Predictors of emotional distress in patients with lymphoma, gastrointestinal, and breast cancer at the Kuwait Cancer Control Centre.

PURPOSE

This study aimed to identify demographic, clinical, and psychosocial predictors of moderate-to-severe emotional distress in cancer patients at Kuwait Cancer Control Centre (KCCC), and to examine whether sex or nationality moderated these relationships. Lymphoma, gastrointestinal, and breast cancer were selected due to their high prevalence and consistent uptake of routine distress screening (K-DART).

METHODS

We retrospectively analyzed K-DART data (2013-2017) from 3262 adult patients who completed validated assessments: PHQ-9 (depression), GAD-7 (anxiety), ESAS-r (symptom burden), and the Canadian Problem Checklist (CPC). Multivariable logistic regression, with AIC-based model selection and multicollinearity checks (variance inflation factors and sensitivity analysis using composite ESAS-r score), identified predictors of moderate-to-severe distress (PHQ-9 or GAD-7 > 10). Interaction terms assessed moderation by sex and nationality.

RESULTS

Greater physical symptom burden (e.g., fatigue: OR 1.36) and CPC social concerns (OR 2.18) were associated with increased odds of emotional distress. Among females, spiritual and practical concerns were additional predictors. Moderation analyses showed that nationality-but not sex-significantly moderated the effects of social concerns: non-Kuwaitis with higher burden experienced disproportionately greater distress. Several statistically significant predictors (e.g., CPC practical concerns, OR ≈ 1.00) were not deemed clinically meaningful.

CONCLUSION

Symptoms and psychosocial concerns, particularly social and spiritual factors, are key predictors of distress in this Gulf population. These findings highlight the need for culturally tailored psychosocial interventions and attention to nationality-related disparities in supportive cancer care.