Distress and Quality of Life in Patients with Advanced Cancer Undergoing Chemotherapy

Main Article Content

Nittaya Suntharnon
Ampaporn Namvongprom
Nam-oy Pakdevong


          This descriptive research aimed to investigate distress, quality of life, and correlation between distress and quality of life in 94 patients with advanced cancer undergoing chemotherapy. Data were collected by
using Distress Thermometer and EORTC QLQ-C30-THAI V.3 with Cronbach’s coefficient alpha =.93. Descriptive statistics, One sample t-test and Spearman Rank Correlation were used to analyze data.
          The findings revealed that most of the patients had moderate distress (M = 4.81, SD = 0.67). Physical problem was a primary cause of distress. Regarding the aspects of quality of life, physical functioning (M = 56.74, SD = 20.64), cognitive functioning (M = 63.83, SD = 14.38), and social functioning (M = 44.33, SD = 19.79) and Global health status/ quality of life (M = 52.75, SD = 16.95) was lower than that of the reference mean (p < .05). However emotional functioning (M = 73.76, SD = 14.30) was significantly higher than that of the reference means (p < .001). While there was no significant difference for the role functioning (p > .05). Distress and quality of life were significantly negative correlated at a low level (rs = -.347, p < .001). Nurses should assess distress and problems of the patients with advanced cancer in order to provide appropriate care to improve quality of life.


Download data is not yet available.

Article Details

How to Cite
Suntharnon, N. ., Namvongprom, A. ., & Pakdevong, N.- oy . (2020). Distress and Quality of Life in Patients with Advanced Cancer Undergoing Chemotherapy. Songklanagarind Journal of Nursing, 40(1), 58–70. Retrieved from https://he02.tci-thaijo.org/index.php/nur-psu/article/view/240698
Research Articles


American Cancer Society. Advanced cancer. [internet]. 2016 [Cited 2016 Dec 15] Available from: https://www.cancer.org/treatment/ understanding-your-diagnosis/advancedcancer/what-is.html.

Zhong C, Liu H, Jiang L, et al. Chemotherapy plus best supportive care versus best supportivecare in patients with non-small cell lung cancer: A meta-analysis of randomized controlledtrials. PLoS One. 2013; 8(3): e58466 1-9.

doi: 10.1371/journal.pone.0058466.

Dessai SB, Chakraborty S, Sajeev K, et al. Pilot study of single-day distress screening with the NCCN distress thermometer to evaluate the feasibility of routine distress screening in tertiary cancer center in rural India. Psycho-Oncology. 2015; 24(7): 832-4. doi: 10.1002/pon.3739.

LeBlanc T, El-Jawahri A, Tulsky J, et al. Using the distress thermometer to highlight palliative care needs of patients with acute myeloid leukemia (AML) (TH361B). JPSM. 2016; 51(2): 343-344. doi: 10.1016/j.jpainsymman.


Makmai S, Sirichayanugul C, Sirichayanugul T. Common symptoms and needs of predischarge advanced-stage cancer patients: A case-study at Phrae hospital, Thailand. Thai Cancer Journal. 2013; 33(4): 132–45. Thai.

Tanomjit K, Thanasilp S. Selected factors related to quality of life of patients with lung cancer. JNSCU. 2015; 27(1): 120-32. Thai.

Diaz-Frutos D, Baca-Garcia E, Garcia-Foncillas J, et al. Predictors of psychological distress in advanced cancer patients under palliative treatments. Eur J Cancer Care (Engl).2016; 25(4): 608-15. doi: 10.1111/ecc.12521

Park SA, Chung SH, Lee Y. Factors influencing the quality of life of patients with advanced cancer. Appl Nurs Res. 2017; 33: 108-112.

National Comprehensive Cancer Network. Distress management. Clinical practiceguidelines. JNCCN. 2007; 5(1): 3-7.

Feldstain A, Tomei C, Bélanger M, et al. Screening for distress in patients with cancer:methodologic considerations. Curr Oncol. 2014;21(2): e330-33. doi: 10.3747/co.21.1794

Laurujisawat P, Jetiyanuwat S. validity of the Thai version of the distress thermometer. Journal of Psychiatric Associaton of Thailand 2013; 58(3): 257-270. Thai.

Salvo N, Zeng L, Zhang L, et al. Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer. Clin Oncol. 2012; 24(2): 139-48.doi: 10.1016/j.clon.2011.05.003.

