Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients

Rodin, Gary; Lo, Christopher; Mikulincer, Mario; Donner, Allan; Gagliese, Lucia; Zimmermann, Camilla

doi:10.1016/j.socscimed.2008.10.037

Cited by 323Palliative and Oncologic CareCancer survivorship and carePalliative Care and End-of-Life Issues

Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients

Rodin, Gary, Lo, Christopher, Mikulincer, Mario, Donner, Allan, Gagliese, Lucia, Zimmermann, Camilla·2009·Social Science & Medicine

DOI 10.1016/j.socscimed.2008.10.037

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Abstract

We tested a model in which psychosocial and disease-related variables act as multiple protective and risk factors for psychological distress in patients with metastatic cancer. We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease.

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Attachment security has been shown to be an important mediator of distress and spiritual wellbeing in patients with advanced cancer and is a potential target of psychotherapeutic interventions.
“Attachment security, which refers to internalized expectations of emotional support from significant others and the flexible capacity to make use of it, 18 has been shown to be an important mediator of distress 3 and spiritual wellbeing 19 in patients with advanced cancer and is a potential target of psychotherapeutic interventions. 20”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [3]
Attachment security may be particularly amenable to therapeutic intervention because the threat posed by illness and death and the anticipation of increasing dependency needs heightens the salience of attachment security.
“Attachment security may be particularly amenable to therapeutic intervention because the threat posed by illness and death and the anticipation of increasing dependency needs heightens the salience of attachment security. 3,4”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [3]

