Relation between perceived injustice and distress in cancer: meaning making and acceptance of cancer as mediators

Abstract

Many advanced cancer patients struggle with distress including depressive symptoms, anxiety, anger about cancer, and anger toward God. Cancer patients may perceive their illness as an injustice (i.e., appraise their illness as unfair, severe, and irreparable or blame others for their illness), and this may be a risk factor for distress. To date, illness-related perceptions of injustice have not been examined in cancer patients. Based on prior research and theory (i.e., Just World Theory, Park’s Meaning Making Model, and Loneliness Theory), there are multiple ways to conceptualize the relationship between perceived injustice related to the cancer experience and distress. The purpose of this project was to compare two theory-based conceptualizations of the relationships between perceived injustice and distress symptoms in advanced lung and prostate cancer patients. Aims were to (1) examine the direct effects of perceived injustice on distress symptoms; (2) examine the indirect effects of perceived injustice on distress symptoms through meaning making and acceptance of cancer (my conceptual model), examine the indirect effects of perceived injustice on psychological outcomes (i.e., distress symptoms and acceptance of cancer) through meaning making (Park’s Meaning Making Model), and compare the two models; (3) examine loneliness as a potential moderator of the mediations based on my conceptual model; and (4) explore whether the associations based on my conceptual model differed between advanced lung and prostate cancer patients. Cross-sectional data from advanced lung (n = 102) and prostate (n = 99) cancer patients were examined. Seven models were tested using path analyses. Results partially supported my conceptual model; perceived injustice was directly and indirectly associated with distress symptoms through acceptance of cancer but not through meaning making. Findings did not support Park’s Meaning Making Model, as meaning making did not help account for the associations between perceived injustice and psychological outcomes. Path analyses also indicated that loneliness was not a significant moderator of the mediations based on my conceptual model. Furthermore, associations based on my conceptual model did not differ between advanced lung and prostate cancer patients. Given mixed support for my conceptual model, supplemental path analyses were conducted that included loneliness as an exploratory mediator of associations between perceived injustice and distress symptoms. Findings suggested that perceived injustice was indirectly associated with distress symptoms through loneliness and acceptance of cancer. Findings support testing acceptance-based interventions to address distress related to perceived injustice in advanced cancer patients.