Kandasamy A, Chaturvedi SK, Desai G. Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer.Indian J Cancer. 2011; 48(1): 55-59. doi: 10.4103/0019-509X.75828.

Brown LF, Kroenke K, Theobald DE, et al.The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psycho-Oncology. 2010; 19(7): 734-41. doi: 10.1002/pon.1627.

Chuchart K, Pruegsanusak K, Dachapunkul T,et al. Quality of life (QOL) in patients suffering from locally advanced stage nasopharyngeal cancer before, during and after receiving carboplatin with concurrent chemoradiotherapy.Songkla Med J. 2010; 28(3): 127-37. Thai.

Lerdpanit P, Namvongprom A, Pakdevong N. Symptom experiences and quality of life of patients with advanced cancer receiving chemotherapy. APHEIT Journal Science & Technology. 2017; 6(8): 45-55. Thai.

European Organization for Research and Treatment of Cancer. The EORTC QLQ–C30 development. 2008; Available from: https://www.eortc.org/app/uploads/sites/2/2018/02/reference_values_manual2008.pdf.

Norwood SL. Research strategies for advanced practice nurses. New Jersey: Practice Hall Health; 2000; 467.

Aaronson NK, Cull, A, Kaasa S, et al.The European-organization-for-research and treatment- of- cancer QLQ-C30 – A qualityof-life. JNCI. 1993; 85(5): 364-76.

Silpakit C, Sirilertrakul S, Jiraiarus, M, et al.The European organization for research and treatment of cancer quality of life questionnaire (EORTC QLQ-C30): validation study of the Thai version. Qual Life Res. 2006; 15(1):

-72. doi: 10.1007/s11136-005-0449-7

Scott, N. W. et al. EORTC QLQ-C30 Reference values [Internet] Available from: http://groups.eortc.be/qol/sites/default/files/img/newsletter/reference_values_manual. 2008: 43.

Patil V, Noronha V, Joshi A, et al. Distress management in patients with head and neck cancer before start of palliative chemotherapy:A Practical approach. JGO. 2018; 4(1): 1-10.doi: 10.1200/JGO.17.00044.

Grassi L, Johansen C, Annunziata M. et al.Distress Thermometer study group screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer. 2013; 119(9): 1714-21.

Yamaguchi T, Morita T, Sakuma Y, Kato, A., et al. Longitudinal follow-up study using the distress and impact thermometer in an outpatient chemotherapy setting. JPSM. 2012;43(2): 236-43.

Liu F, Huang J, Zhang L, Fan, F., et al. Screening for distress in patients with primary brain tumor using distress thermometer: asystematic review and meta-analysis. BMC Cancer. 2018; 18(1): 1-8. doi: 10.1186/s12885-


Tang L, Fritzsche K, Leonhart R, et al. Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients.Health Qual Life Outcomes. 2017; 15(1): 1-10.doi: 10.1186/s12955-017-0803-9

McFarland DC, Shaffer KM, Tiersten A, et al. J. Prevalence of physical problems detected by the distress thermometer and problem list in patients with breast cancer. Psycho-oncology. 2018; 27(5): 1394-403. doi:10.1002/pon.4631.

Li Q, Lin Y, Qiu Y, et al. The assessment of health-related quality of life and related factors in Chinese elderly patients undergoing chemotherapy for advanced cancer: A crosssectional study. EJON. 2014; 18(4): 425-35.

Sansom N, Thanasilp S. Selected Factors Related to Quality of Life of Terminal Cancer Patients. JNSCU. 2010; Special: 42-53. Thai.

Rha SY, Lee J. Symptom clusters during palliative chemotherapy and their influence on functioning and quality of life. Supportive Care in Cancer. 2017; 25(5): 1519-27.

Panya P, Saneha C, Puwarawuttipanit W, et al. Factors influencing on nutritional status in patients with colorectal cancer receiving chemotherapy. Journal of Nursing Science. 2016; 34(1): 66-76. Thai

Giesinger JM, Wintner LM, Oberguggenberger AS, et al. Quality of life trajectory in patients with advanced cancer during the last year of life. Journal of palliative medicine. 2011; 14(8): 904-12.

Sarenmalm EK, Nasic S, Håkanson C, et al. Swedish version of the distress thermometer: validity evidence in patients with colorectalcancer. JNCCN. 2018; 16(8): 959-66.

Zhu G, Yang G, Xu DS, et al. Application of a modified distress thermometer to screen for psychological distress in 140 patients with malignancies, and an analysis of related factors. JNO. 2018; 3(1): 39-44.