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Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities
Mehnert, A., Brähler, E., Faller, H., Härter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J., Boehncke, A., Hund, B., et al. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2014.56.0086 · Cited by 649 · see citing works
Resilience in Cancer Patients
Seiler, A., & Jenewein, J. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00208 · Cited by 507 · see citing works
Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer
Rodin, G., Lo, C., Rydall, A., Shnall, J., Malfitano, C., Chiu, A., Panday, T., Watt, S., An, E., Nissim, R., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.77.1097 · Cited by 338 · see citing works
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Spirituality and well‐being in cancer patients: a review
Visser, A., Garssen, B., & Vingerhoets, A. (2010) · Psycho-Oncology · doi:10.1002/pon.1626 · Cited by 320 · see citing works
Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline
Grassi, L., Caruso, R., Riba, M. B., Lloyd-Williams, M., Kissane, D., Rodin, G., McFarland, D., Campos-Ródenas, R., Zachariae, R., Santini, D., et al. (2023) · ESMO Open · doi:10.1016/j.esmoop.2023.101155 · Cited by 316 · see citing works
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Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence
Kretchy, I. A., Owusu-Daaku, F. T., & Danquah, S. A. (2014) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-8-25 · Cited by 264 · see citing works
Evidence‐based treatment of depression in patients with cancer
Li, M., Fitzgerald, P., & Rodin, G. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.39.7372 · Cited by 236 · see citing works
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Longitudinal Study of Depressive Symptoms in Patients With Metastatic Gastrointestinal and Lung Cancer
Lo, C., Zimmermann, C., Rydall, A., Walsh, A., Jones, J. M., Moore, M. J., Shepherd, F. A., Gagliese, L., & Rodin, G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.26.9712 · Cited by 228 · see citing works
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The association of demoralization with mental disorders and suicidal ideation in patients with cancer
Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G., & Mehnert, A. (2017) · Cancer · doi:10.1002/cncr.30749 · Cited by 182 · see citing works
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Understanding patients’ experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography
Rodríguez‐Prat, A., Balaguer, A., Booth, A., & Monforte‐Royo, C. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016659 · Cited by 183 · see citing works
Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice.
Bovero, A., Leombruni, P., Miniotti, M., Rocca, G., & Torta, R. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12360 · Cited by 169 · see citing works
Systematic review of meaning in life assessment instruments
Brandstätter, M., Baumann, U., Borasio, G. D., & Fegg, M. J. (2012) · Psycho-Oncology · doi:10.1002/pon.2113 · Cited by 171 · see citing works
Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer
Lo, C., Hales, S., Jung, J., Chiu, A., Panday, T., Rydall, A., Nissim, R., Malfitano, C., Petricone-Westwood, D., Zimmermann, C., et al. (2014) · Palliative Medicine · doi:10.1177/0269216313507757 · Cited by 166 · see citing works
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A couple‐based intervention for patients and caregivers facing end‐stage cancer: outcomes of a randomized controlled trial
McLean, L. M., Walton, T., Rodin, G., Esplen, M. J., & Jones, J. M. (2011) · Psycho-Oncology · doi:10.1002/pon.2046 · Cited by 158 · see citing works
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Effects of existential interventions on spiritual, psychological, and physical well‐being in adult patients with cancer: Systematic review and meta‐analysis of randomized controlled trials
Bauereiß, N., Obermaier, S., Özünal, S. E., & Baumeister, H. (2018) · Psycho-Oncology · doi:10.1002/pon.4829 · Cited by 149 · see citing works
Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients
Bernard, M., Strasser, F., Gamondi, C., Braunschweig, G., Forster, M., Kaspers-Elekes, K., Veri, S., Borasio, G. D., Pralong, G., Pralong, J., et al. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.07.019 · Cited by 147 · see citing works
Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer
Ross, S., Agin-Liebes, G., Lo, S., Zeifman, R. J., Ghazal, L., Benville, J., Franco Corso, S., Bjerre Real, C., Guss, J., Bossis, A., et al. (2021) · ACS Pharmacology & Translational Science · doi:10.1021/acsptsci.1c00020 · Cited by 139 · see citing works
Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model
Vehling, S., & Mehnert, A. (2013) · Psycho-Oncology · doi:10.1002/pon.3417 · Cited by 135 · see citing works
The Frequency and Correlates of Spiritual Distress Among Patients With Advanced Cancer Admitted to an Acute Palliative Care Unit
Hui, D., de la Cruz, M., Thorney, S., Parsons, H. A., Delgado-Guay, M. O., & Bruera, E. D. (2010) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909110385917 · Cited by 137 · see citing works
Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?
Johnson, K. S., Tulsky, J. A., Hays, J. C., Arnold, R. M., Olsen, M. K., Lindquist, J. H., & Steinhauser, K. E. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1656-2 · Cited by 129 · see citing works
Mental disorders and the desire for death in patients receiving palliative care for cancer
Wilson, K. G., Dalgleish, T. L., Chochinov, H. M., Chary, S., Gagnon, P. R., Macmillan, K., De Luca, M., O'Shea, F., Kuhl, D., & Fainsinger, R. L. (2016) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2013-000604 · Cited by 123 · see citing works
Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review
Reiche, S., Hermle, L., Gutwinski, S., Jungaberle, H., Gasser, P., & Majić, T. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.09.012 · Cited by 122 · see citing works
