Loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients

Cancer patients commonly suffer from loneliness, poor spiritual status, and fear of death; however, these evaluations are rarely revealed in urological cancer patients. Thus, this study aimed to assess the loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients. A total of 324 urological (including renal, bladder, and prostate) cancer patients and 100 healthy controls were included. The University of California and Los Angeles loneliness scale (UCLA-LS), functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp), and death attitude profile-revised (DAP-R) scores were evaluated. The results showed that the UCLA-LS score was higher, but the FACIT-Sp score was lower in urological cancer patients than in healthy controls. According to the DAP-R score, fear of death, death avoidance, and approaching death acceptance were elevated, but neutral acceptance was lower in urological cancer patients than in healthy controls. Among urological cancer patients, the UCLA-LS score was highest but the FACIT-Sp score was lowest in bladder cancer patients; regarding the DAP-R score, fear of death and death avoidance were highest, but approaching death acceptance was lowest in bladder cancer patients. Interestingly, single/divorced/widowed status, bladder cancer diagnosis, higher pathological grade, surgery, systemic treatment, and local treatment were independent factors for higher UCLA-LS score or lower FACIT-Sp score. In conclusion, urological cancer (especially bladder cancer) patients bear increased loneliness and reduced spiritual well-being; they also carry higher fear of death, death avoidance, and approaching death acceptance but lower neutral acceptance of death.

The effect of direct and indirect exposure to violence on youth survival expectations.

PURPOSE: Research finds that adolescents gravely overestimate their risk of death and that these pessimistic attitudes correlate with risky behaviors undermining health and well-being; however, it remains unclear why adolescents have negative expectations about their survival. Because youth are most likely to be exposed to violence (as victims and/or witnesses), perhaps these experiences are key in undermining expectations about the future. We explored the effect of direct and indirect exposures to violence-across various contexts-on adolescents' survival expectations. METHODS: Using data from the National Longitudinal Study of Adolescent Health, we tested the effect of violent experiences: individual direct and vicarious violence, familial and relational violence, school violence, and community violence on adolescents' expectations of surviving to 35 years of age. RESULTS: Victims of childhood physical abuse were less likely to expect to survive to 35 years of age. Although not significant at the conventional p < .05 level, violent victimization (being jumped, cut/stabbed, shot, or threatened with a weapon) and intimate partner violence were marginally associated with decreased survival expectations (p < .10). School and community violence undermined expectations at the bivariate level, but became nonsignificant after adjustments for individual demographic characteristics. CONCLUSIONS: Violent victimization in childhood and adolescence is a public health issue with both immediate and long-term consequences. Violence exposure severely compromises individuals' optimism about the future and places them at risk for behaviors that can further undermine well-being. Practitioners should be mindful of diminished survival expectations as a less overt consequence of exposure to violence.