Unintended consequences of screening for anxiety and depression among survivors of pediatric, adolescent, and young adult (P-AYA) cancer.

Abstract

148 Background: Screening for psychosocial issues has been mandated to identify survivors in need of assistance and improve outcomes. Although screening identifies some individuals at risk for difficulties, many who screen positively ultimately decline intervention. Moreover, screening has the potential to "miss" patients who desire intervention but screen negatively for psychosocial need. We explored these issues among a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed an assessment including the Hospital Anxiety and Depression Scale (HADS) and desire for assistance with Anxiety and Depression following a survivorship visit. HADS subscale scores of > 8 indicated at least mild symptoms. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were low and below the cutpoint of 8 (all t < -7.8; p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. Screening positive for anxiety was associated with a desire for intervention (X2 = 20.77; p < .001 ), while screening positively for depression was not (p > 0.05). Among those screening positively for anxiety, 50% desired intervention, while among those screening positively for depression only 38% desired intervention. Moreover, among those desiring intervention for anxiety or depression, 36% and 68% screened negatively for symptoms, respectively. Conclusions: Many P-AYA survivors screening positively for anxiety or depression do not desire intervention. As well, screening would exclude between 36%-68% of those desiring intervention, representing a missed opportunity to potentially improve outcomes. Screening without assessing desire for intervention likely over identifies individuals who do not desire help while missing a relatively large number of those who do wish for assistance.