Trajectory and predictors of psychological distress and posttraumatic growth among rectal cancer patients undergoing combined modality treatment: An exploratory prospective study

Objective: This exploratory prospective cohort study aimed to investigate the trajectory of psychological distress and posttraumatic growth (PTG) in rectal cancer patients from diagnosis to follow-up and to explore factors that could predict PTG and psychological distress at follow-up. Method: We assessed psychological distress (anxiety and depression), PTG, physical symptoms, quality of life, cancer-related coping, state and trait affectivity, resilience, and alexithymia in 43 rectal cancer patients, M (SD) age: 61.6 (12.6); 67.4% men, after diagnosis (T0), after preoperative radiochemotherapy (T1), after surgical resection (T2), and 1 year after surgery (T3, follow-up). Results: Psychological distress, especially anxiety symptoms, showed a significant reduction between T0 and T1 (p <.001), which increased again between T1 and T2 (p =.048). PTG showed a progressive increase, with a significant increase between T2 and T3 (p <.001). The exploratory hierarchical multiple regression analyses showed that low positive state affectivity (p =.005) and high health anxiety (p =.007) at T1 and high negative state affectivity (p =.012) at T3 were significant predictors of psychological distress at follow-up. Higher levels of PTG at T1 (p <.001) and greater use of adaptive coping styles of Fighting Spirit at T0 (p =.009) and Fatalism at T1 (p =.031) were significant predictors of PTG at follow-up. Conclusions: The (fluctuating and linear, respectively) trajectories of psychological distress and PTG seem to be related to the psychological reactions to the different treatment phases, especially diagnosis and preoperative treatment. Data suggest the need to implement psychological screening and tailored support programs aimed at fostering PTG and reducing psychological distress from the earliest phases of cancer treatment.