Katherine Ramos and Laura Porter

Psychological Distress, Cognitive Impairment Highly Prevalent in Veterans with Lung Cancer

Published

Psychological distress is a significant yet often underrecognized issue among veteran patients with lung cancer. Duke Cancer Institute’s Katherine Ramos, PhD, associate professor in psychiatry and behavioral sciences, and Laura Porter, PhD, professor in psychiatry and behavioral sciences, published these findings in Psychological Servicesand suggested approaches for providers.

Findings from the study revealed higher rates of distress among veteran patients, based on feedback from self-reported surveys and National Comprehensive Cancer Network (NCCN) screeners. While research shows 25 to 60 percent of cancer patients report distress, 67 percent of participants in this study scored above the cutoff on the NCCN distress measure.

Most of these participants reported feelings of sadness (75 percent), worry (73 percent) and depression (60 percent), based on the follow-up symptom checklist from the NCCN screener. Results also showed many participants reported experiencing mental health disorders such as clinical depression, anxiety and cancer-related post-traumatic stress disorder (PTSD).

Ramos said stigma around a lung cancer diagnosis, including feelings of shame around behavioral contributing factors like smoking, may contribute to these feelings of distress.

“These lifestyle behaviors and real interactions patients have in the healthcare system create circumstances where patients feel responsible for their diagnosis,” she said. “Because of that, they may feel less engaged with supportive care and may not seek out opportunities to participate in research studies.”

Additionally, many participants (62 percent) in this study reported mild experiences of cognitive impairment, such as forgetfulness and difficulty focusing. These impairments can reduce a patient’s ability to regulate emotions and communicate important information. Ramos said this finding should inform how providers interact with these patients.

One contributing factor specific to the veteran lung cancer patient population is the indoctrination of military culture into a patient’s personal life. Ramos said veterans may find it difficult to seek help when they are in a vulnerable position, such as following a cancer diagnosis. This can lead to poor communication with healthcare providers, missed follow-up care, and difficulties in symptom monitoring.

“The ‘stiff-upper-lip’ mentality, particularly among older military cohorts, and emphasis on prioritizing the unit over the individual can make it difficult for these patients to open up about their feelings,” she said.

Ramos said these findings highlight the need for better comprehensive screening and care for these patients. She said having providers focus more on psychoeducation for patients and emphasizing the importance of them involving a loved one in their care could make a big difference in their overall outcomes.

“It can be hard for patients to emotionally accept their cancer diagnosis,” Ramos said. “As providers, we need to help reduce shame and open them up to try different coping skills and evidence-based treatments that incorporate the mind-body connection into their care.”

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Carolyn Dean

Carolyn Dean

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