The structure of risk factors and outcomes for family caregivers: Implications for assessment and treatment
Zarit, S. H., Femia, E. E., Kim, K., & Whitlatch, C. J. (2010) · Aging & Mental Health · doi:10.1080/13607860903167861 · Cited by 116 · see citing works
Demoralization and death anxiety in advanced cancer
An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018) · Psycho-Oncology · doi:10.1002/pon.4843 · Cited by 115 · see citing works
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The relationship between depression and physical symptom burden in advanced cancer
Fitzgerald, P., Lo, C., Li, M., Gagliese, L., Zimmermann, C., & Rodin, G. (2015) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2012-000380 · Cited by 101 · see citing works
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The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons
Monod, S., Rochat, E., Büla, C., Jobin, G., Martin, E., & Spencer, B. (2010) · BMC Geriatrics · doi:10.1186/1471-2318-10-88 · Cited by 98 · see citing works
Clinical Validation of the Nursing Diagnosis Spiritual Distress in Cancer Patients Undergoing Chemotherapy
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. M. D. S. (2015) · International Journal of Nursing Knowledge · doi:10.1111/2047-3095.12105 · Cited by 93 · see citing works
Resilience and related factors in colorectal cancer patients: A systematic review
Sihvola, S. P., Kuosmanen, L., & Kvist, T. A. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.102079 · Cited by 92 · see citing works
Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer
Lo, C., Hales, S., Chiu, A., Panday, T., Malfitano, C., Jung, J., Rydall, A., Li, M., Nissim, R., Zimmermann, C., et al. (2019) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2015-000866 · Cited by 87 · see citing works
“Attachment security may be particularly amenable to therapeutic intervention because the threat posed by illness and death and the anticipation of increasing dependency needs heightens the salience of attachment security.(3,4) There was no support for effects on the 7 remaining secondary outcomes, for which the probab…”
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The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: Cross-sectional survey with four-week follow-up
Rayner, L., Lee, W. E., Price, A. C., Monroe, B., Sykes, N. P., Hansford, P., Higginson, I. J., & Hotopf, M. H. (2011) · Palliative Medicine · doi:10.1177/0269216310387458 · Cited by 87 · see citing works
Effects of family-oriented dignity therapy on dignity, depression and spiritual well-being of patients with lung cancer undergoing chemotherapy: A randomised controlled trial
Xiao, J., Chow, K. M., Choi, K. C., Ng, M. S. N., Huang, C., Ding, J., & Chan, C. W. H. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104217 · Cited by 79 · see citing works
Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis
Holwerda, N., Sanderman, R., Pool, G., Hinnen, C., Langendijk, J. A., Bemelman, W. A., Hagedoorn, M., & Sprangers, M. A. G. (2012) · Acta Oncologica · doi:10.3109/0284186x.2012.689856 · Cited by 79 · see citing works
Patients feeling severely affected by multiple sclerosis: How do patients want to communicate about end-of-life issues?
Buecken, R., Galushko, M., Golla, H., Strupp, J., Hahn, M., Ernstmann, N., Pfaff, H., & Voltz, R. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.03.010 · Cited by 77 · see citing works
Psychological Interventions for Patients With Advanced Disease: Implications for Oncology and Palliative Care
Rodin, G., An, E., Shnall, J., & Malfitano, C. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.19.00058 · Cited by 75 · see citing works
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Relationship Between Symptom Burden, Distress, and Sense of Dignity in Terminally Ill Cancer Patients
Oechsle, K., Wais, M. C., Vehling, S., Bokemeyer, C., & Mehnert, A. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.10.022 · Cited by 71 · see citing works
Coping, Quality of Life, Depression, and Hopelessness in Cancer Patients in a Curative and Palliative, End-of-Life Care Setting
van Laarhoven, H. W. M., Schilderman, J., Bleijenberg, G., Donders, R., Vissers, K. C. P., Verhagen, C. A. H. H. V. M., & Prins, J. B. (2010) · Cancer Nursing · doi:10.1097/ncc.0b013e3181f9a040 · Cited by 69 · see citing works
Psychological Well-Being and Quality of Care: A Factor-Analytic Examination of the Palliative Care Outcome Scale
Siegert, R. J., Gao, W., Walkey, F. H., & Higginson, I. J. (2010) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2009.11.326 · Cited by 64 · see citing works
The meaning of self-reported death anxiety in advanced cancer
Tong, E., Deckert, A., Gani, N., Nissim, R. S., Rydall, A. C., Hales, S., Rodin, G., & Lo, C. (2016) · Palliative Medicine · doi:10.1177/0269216316628780 · Cited by 63 · see citing works
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The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model
Monforte‐Royo, C., Crespo, I., Rodríguez‐Prat, A., Marimón, F., Porta-Sales, J., & Balaguer, A. (2018) · Psycho-Oncology · doi:10.1002/pon.4900 · Cited by 62 · see citing works
Supportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement
Cleary, J. F., Ddungu, H., Distelhorst, S. R., Ripamonti, C. I., Rodin, G., Bushnaq, M. A., Clegg‐Lamptey, J., Connor, S. R., Diwani, M., Eniu, A. E., et al. (2013) · The Breast · doi:10.1016/j.breast.2013.07.052 · Cited by 62 · see citing works
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Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life‐threatening disorder
Gheihman, G., Zimmermann, C., Deckert, A., Fitzgerald, P., Mischitelle, A., Rydall, A. C., Schimmer, A. D., Gagliese, L., Lo, C., & Rodin, G. (2015) · Psycho-Oncology · doi:10.1002/pon.3940 · Cited by 60 · see citing works
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Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer
