SYMPTOM REPORTING IN CANCER-PATIENTS - THE ROLE OF NEGATIVE AFFECT AND EXPERIENCED SOCIAL STIGMA

BACKGROUND. Recent research suggests that patients' appraisal of somat ic symptoms is more closely related to emotional variables (particular ly negative affect) than to their actual health as determined by exter nal criteria. METHODS. Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organizatio n for Research and Treatment of Cancer (EORTC) quality of life questio nnaire-C30, which included a positive/negative affect scale and a scal e tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgemen t on a standardized scale at the end of the examination, and an additi onal two external physicians later rated the patients based on the fin dings listed in the medical record. RESULTS. Patients' reports of soma tic symptoms were strongly correlated with two measures of negative af fect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported sym ptoms and the examining or external physicians' ratings were considera bly weaker (r = 0.31 and r = 0.19). According to a multiple linear reg ression with 6 predictors, negative affect was the best single predict or of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negativ e affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect const ituted two additional separate factors. CONCLUSIONS. Cancer patients' reporting of somatic symptoms by means of a standardized quality of li fe questionnaire is closely related to emotional and social distress a nd is not equivalent to health status as determined from a clinical pe rspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor fo llow-up programs. (C) 1996 American Cancer Society.