Psychological Distress, Uncertainty Intolerance, and Quality of Life of Patients with Cancer and Their Caregivers: A Comparative Study
Abstract
Background: Psychological distress and uncertainty intolerance in cancer patients are linked to various physical consequences and negative psychological impacts, such as increased symptom severity, disruption in daily life, and reduced quality of life. These issues also affect family caregivers of cancer patients. This study aims to describe the psychological distress, uncertainty intolerance, and quality of life in cancer patients and their family caregivers.
Methods: This was a cross-sectional study with 57 cancer patients and 57 caregivers at Dr. Sardjito Hospital, Yogyakarta-Indonesia, in July-August 2023. Psychological distress was measured by using the Kessler Scale (K-10), uncertainty using the Intolerance Uncertainty Scale (IUS-12), and quality of life using the EORTC QLQ-C30 and SF-36. Data were analyzed using Mann-Whitney and Kruskal-Wallis tests.
Results: Significant differences were found in uncertainty intolerance between patients and caregivers (p=0.001) and caregivers’ marital status (p=0.045). Quality of life varied among patients based on age, gender, marital status, cancer type, and treatment (p<0.05). Caregivers’ quality of life differed by age in physical and emotional roles (p≤0.005).
Conclusions: There is a significant difference between the intolerance uncertainty of cancer patients and family caregivers. Meanwhile, the quality of life of cancer patients and the quality of life of family caregivers have differences in each scale and domain in several of their demographic characteristics. Longitudinal studies are needed to understand the trajectory of psychological distress and uncertainty intolerance over time.
Keywords
DOI: 10.33371/ijoc.v19i2.1300
Article Metrics


References
Mao JJ, Pillai GG, Andrade CJ, et al. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin. 2022 Mar 1;72(2):144–64.
Indonesia The Ministry of Health. Ditjen P2P. 2019 [cited 2023 Dec 20]. Cancer in Indonesia ranks 8th in Southeast Asia and 23rd in Asia. Available from: https://p2p.kemkes.go.id/penyakit-kanker-di-indonesia-berada-pada-urutan-8-di-asia-tenggara-dan-urutan-23-di-asia/
Kristanti MS, Effendy C, Utarini A, et al. The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach. Palliat Med. 2019 Mar 27;33(6):676–84.
Guan T, Qan’ir Y, Song L. Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers. Support Care Cancer. 2021;29(8):4623–40.
Guan T, Guo P, Judge Santacroce S. Illness Uncertainty and Its Antecedents for Patients With Prostate Cancer and Their Partners. Oncol Nurs Forum. 2020 Nov;47(6):721–31.
Carleton RN. Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30–43.
Zhang Y. Uncertainty in Illness: Theory Review, Application, and Extension. Oncol Nurs Forum. 2017 Nov;44(6):645–9.
Germino BB, Mishel MH, Crandell J, et al. Outcomes of an uncertainty management intervention in younger African American and Caucasian breast cancer survivors. Oncol Nurs Forum. 2013 Jan;40(1):82–92.
Panjwani AA, Millar BM, Revenson TA. Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer. Int J Behav Med. 2021;28(1):14–20.
Cohen M, Yagil D, Aviv A, et al. Cancer patients attending treatment during COVID-19: intolerance of uncertainty and psychological distress. J Cancer Surviv [Internet]. 2022;16(6):1478–88.
Vander Haegen M, Etienne AM. Intolerance of uncertainty in parents of childhood cancer survivors: A clinical profile analysis. J Psychosoc Oncol. 2018 Nov 2;36(6):717–33.
Cerea S, Sansoni M, Scarzello G, et al. Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress. Support Care Cancer. 2022;30(11):9127–39.
Istiqomah AN, Helmi AF, Widhiarso W. Translasi, adaptasi dan validasi skala Intolerance of Uncertainty Short Version 12-item (IUS-12) ke Bahasa Indonesia. Psikologika J Pemikir dan Penelit Psikol. 2022;27(1):107–24.
Fananni MR. Hubungan Antara Strategi Coping Terhadap Psychological Distress Pada Family Caregive Kanker. In: Prosiding Seminar Nasional Unimus [Internet]. 2021. Available from: https://prosiding.unimus.ac.id/index.php/semnas/article/viewFile/934/941
Perwitasari DA, Atthobari J, Dwiprahasto I, et al. Translation and Validation of EORTC QLQ-C30 into Indonesian Version for Cancer Patients in Indonesia. Jpn J Clin Oncol. 2011 Apr 1;41(4):519–29.
Perwitasari DA. Development the validation of Indonesian version of SF-36 questionnaire in cancer disease. Indones J Pharm. 2012;23(4):248–53.
Teo I, Ng S, Bundoc FG, et al. A prospective study of psychological distress among patients with advanced cancer and their caregivers. Cancer Med. 2023 Apr 1;12(8):9956–65.
Li J, Liu L, Chen M, et al. Effect of intimacy and dyadic coping on psychological distress in pancreatic cancer patients and spousal caregivers. Front Psychol. 2023;14.
Zhao H, Li X, Zhou C, et al. Psychological distress among Chinese patients with breast cancer undergoing chemotherapy: Concordance between patient and family caregiver reports. J Adv Nurs. 2022 Mar 1;78(3):750–64.
Badger TA, Segrin C, Crane TE, et al. Social Determinants of Health and Symptom Burden During Cancer Treatment. Nurs Res. 2023;72(2).
Lu Q, Mårtensson J, Zhao Y, Johansson L. Living on the edge: Family caregivers’ experiences of caring for post-stroke family members in China: A qualitative study. Int J Nurs Stud. 2019;94:1–8.
Blom M, Guicherit OR, Hoogwegt MT. Perfectionism, intolerance of uncertainty and coping in relation to fear of cancer recurrence in breast cancer patients. Psychooncology. 2023 Apr 1;32(4):581–8.
Shams M, Pardini S, Del Bianco P, et al. The predictive role of intolerance of uncertainty and trait of worry in breast cancer patients: A prospective, observational, single-center clinical study. Front Psychol. 2023;14.
Putri AR, Pimolkatekul S, Wibawa YA, et al. Effect of transitional nursing care on quality of life among patients with type 2 diabetes: A meta-analysis of randomized controlled trials. Nurs Pract Today. 2023 Oct 18;10.
Gautama MSN, Damayanti A, Khusnia AF. Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials. Indian J Palliat Care. 2023;29(1):28–35.
Refbacks
- There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.