Psychological Distress and Clinical Outcomes in Patients Undergoing Radiotherapy

Study Rationale and Objective: Psychological distress in cancer patients is a recognized catalyst for negative clinical outcomes, yet it remains under-monitored in many tertiary care settings. This research was designed as a prospective longitudinal study to move beyond single-point prevalence surveys and capture the fluctuating nature of distress throughout the radiotherapy (RT) trajectory. The primary objective was to evaluate the longitudinal patterns of distress and identify independent clinical and socioeconomic predictors that correlate with treatment adherence and unplanned healthcare utilization.

Operational Framework: The study tracked a purposive sample of 374 cancer outpatients across eight distinct assessment phases: Baseline (T0): Pre-treatment assessment of demographic, socioeconomic, and clinical status.

Weekly Monitoring (T1-T8): Real-time tracking of distress levels and symptom accumulation throughout the typical 2- to 8-week RT course.

Follow-up (T9): Post-treatment assessment one month after the completion of radiotherapy.

Multidimensional Assessment: Distress was quantified using the NCCN Distress Thermometer (DT), a 0-10 visual analogue scale, with a score≥4 triggering clinical concern. To identify the specific drivers of this distress, participants utilized a 42-item Problem List covering five critical domains:

Physical: Monitoring the accumulation of RT-related side effects such as fatigue, pain, and changes in appearance.

Practical: Identifying logistical barriers, including financial instability (specifically under the Universal Coverage Scheme), transportation difficulties, and work interference.

Psychological: Tracking anxiety, fear, and sadness. Social/Family: Assessing caregiving burdens and relationship stressors. Spiritual: Exploring concerns regarding faith and the meaning of life. Statistical Focus: The study employed multivariate ordinal logistic regression to isolate independent predictors of distress severity while controlling for age and gender. This rigorous analysis aimed to confirm how clinical factors, such as Advanced Cancer Stage (III-IV), and socioeconomic factors, such as Healthcare Coverage type, significantly increase the risk of high psychological burden. By correlating these predictors with tangible clinical outcomes, including significant weight changes, missed appointments, and unplanned hospital admissions, the study provides an evidence-based rationale for a multidisciplinary, holistic nursing approach in oncology departments.

Inclusion criteria

• Patients diagnosed with cancer who are receiving treatment through radiotherapy.
• Individuals aged 18 years or older.
• Ability to communicate effectively and understand the Thai language.
• Voluntary agreement to participate in the research project.

Exclusion criteria

• Presence of emergency medical conditions or a clinical necessity to receive treatment by other methods.
• Inability to attend follow-up monitoring assessments as dictated by the study protocol.
• Participants who request to withdraw from the project during the study period.
• Failure to complete the full course of radiotherapy treatment due to disease progression.
• A physician's diagnosis of a brain or neurological condition that interferes with the patient's ability to perceive or assess their own symptoms.