Vehling, S., Oechsle, K., Koch, U., & Mehnert, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0059417 · Cited by 58 · see citing works
Depression in advanced cancer – Assessment challenges and associations with disease load
Lie, H. C., Hjermstad, M. J., Fayers, P. M., Finset, A., Kaasa, S., & Loge, J. H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.006 · Cited by 59 · see citing works
Differential patient–caregiver opinions of treatment and care for advanced lung cancer patients
Zhang, A. Y., Zyzanski, S. J., & Siminoff, L. A. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2009.12.023 · Cited by 56 · see citing works
Spiritual Well-Being and Spiritual Distress in Cancer Patients Undergoing Chemotherapy: Utilizing the SWBQ as Component of Holistic Nursing Diagnosis
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. M. D. S. (2017) · Journal of Religion and Health · doi:10.1007/s10943-017-0390-4 · Cited by 56 · see citing works
Is spirituality related to survival in advanced cancer inpatients in Korea?
Shin, D. W., Suh, S., Kim, S., Park, J., Yoon, S., Kim, Y. J., Kang, B., Kwon, J. H., Park, Y., Park, K., et al. (2017) · Palliative & Supportive Care · doi:10.1017/s1478951517001031 · Cited by 55 · see citing works
Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial
Iani, L., Vincenzo, F. D., Maruelli, A., Chochinov, H. M., Ragghianti, M., Durante, S., & Lombardo, L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01468 · Cited by 56 · see citing works
The role of palliative care in patients with neurological diseases
Borasio, G. D. (2013) · Nature Reviews Neurology · doi:10.1038/nrneurol.2013.49 · Cited by 53 · see citing works
Efficacy of a brief manualized intervention Managing Cancer and Living Meaningfully (CALM) adapted to German cancer care settings: study protocol for a randomized controlled trial
Scheffold, K., Philipp, R., Engelmann, D., Schulz‐Kindermann, F., Rosenberger, C., Oechsle, K., Härter, M. C., Wegscheider, K., Lordick, F., Lo, C., et al. (2015) · BMC Cancer · doi:10.1186/s12885-015-1589-y · Cited by 52 · see citing works
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Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments
Bellido‐Pérez, M., Monforte‐Royo, C., Tomás‐Sábado, J., Porta-Sales, J., & Balaguer, A. (2016) · Palliative Medicine · doi:10.1177/0269216316669867 · Cited by 50 · see citing works
Quality of Life and Symptom Burden in Cancer Patients Admitted to An Acute Palliative Care Unit
Jones, J. M., Cohen, S. R., Zimmermann, C., & Rodin, G. (2010) · Journal of Palliative Care · doi:10.1177/082585971002600205 · Cited by 50 · see citing works
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The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales
O’Connor, M., White, K., Kristjanson, L. J., Cousins, K., & Wilkes, L. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03927.x · Cited by 50 · see citing works
Efficacy of the Managing Cancer and Living Meaningfully ( <scp>CALM</scp> ) individual psychotherapy for patients with advanced cancer: A single‐blind randomized controlled trial
Mehnert, A., Koranyi, S., Philipp, R., Scheffold, K., Kriston, L., Lehmann‐Laue, A., Engelmann, D., Vehling, S., Eisenecker, C., Oechsle, K., et al. (2020) · Psycho-Oncology · doi:10.1002/pon.5521 · Cited by 47 · see citing works
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Psychological Distress Among Patients With Advanced Cancer
Huda, N., Shaw, M. K., & Chang, H. (2021) · Cancer Nursing · doi:10.1097/ncc.0000000000000940 · Cited by 47 · see citing works
Hope in Newly Diagnosed Cancer Patients
Duggleby, W., Ghosh, S., Cooper, D. M., & Dwernychuk, L. (2013) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.12.004 · Cited by 47 · see citing works
Managing Cancer And Living Meaningfully: study protocol for a randomized controlled trial
Lo, C., Hales, S., Rydall, A. C., Panday, T., Chiu, A., Malfitano, C., Jung, J., Li, M., Nissim, R. S., Zimmermann, C., et al. (2015) · Trials · doi:10.1186/s13063-015-0811-1 · Cited by 47 · see citing works
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The clinical evaluation of the wish to hasten death is not upsetting for advanced cancer patients: A cross-sectional study
Porta-Sales, J., Crespo, I., Monforte‐Royo, C., Marín, M., Abenia-Chavarria, S., & Balaguer, A. (2019) · Palliative Medicine · doi:10.1177/0269216318824526 · Cited by 46 · see citing works
The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach
Kremeike, K., Frerich, G., Romotzky, V., Boström, K., Dojan, T., Galushko, M., Shah‐Hosseini, K., Jünger, S., Rodin, G., Pfaff, H., et al. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-00548-7 · Cited by 45 · see citing works
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Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer
Guerrero-Torrelles, M., Monforte‐Royo, C., Tomás‐Sábado, J., Marimón, F., Porta-Sales, J., & Balaguer, A. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.04.018 · Cited by 45 · see citing works
Managing Cancer and Living Meaningfully (CALM) Intervention on Chemotherapy-Related Cognitive Impairment in Breast Cancer Survivors
Ding, K., Zhang, X., Zhao, J., Zuo, H., Bi, Z., & Cheng, H. (2020) · Integrative Cancer Therapies · doi:10.1177/1534735420938450 · Cited by 45 · see citing works
Sources of spiritual well-being in advanced cancer
Lo, C., Zimmermann, C., Gagliese, L., Li, M., & Rodin, G. (2011) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2011-000005 · Cited by 44 · see citing works
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Hope, Symptoms, and Palliative Care
Davis, M. P., Lagman, R. L., Parala‐Metz, A., Patel, C. A., Sanford, T. M., Fielding, F., Brumbaugh, A., Gross, J., Rao, A., Majeed, S., et al. (2016) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909115627772 · Cited by 44 · see citing works
The Psychometric Properties of the Meaning in Life Questionnaire (MLQ) in Patients with Life-Threatening Illnesses
