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Physical Sequelae and Depressive Symptoms in Gynecologic Cancer Survivors: Meaning in Life as a Mediator

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Continuing symptoms and poor health following cancer treatments may alter meaning in life for cancer survivors. Gynecologic cancer survivors are particularly troubled with physical sequelae. In addition, for the most common sites of disease, such as breast and gynecologic cancers, the prevalence of depression is also high.

Purpose

This study tests meaning in life as a mechanism for the relationship between physical symptoms and depressive symptoms.

Methods

Gynecologic cancer survivors (N = 260) participated. Measures of physical sequelae (nurse rated symptoms/signs, patient-reported gynecologic symptoms), meaning in life (harmony, life purpose, spirituality, and conversely, confusion and loss), and depressive symptoms were obtained at the time of a routine clinical follow-up visit 2–10 years following the completion of treatment. Latent variables were defined, and structural equation modeling tested a mediator model.

Results

Analyses support partial mediation. That is, survivors with more physical sequelae also reported lower levels of meaning in life, which was associated with higher levels of depressive symptoms.

Conclusions

Gynecologic cancer patients have been neglected in psychosocial research, and findings highlight the importance of existential issues in their lives. While many adjust well, those with persistent physical functioning deficits may experience depressive symptoms. By appreciating the role of meaning in their experience, we may help survivors foster their own growth and perspectives important for their future.

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Acknowledgment

The study was supported by grants from Henry M. Jackson Foundation for Military Medicine (Department of Defense; Gynecological Cancer Center for Health Disparities GCC-2004-1) and the National Cancer Institute (RO1CA92704, KO5 CA098133) and The Ohio State University Alumni Grants for Graduate Research and Scholarship. We thank the patients for their participation. These individuals also made important contributions: Kristen Carpenter, Ph.D., Elisabeth Yost, B.A., Lois Dial, R.N., Laura Peterson, M.P.H., and gynecologic oncologists David E. Cohn, M.D., Larry J. Copeland, M.D., Lynne A. Eaton, M.D., and David O’Malley, M.D.

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Authors and Affiliations

  1. Department of Psychology, The Ohio State University, 1835 Neil Ave., Columbus, OH, 43210-1222, USA

    Laura E. Simonelli Ph.D., Jeffrey Fowler M.D., G. Larry Maxwell M.D. & Barbara L. Andersen Ph.D.

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  1. Laura E. Simonelli Ph.D.
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  2. Jeffrey Fowler M.D.
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  3. G. Larry Maxwell M.D.
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  4. Barbara L. Andersen Ph.D.
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Correspondence to Barbara L. Andersen Ph.D..

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Simonelli, L.E., Fowler, J., Maxwell, G.L. et al. Physical Sequelae and Depressive Symptoms in Gynecologic Cancer Survivors: Meaning in Life as a Mediator. ann. behav. med. 35, 275–284 (2008). https://doi.org/10.1007/s12160-008-9029-8

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  • DOI: https://doi.org/10.1007/s12160-008-9029-8

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