The incidence of anxiety and depression in adult cancer outpatients in an area of social deprivation.

Abstract

e20709 Background: Psychological distress is common in cancer patients and negatively impacts patient quality of life. Untreated depression predicts early death in patients with advanced cancer. Anxiety and depression may be unrecognised in cancer patients as symptoms can be mistakenly attributed to the underlying malignancy. We assessed the incidence of anxiety and depression in patients attending two hospitals located in areas of significant social deprivation and ethnic diversity. Methods: Patients attending the oncology department at North Middlesex University Hospital and Princess Alexandra Hospital during a one week period were invited to complete a questionnaire. We collected socio-demographic data. The rest of the questionnaire consisted of the Hospital Anxiety and Depression Scale (HADS). HADS is a 14 question, validated screening tool. Total scores range from 0-42, but can be divided into two subscales: HADS-D for depression and HADS-A for anxiety. Interpretation is based primarily on cut-off scores suggested by the test’s authors. In a previously reported non-clinical sample, mean total HADS was 9.82, HADS-D 3.68 and HADS-A 6.14. Results: 96 patients completed the questionnaire. 64 out of 96 patients (67%) were aged between 50 and 79 years. The majority were of white UK ethnicity. The most common types of cancer were breast and colorectal. Seventy five patients (78%) had a ‘normal’ total HADS (≤14). The mean scores for total HADS, HADS-D and HADS-A were 10.53, 4.61 and 5.93, respectively. On the HADS-A subscale, 14 patients had mild anxiety, 12 had moderate and 2 patients had severe anxiety. Depression scores were slightly lower: 12 patients had mild depression and 4 had moderate depression. No patient had severe depression. Only 6 (6%) patients reported taking anti-depressant medication. Conclusions: We demonstrate lower levels of anxiety and depression in a mixed group of cancer patients than previously reported. We explore the possible causes for this difference. Thresholds set to identify ‘cases’ in a non-clinical population may be too high for cancer patients. HADS is a useful screening tool in oncology patients but should be combined with clinical assessment to improve sensitivity and specificity.