Naghiyaee, M., Bahmani, B., & Asgari, A. (2020) · The Scientific World JOURNAL · doi:10.1155/2020/8361602 · Cited by 44 · see citing works
Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers – a randomized controlled study
Seiler, A., Amann, M., Hertler, C., Christ, S. M., Schettle, M., Kaeppeli, B. M., Jung-Amstutz, J., Nigg, C., Pestalozzi, B. C., Imesch, P., et al. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01408-4 · Cited by 43 · see citing works
From evidence to implementation: The global challenge for psychosocial oncology
Rodin, G. (2018) · Psycho-Oncology · doi:10.1002/pon.4837 · Cited by 43 · see citing works
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Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer—A cross-sectional survey in China
Liu, H., Liu, X., Liu, Z., Wang, Y., Feng, R., Zheng, R., Xie, R., Tao, H., Wu, Y., Li, X., et al. (2022) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2022.100134 · Cited by 42 · see citing works
Maintaining the Will to Live of Patients With Advanced Cancer
Khan, L., Wong, R. K. S., Li, M., Zimmermann, C., Lo, C., Gagliese, L., & Rodin, G. (2010) · The Cancer Journal · doi:10.1097/ppo.0b013e3181f45b90 · Cited by 40 · see citing works
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Recent trends in the management of depression in persons with cancer
Panjwani, A. A., & Li, M. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000727 · Cited by 41 · see citing works
Couples facing advanced cancer: examination of an interdependent relational system
Lo, C., Hales, S., Braun, M., Rydall, A. C., Zimmermann, C., & Rodin, G. (2013) · Psycho-Oncology · doi:10.1002/pon.3289 · Cited by 40 · see citing works
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(2018) · doi:10.1002/pon.4488 · Cited by 42 · see citing works
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Death talk and relief of death-related distress in patients with advanced cancer
An, E., Wennberg, E., Nissim, R. S., Lo, C., Hales, S., & Rodin, G. (2017) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2016-001277 · Cited by 39 · see citing works
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Symptom Assessment in Patients with Advanced Cancer: Are the Most Severe Symptoms the Most Bothersome?
Li, B., Mah, K., Swami, N., Pope, A. J., Hannon, B. L., Lo, C., Rodin, G., Le, L. W., & Zimmermann, C. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0622 · Cited by 39 · see citing works
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Correlates of self‐rated attachment in patients with cancer and their caregivers: a systematic review and meta‐analysis
Nissen, K. G. (2016) · Psycho-Oncology · doi:10.1002/pon.4057 · Cited by 36 · see citing works
Dissociative symptomatology in cancer patients
Civilotti, C., Castelli, L., Binaschi, L., Cussino, M., Tesio, V., Fini, G. D., Veglia, F., & Torta, R. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00118 · Cited by 37 · see citing works
Use of the Classic Hallucinogen Psilocybin for Treatment of Existential Distress Associated with Cancer
Grob, C. S., Bossis, A. P., & Griffiths, R. R. (2013) · Psychological Aspects of Cancer · doi:10.1007/978-1-4614-4866-2_17 · Cited by 53 · see citing works
Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness
Mitchell, U. A., Ailshire, J., Brown, L. L., Levine, M. E., & Crimmins, E. M. (2016) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbw031 · Cited by 36 · see citing works
‘Desire to Die’ in palliative care patients—legal framework and recommendations of the national evidence-based guideline on palliative care in Germany
On behalf of the Working Group on Desire to Die of the German Palliative Care Guideline, Kremeike, K., Pralong, A., Boström, K., Bausewein, C., Simon, S. T., Lindner, R., & Voltz, R. (2021) · Annals of Palliative Medicine · doi:10.21037/apm-20-381 · Cited by 36 · see citing works
Is trained communication about desire to die harmful for patients receiving palliative care? A cohort study
Voltz, R., Boström, K., Dojan, T., Rosendahl, C., Gehrke, L., Shah‐Hosseini, K., & Kremeike, K. (2021) · Palliative Medicine · doi:10.1177/02692163211065671 · Cited by 34 · see citing works
Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study
Fisher, K., Seow, H. Y., Brazil, K., Freeman, S., Smith, T. F., & Guthrie, D. M. (2014) · BMC Palliative Care · doi:10.1186/1472-684x-13-10 · Cited by 34 · see citing works
Spiritual Well-Being and Quality of Life of Women with Ovarian Cancer and Their Spouses
Frost, M. H., Johnson, M. E., Atherton, P. J., Petersen, W. O., Dose, A. M., Kasner, M. J., Burger, K. N., Sloan, J. A., & Pipe, T. B. (2011) · The Journal of Supportive Oncology · doi:10.1016/j.suponc.2011.09.001 · Cited by 32 · see citing works
Depression and anxiety in supportive oncology
Li, M., Boquiren, V., Lo, C., & Rodin, G. (2011) · Supportive Oncology · doi:10.1016/b978-1-4377-1015-1.00052-7 · Cited by 32 · see citing works
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Spiritual well-being in lung cancer survivors
Frost, M. H., Novotny, P. J., Johnson, M. E., Clark, M. M., Sloan, J. A., & Yang, P. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1757-z · Cited by 32 · see citing works
Experience of grief by patients with cancer in relation to perceptions of illness: The mediating roles of identity centrality, stigma-induced discrimination, and hopefulness
Danışman, I. G., Yalçınay-İnan, M., & Yiğit, İ. (2017) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2017.1340389 · Cited by 32 · see citing works
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The Desire for Hastened Death in Patients with Metastatic Cancer
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U N C O R R E C T E D P R O O F Original Article The Desire for Hastened Death in Patients with Metastatic Cancer
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Longitudinal Study of Depressive Symptoms in Patients With Metastatic Gastrointestinal and Lung Cancer
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Self-citation

