Factors correlated with demoralization among cancer patients: A systematic review and meta-analysis

Abstract Objectives Demoralization isa common psychological problem in cancer patients. The purpose of this study is to systematically evaluate the correlated factors of demoralization among cancer patients. We also summarized the available evidence, effect estimates, and the strength of statistical associations between demoralization and its associated factors. Methods We systematically searched PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, PsycINFO, and 2 electronic databases to identify studies published up to October 2023 with data on the correlates of demoralization. Two researchers independently reviewed references, extracted data, and assessed data quality. Meta-analysis was performed using R4.1.1 software. Results Thirty-eight studies were included in this meta-analysis. For the most studied sociodemographic correlates, demoralization was negatively correlated with income ( z = −0.29, 95% CI: −0.51, −0.02), education ( z = − 0.11, 95% CI: − 0.16, −0.05), and age ( z = −0.45, 95%CI: −0.75, −0.01). For the most studied clinical correlates, demoralization was positively correlated with symptom burden (z = 0.37, 95% CI: 0.22, 0.50) and negatively correlated with quality of life ( z = −0.40, 95% CI: −0.54, −0.24). For the most studied psychosocial correlates, demoralization was negatively correlated with social support ( z = −0.39, 95% CI: −0.51, −0.26) and positively correlated with anxiety ( z = 0.65, 95% CI: 0.56, 0.73), depression ( z = 0.61, 95% CI: 0.54, 0.67), and suicidal ideation ( z = 0.48, 95% CI: 0.34, 0.60). Significance of results Demoralization showed either positive or negative associations with sociodemographic, clinical, and psychological variables. More research is needed to explore the underlying mechanisms to develop effective interventions. This review provides information on the factors associated with demoralization in cancer patients, which can be used to inform strategies for clinical care providers.