Psychological Distress and the Role of Health Locus of Control in Lung Cancer Patients during the Covid-19 Pandemic

Aim: To prospectively investigate the prevalence of psychological distress experienced by lung cancer patients during COVID-19 pandemic, the factors contributing in its increase, and the impact of health locus of control on it.

Materials and Methods: 160 consecutive lung cancer outpatients were studied, at the Oncology Clinic of Chest Diseases General Hospital “Sotiria”, Athens, Greece. Health behaviours and psychological distress were assessed using the Health Locus of Control Scale (HLOCS) and the Distress Thermometer (DT), respectively. Demographic and medical data were retrieved through medical records.

Results: The mean age of the sample was 66.2 years and the majority was men, with chemotherapy being the most frequents treatment modality. The most frequent physical problems were fatigue (63.7%), breathing (48.1%), and sleep disorders (45.0%). Nervousness (41.3%), anxiety (46.9%), fears (21.9%) and grief (29.4%) were the most prevalent emotional problems. Women experienced overall distress at a greater extent compared to men (p .012), with significant differences in physical (p=.005), emotional (p=.001), family (p= .011) and practical problems (p=.008), and more specifically with treatment-related decisions (p=.000), depression (p=.000), fears (p=.000), grief (p=.000), spiritual/religious worries (p=.008) and appearance (p=.000) A strong positive correlation was found between all DT subscales (p .012). HLOC tended to be external since distress was positively affected by the subscales “doctors” and “chance”, indicating that patients rely more on these two factors to control their disease rather than themselves. HLOC was also positively correlated with the presence of psychological problems (p < .05), with a difference between the two sexes, with men having higher scores in iHLOC compared to women (p=.004).

Conclusions: External HLOC has a negative impact on psychological distress, which in turn is affected by interdependent emotional and physical problems. These should be taken into account when treating lung cancer patients amidst unpredictable situations and frequent screening should be applied, in order to enhance lung cancer patients’ quality of life.