Authors: Rodin, G., Lo, C., Mikulincer, M., Donner, A., Gagliese, L., & Zimmermann, C.
Affiliations: University Health Network (CA)
Reichman University (IL)
Western University (CA)
York University (CA)
Corresponding author: Rodin, Gary
ORCID: Rodin, Gary
Lo, Christopher
Mikulincer, Mario
Gagliese, Lucia
Zimmermann, Camilla
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 2009-02
Volume: 68
Issue: 3
Pages: 562-569
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/j.socscimed.2008.10.037
OpenAlex: W2145839824
Cited by: 323
References: 92
Citations by year: 2026: 15 · 2025: 18 · 2024: 23 · 2023: 12 · 2022: 22 · 2021: 30 · 2020: 22 · 2019: 18 · 2018: 12 · 2017: 24 · 2016: 14 · 2015: 22 · 2014: 20 · 2013: 20 · 2012: 11
FWCI: 13.19
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Social Science & Medicine (publishedVersion)
PubMed (publishedVersion)
ResearchOnline - JCU (James Cook University) (submittedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: metastatic cancer, psychological distress, depression, hopelessness, suicidal ideation, psychosocial risk factors, disease burden, insecure attachment, self-esteem, spiritual well-being, palliative care, gastrointestinal cancer, lung cancer, mediation
MeSH terms: Age Factors, Aged, Anxiety, Attitude to Death, Attitude to Health, Cancer Care Facilities, Depressive Disorder, Female, Gastrointestinal Neoplasms, Humans, Lung Neoplasms, Male, Middle Aged, Models, Psychological, Neoplasm Metastasis, Neoplasm Staging, Ontario, Risk Factors, Self Concept, Cost of Illness, Sickness Impact Profile, Spirituality

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Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients

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