Available from: http://www.

Ministry of Public Health. Public health statistics 2015. Bangkok: Samchrean Printing; 2016. (in Thai).

Berger N A, Savvides P, Koroukian S M, Kahana E F, Deimling G T, Rose J H., et, al. Cancer in the elderly. Trans Am Clin Climatol. 2006; 117: 147-56.

National Cancer Institute. Hospital-based cancer registry 2016. Bangkok: Pornsup Printing; 2017. (in Thai)

Paloutzian R F, Ellison C W. Loneliness, spiritual well-being, and the quality of life. In: Peplau LA, Perlman D. (Eds), Loneliness: a sourcebook of current theory, Research and therapy (pp 224-237). New York: John Wiley& Sons;1982.

O'Brien M E. Spirituality in nursing (4 ed.). Sudbury: Jones & Bartelett Learning; 2011.

Bai M, Lazenby M, Jeon S, Dixon J, McCorkle R. Exploring the relationship between spiritual well-being and quality of life among patients newly diagnosed with advanced cancer. Palliat Support Care. 13 (4) ;2015:927 – 35.

Rohde G, Kersten C, Vistad I, Mesel T. Spiritual well-being in patients with metastatic colorectal cancer receiving noncurative chemotherapy: a qualitative study. Cancer Nurs. 2017; 4(3), 209-16.

Khamboon T, Pongthavornkamol K, Olson K, Viwatwongkasem C, Wattanakitkrileart D, Lausoontornsiri W. Symptom experiences and symptom cluster across dimensions in Thais with advanced lung cancer. Pacific Rim Int J Nurs Res. 2015;19(4),330-44.

Get-Kong S, Hanucharurnkul S, McCorkle R, Viwatwongkasem C, Junda T, Ittichaikulthol W. Symptom experience, palliative care and spiritual well-being among Thais with advanced cancer. Pacific Rim Int J Nurs Res. 2010;14(3):219-34. Available from: PRIJNR/article/ view/ 6287

Rabow MW, Knish SJ. Spiritual well-being among outpatients with cancer receiving concurrent oncologic and palliative care. Support. Care Cancer. 2015;23(4):919-23.

Jarassaeng N, Mongkonthawornchai S, Buntakheaw P, Hanlakhon P, Bunjun S, Arunponpaisal S. Depression in Chronic Illnesses at the OPD. Section in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Journal of Psychiatric Association of Thailand. 2012;57(4):439-46. (in Thai).

Nikbakhsh N, Moudi S, Addasian S, Khafri S. Prevelence of depression and anxiety among cancer patients. Caspian J Intern Med. 2014: 5(3):167-70.

Stutzman H, Abraham S. A correlational study of spiritual well-being and depression in the adult cancer patient. Health Care Manag. (Frederick). 2017;36(2): 164–72.

Poonsamer O, Wirojratana V, Jitramontree N, Thosingha O. The relationships between knowledge of chemotherapy treatment, skills of self-care, social support and well-being during transition among older patients with cancer receiving chemotherapy. Journal of The Royal Thai Army Nurses. 2014;15(2):368-77. (in Thai).

Tantitrakul, W., Thanasilp, S. Factors Related to Spiritual Well Being of Terminal cancer patients. Journal of Thai Traditional and Alternative Medicine. 2009;2(3):27-35. (in Thai)

Griffiths J, Puttinoi S, Pongsaksri M. The general practitioner assessment of cognition (Thai Version): Validity and Reliability. Poster session presented at Rewinding the aging clock. 9th Pan-Pacific Conference on Rehabilitation cum, 21st Annual Congress of Gerontology, 2014 Nov 29-30; Jockey Club Auditorium, The Hong Kong Polytechnic University, Hong Kong;2014

Erdfelder E, Faul F, Buchner A. GPOWER: A general power analysis program. Behav Res Meth Ins C. 1996:28(1):1-11.

Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler H T. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000;89(5):1162-71.

Janthathai A, Pongthavornkamol K, Wattanakitkrilert D, Soparattanapaisarn N. Factors predicting health-related quality of life among colorectal cancer survivors during 6 months to 5 years after treatment completion. Journal of Nursing Science. 2018;36(4):52-65. (in Thai)

Sheikh JI, Yesavage JA. Geriatric depression scale (gds): recent evidence and development of a shorter version. Clinical gerontology: a guide to assessment and intervention. New York: The Haworth Press;1986. p.165-73.

Wongpakaran N, Wongpakaran T, Van Reekum R. The use of GDS-15 in detecting MDD: a comparison between residents in a Thai long-term care home and geriatric outpatients. J Clin Med Res. 2013;5(2):101-11.

Schaefer C, Coyre JC, Lazarus RS. The health-related functions of social support. J. Behav. Med. 1981;4(4):381-406.

Rujipairoch P. Relationships between spiritual well-being, social support, and perceived severity of illness to psychological self-care behavior in breast cancer patients. [Master Thesis of Nursing Science]. Bangkok: Mahidol University;2007. (in Thai).

Paloutzian R F, Ellison C W. Loneliness, spiritual well-being, and the quality of life. In: Peplau LA, Perlman D. (Eds), Loneliness: a sourcebook of current theory, research and therapy (pp New York: John Wiley& Sons;1982. p. 224-37.

Noipiang T. Perceived severity of illness social support and spiritual well-being among breast cancer patients. [Master Thesis of Nursing Science]. Chiang Mai: Chiang Mai University; 2002. (in Thai).

Chuatrakul P, Panuthai S, Khampolsiri T. Fatigue among older patients with colorectal cancer receiving chemotherapy and related factors. Nursing Journal. 2013;40(3):62-74. (in Thai).

Junsomkoy C, Wirojratana V, Chanruangvanich W. Relationships between basic conditioning factors, symptom severity, palliative self-care behaviors and quality of life in older adults with advanced cancer receiving chemotherapy. Journal of The Royal Thai Army Nurses. 2018;19(Supplement Issue 2):108-17. (in Thai).

Balducci L. Geriatric oncology, spirituality, and palliative care. J Pain Symptom Manage. 2019;57(1):171-75.

Tomstam, L. Gerotrancendence: A developmental theory of positive aging. New York: Springer; 2005.

Schultz M, Meged-Book T, Mashiach T, Bar-Sela G. Distinguishing between spiritual distress, general distress, spiritual well-being, and spiritual pain among cancer patients during oncology treatment. J Pain Symptom Manage. 2017;54(1):66-73.

Gonzalez P, Castaneda SF, Dale J, Medeiros E A, Buelna C, Nunez A, et al. Spiritual well-being and depressive symptoms among cancer survivors. Support Care Cancer. 2014; 22(9):2393-400.

Cobb S. Social support as a moderator of life stress. Psychosom. Med. 1976;38(5): 300-14.




How to Cite

Arsanok P, Wirojratana V, Jitramontree N. The influence of symptom distress, depression, and social support on spiritual well-being among older patients with advanced cancer during treatment. Thai J. Cardio-Thorac Nurs. [Internet]. 2022 Sep. 24 [cited 2024 Apr. 22];33(1):84-98. Available from:



Research Articles