In the present study, 31 of 34 cancer patients completed intervention (91.2%). The characteristics of the 31 subjects who completed the therapy program was mean age of the participants was 50.5 years (from 32 to 65 years).100% of the subjects were women. Regarding marital status, 81% of subjects were married and 19% were unmarried or divorced. Twenty-three patients underwent breast-conserving surgery and the other eight underwent mastectomy. With regard to metastasis, 61% of participants had no metastasis, 26% showed spread to lymph nodes, and 6% showed spread to bone.
The mean and standard deviation (SD) of the subscale scores of the Mental Adjustment to Cancer (MAC) assessment, divided into low- and high-scoring groups(LG,HG) were shown.Mean MAC scores for “Fighting spirit(score range:16-64)” were 52.53±4.40 (HG),39.14±4.67(LG), for “Hopelessness (score range:6-24) ” were 12.77±1.78(HG),7.35±1.22(LG), for “Anxious preoccupation(score range:9-36)”were 28.07±2.89, (HG),20.00±2.26(LG), for “Fatalism (score range:8-32) ”were 23.08±3.30 (HG),14.38±2.45(LG), and the mean score for “Avoidance (score range:1-4) ” were 3.63±.52(HG),1.48±.51(LG).
Correlation coefficients among the assessment subscales are shown in Table 1.
Table 1 insertion
MAC-Hopelessness was significantly associated with Tension (r=.65; p=0.000), Depression (r=.50; p=0.005), Anger (r=.61; p=0.000), Fatigue (r=.66; p=0.000), and Confusion (r=.58; p=0.001) of the POMS assessment, and with Overall QOL(r=.72; p=0.000), Orientation (r=.-53; p=0.003), and Spirituality (r=.-56; p=0.001) of the SELT-M assessment. MAC-fighting spirit was significantly associated with Overall QOL (r=.60; p=0.001), Orientation (r=.61; p=0.000), and Spirituality (r=.64; p=0.000) of the SELT-M assessment.
Impact of intervention on spiritual well-being.
To analyze the impact of intervention on spiritual well-being (SELT-M subscale), a mixed, two-factor repeated measures ANOVA was performed, with coping style for cancer (MAC subscales divided into low- and high-scoring groups) as the between-subject factors, and time as the within-subject factor (Table 2).
Table 2 insertion
Figure 1 MAC “ hopelessness” and SELT-M “QOL”(Figure1 insertion)
For SELT-M “Overall QOL”, significant interaction was observed with the MAC “hopelessness” subscale (F (2, 48) =3.94, p≺.05). As a result of the simple main effect, SELT-M “Overall QOL” scores were significantly increased after intervention, and these scores were maintained a month after intervention, particularly in those with high MAC “Hopelessness” scores (F (1, 24) =6.14, p≺.05 (Figure 1)).
For SELT-M “Spirituality”, no significant interactions were identified among any of the factors. However, time was identified as a significant main effect on MAC subscale scores. The SELT-M “Spirituality” scores were significantly increased after intervention, and these scores were maintained up to a month after intervention. A similar pattern of findings was observed in the analysis of the “Support” and “Orientation” subscales of the SELT-M. No significant interactions were observed in either of the factors. However, except for the subscale “Avoidance”, time was identified as a significant main factor of the MAC subscale scores.
Impact of intervention on emotional distress
The means and SDs of the POMS subscale scores (score range:0-20) are found that: the average intensity of “Tension-anxiety ”was 7.83(SD=4.59); the average intensity of “Depression” was 5.00(SD=4.40); the average intensity of “Anger-Hostility” was 3.66(SD=2.66); the average intensity of “Vigor” was 6.03(SD=3.32); the average intensity of “Fatigue” was 6.86(SD=5.01); and the average intensity of “Confusion” was 5.52(SD=2.81).
To analyze the impact of intervention on emotional distress (POMS), a mixed, two-factor repeated measures ANOVA was performed, with coping style for cancer (MAC subscales divided into low- and high-scoring subjects) as the between-subject factors, and time as the within-subject factor.
No statistically significant effects due to intervention were observed on the POMS subscale scores.
Qualitative analysis
The associations among <category>, <hopelessness> (2 MAC-based groups: High- and Low-hopelessness), and <QOL> (2 SELT-M-based groups: High- and Low-QOL) were examined by performing multiple correspondence analysis for each questionnaire subscale. In correspondence analysis, the closer the distance between categories, the higher the similarity between the items. Through the analysis for the High-hopelessness group, two statements {Daily life to me seems: } and {The purpose of my life is: } yielded notable results.
Figure 2 Multiple correspondence analysis correspondence map(Figure2 insertion)
As shown in Figure 2, the following variables were identified at P1 and P3 through classification of descriptions for {Daily life to me seems: } adopting the KJ method: P1: <duty/routine>, <place to stay>, <own benefit>, <role>, <essential>, <difficulty>, and <pleasure>; and P3: <duty/routine>, <place to stay>, <role>, <essential>, <pleasure>, <communication with others>, and <others>.
The distances between the High-hopelessness (P1: x=-0.887, y=0.105; and P3: x=-0.815, y=0.422) and High-QOL (x=0.756, y=-0.860; and x=0.517, y=-0.082) groups, and between the High-hopelessness (x=-0.887, y=0.105; and x=-0.815, y=0.422) and Low-QOL (x=-1.154, y=-0.322; and x=-1.707, y=-1.251) groups at P1 and P3 were 1.88: 0.58 and 1.42: 1.90, respectively. Thus, the distance between the High-hopelessness and High- QOL groups was shorter at 1 month after intervention, representing their closer association.
Related factors were examined, focusing on <essential> and <duty/routine>. At P1, <duty/routine> (x=-0.737, y=-0.616, distance=0.74) was closer to the High-hopelessness group than <essential> (x=0.269, y=0.550, distance=1.24). In contrast, at P3, <essential> (x=-0.285, y=-0.650, distance=0.58) was more closely associated with the group than <duty/routine> (x=-0.902, y=-1.01, distance=1.43). <Essential> also became closer to the High-QOL group at P3 (distance at P1 and P3: 1.49 and 1.23, respectively), suggesting that <essential> increased the QOL in the High-hopelessness group. <Difficulty>, which was associated with the High-hopelessness group at P1, did not appear after intervention.
Furthermore, by similarly analyzing descriptions for {My life goals are: }, <smile> was also found to increase the QOL in the High-hopelessness group.