Depressive Symptomatology Following Interdisciplinary Palliative Rehabilitation: Mechanisms of Change and Longitudinal Course

Abstract

Patients with advanced cancer (PWAC) are living months-years longer. With advances in oncological care, their illness can be considered chronic rather than terminal. This population of survivors emerged within the last two decades and their needs are not well understood nor are appropriate resources available. A particular concern is depression. Both clinical and subclinical depressive symptomatology can impede functioning and quality of life (QOL). Using secondary clinical data from a palliative rehabilitation program (PRP), the thesis objectives were to a) examine pre-post changes in functioning and QOL, b) examine the mechanisms of change in depressive symptomatology, and c) examine the longitudinal course of depressive symptomatology. Study 1 examined pre-post changes in QOL and functioning. Outcomes from 67 PRP patients were analyzed using paired t-tests. Results revealed ameliorations in the majority of domains (e.g. physical functioning, malnutrition) including self-reported “depression.” These results counter the existing literature that has shown that these typically stay stable until one month before death, when they drastically worsen. This begins to support that rehabilitation may be beneficial for PWAC. Study 2 focused on the finding that depression scores decreased. Changes in systemic inflammation, exercise, and general self-efficacy (GSE) from 80 PRP patients were examined as predictors of change in depressive symptomatology using a hierarchical linear regression. The model accounted for 15% of change in depression symptomatology, and GSE was the only significant predictor. This suggests that a GSE theoretical framework may be helpful in reducing depressive symptomatology in interdisciplinary palliative rehabilitation. Study 3 focused on longitudinal depressive symptomatology. Three-month follow-up data from 80 patients were analyzed using a repeated measures ANOVA for continuous data and a Cochrane’s Q analysis for grouped data. Results revealed that patients maintained reduced scores at follow-up. This counters the existing literature, in which longitudinal maintenance is poor following exercise-based interventions. Therefore, PRP may offer something beyond what other published interventions have previously. These finding will be discussed in the context of other existing literatures and the implications will be discussed.