Hospital Anxiety and Depression Scale (HADS) score trends among testicular cancer survivors: A longitudinal study.

Abstract

5042 Background: The rarity of testicular germ cell tumors, in conjunction with the young age of its patients, makes it challenging to study its long-term adverse effects. We sought to investigate the changes in Hospital Anxiety and Depression Scale (HADS) scores over time in our institutional cohort of testicular cancer (TC) survivors, hypothesizing that anxiety and depression indices will improve over time, and specifically after treatment completion. Methods: A longitudinal analysis of TC survivors at the University of Pennsylvania between 2013 and 2020, quality of life metrics were measured annually during routine clinic visits. A validated HADS score was utilized to calculate indices of anxiety and depression. Multivariable linear mixed-effects regression models adjusted for pathology type, stage, treatment type, age, marital status, education, income, insurance, employment status, living situation, and time from diagnosis to first survey administration were used to calculate the mean predicted HADS, HADS-Anxiety, and HADS-Depression scores. ANOVA was used to test for parallelism and changes between survey scores. Each item is rated on a 4-point scale (ranging from 0 = no not at all, to 3 = yes definitely), for a total score ranging from 0-21 for each sub-scale with a cut-off point of 8/21 for anxiety or depression. Results: A total of 353 patients were included in the study. Baseline mean scores were 7.3, 4.9, and 2.4 for HADS overall, HADS-Anxiety, and HADS-Depression, respectively. Mean scores did not change over time, ANOVA testing of p=0.84, p=0.78, and p=0.0.65 for overall HADS, HADS-Anxiety, and HADS-Depression, respectively. Stratification by pathology, stage, or treatment did not show any significant interaction. Conclusions: Our data demonstrates that there was no significant change over time in HADS scores, thus considering the risks associated with depression and anxiety, such as suicide, it is essential to consider early referrals to psychiatric services. Our results are from a single institution, limited by a small sample size, and data lacks granularity, including mental health history. Nonetheless, our findings serve as a framework for future prospective studies of TC survivors.