Abstract
BackgroundGastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress.MethodsThis was a cross sectional study of anxiety and depression in patients with gastrointestinal cancer attending to the Tehran Cancer Institute. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). This is a widely used valid questionnaire to measure psychological distress in cancer patients. Demographic and clinical data also were collected to examine anxiety and depression in sub-group of patients especially in those who knew their cancer diagnosis and those who did not.ResultsIn all 142 patients were studied. The mean age of patients was 54.1 (SD = 14.8), 56% were male, 52% did not know their cancer diagnosis, and their diagnosis was related to esophagus (29%), stomach (30%), small intestine (3%), colon (22%) and rectum (16%). The mean anxiety score was 7.6 (SD = 4.5) and for the depression this was 8.4 (SD = 3.8). Overall 47.2% and 57% of patients scored high on both anxiety and depression. There were no significant differences between gender, educational level, marital status, cancer site and anxiety and depression scores whereas those who knew their diagnosis showed a significant higher degree of psychological distress [mean (SD) anxiety score: knew diagnosis 9.1 (4.2) vs. 6.3 (4.4) did not know diagnosis, P < 0.001; mean (SD) depression score: knew diagnosis 9.1 (4.1) vs. 7.9 (3.6) did not know diagnosis, P = 0.05]. Performing logistic regression analysis while controlling for demographic and clinical variables studied the results indicated that those who knew their cancer diagnosis showed a significant higher risk of anxiety [OR: 2.7, 95% CI: 1.1–6.8] and depression [OR: 2.8, 95% CI: 1.1–7.2].ConclusionPsychological distress was higher in those who knew their cancer diagnosis. It seems that the cultural issues and the way we provide information for cancer patients play important role in their improved or decreased psychological well-being.
Highlights
IntroductionNordin et al in their studies of gastrointestinal cancer patients have shown that overall 17% of gastrointestinal patients suffer from anxiety and 21% experience depression and that those with gastric cancer are more vulnerable to psychological distress in connection with the diagnosis than are colorectal cancer patients [8,9]
Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran
The prevalence of psychiatric disorders in cancer patients varies greatly among studies ranging from 9% to 60% [3,5,6], in large studies using standardized psychiatric interviews and applying research diagnostic criteria the range narrows from 10% to 30% [7]
Summary
Nordin et al in their studies of gastrointestinal cancer patients have shown that overall 17% of gastrointestinal patients suffer from anxiety and 21% experience depression and that those with gastric cancer are more vulnerable to psychological distress in connection with the diagnosis than are colorectal cancer patients [8,9] They showed that there are only minor changes over time in the average values of emotional well being in these patients [10]. In addition they have indicated that levels of anxiety and depression at diagnosis could predict a similar status 6 months later [11]. Recent studies have reported that anxiety is more common in younger patients and depression in those who experience longterm hospitalization and that coping style might be an important factor in contributing to the level of anxiety and depression in gastrointestinal cancer patients [13,14]
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