Researchers from Amsterdam UMC's Cancer Center Amsterdam (CCA) and Amsterdam Public Health (APH) have discovered that not only the intensity of emotions, but also how much they fluctuate, may help identify cancer patients who could benefit from professional psychological support. This is the first time emotional fluctuations have been studied in this way among cancer patients.

A cancer diagnosis can trigger a wide range of emotions, including fear, sadness, worry and irritability. These responses are normal and can even be helpful. Emotions help people cope with their illness and are therefore sometimes referred to as 'adaptive emotions'. However, in a small proportion of patients, emotions become maladaptive and interfere with daily life. Examples include extreme anxiety that leads someone to avoid medical examinations, or persistent sadness despite treatment going well.

How are patients currently screened?

To identify patients who may need psychological support, healthcare professionals typically use a short questionnaire. Patients rate how much distress they are experiencing at that moment on a scale from zero to ten. Those who score above a certain threshold are generally offered psychological support.

However, this approach has its limitations. Many patients who score highly do not want a referral or do not make use of the support offered. Conversely, patients experiencing maladaptive emotions may go unnoticed. This is because the questionnaires only measure how intensely someone feels at a particular moment, rather than how their emotions change over time.

Tracking emotions throughout the day

To distinguish between adaptive and maladaptive emotions, the researchers followed 132 cancer patients over a two-week period. Five times a day, participants answered questions about their mood on their phones, creating an emotional diary with 70 measurements per patient.

The researchers analysed patterns of emotional fluctuations: how long emotions persisted, how pronounced the emotional highs and lows were, and how rapidly emotions changed. They then examined whether these patterns differed between patients with adaptive and maladaptive emotions. Patients had been classified into these two groups beforehand, based on a psychiatric interview and their own perceived need for professional support.

A striking finding

The results were clear: patients with maladaptive emotions not only experienced more intense feelings, but also showed greater emotional fluctuations. Their moods varied more widely and changed more rapidly than those of patients with adaptive emotions. The assumption that maladaptive emotions tend to persist for longer was not supported by the findings.

"Emotional intensity alone does not tell the whole story. Our research shows that fluctuations in emotions may provide an additional indication that a patient could benefit from professional support," says researcher Elise Doppenberg-Smit, who will defend her PhD thesis on this research at Vrije Universiteit Amsterdam on 4 November.

What does this mean for patients?

The findings could help healthcare professionals better identify which cancer patients need psychological support. According to the researchers, further research is needed to determine how these insights can best be applied in clinical practice, for example by incorporating measures of emotional fluctuations into existing screening methods.

The study was published in Supportive Care in Cancer and conducted by Amsterdam UMC in collaboration with five Dutch hospitals, with support from the Dutch Cancer Society (KWF).

Read the publication: Emotion dynamics as indicators of maladaptive emotions in patients with cancer