Emotional Distress In Cancer Patients Research Articles

Effect of a Single-Session Mindfulness-Based Swinging Technique (MBST) Intervention on Emotional Distress in Cancer Patients Undergoing PET-CT Scan: A Randomized Controlled Trial

Effect of a Single-Session Mindfulness-Based Swinging Technique (MBST) Intervention on Emotional Distress in Cancer Patients Undergoing PET-CT Scan: A Randomized Controlled Trial

Emotional Distress in Cancer Patients During the First Wave of the COVID-19 Pandemic.

Background: The COVID-19 pandemic has caused mental health problems worldwide. The psychopathological implications of COVID-19 in cancer patients have rarely been addressed. Considering the increased vulnerability of oncology patients, this issue needs to be addressed to improve the long-term mental health status of these patients.Methods: We conducted a prospective study in outpatients under active cancer treatment during the first wave of the COVID-19 pandemic. A semi-structured 24-question survey was designed to measure baseline sociodemographic, psychosocial and COVID-19 exposure characteristics. The Hospital Anxiety and Depression Scale was used to measure psychological symptoms. A descriptive and analytical univariate analysis of the variables studied was performed. We used the Z-score to compare different populations (experimental and historical control cohort).Results: 104 patients were included, the majority of which were women (64.4%), were above 65 years of age (57.7%), had either lung and breast cancer (56.7%), had advanced disease (64%) and were undergoing chemotherapy (63.5%). 51% of them expressed greater fear of cancer than of COVID-19 infection or both.In relation to HADS, 52.8% of emotional distress, 42.3% of anxiety and 58.6% of depression rates were detected. The main factors related with higher rates of psychological symptomatology were history of previous psychotropic drug consumption and the adoption of additional infection prevention measures because they considered themselves at risk of severe COVID-19 infection (p = 0.008; p = 0.003 for emotional distress, p = 0.026; p = 0.004 for anxiety, and p = 0.013; p = 0.008 for depression). Tumor type, stage, oncologic treatment or rescheduling of cancer treatments were not related to higher levels of psychological symptomatology.Comparison of our results with another population of similar characteristics was not significant (Z score = −1.88; p = 0.060).Conclusions: We detected high rates of emotional distress during the first wave of the COVID-19 pandemic among cancer patients in active treatment (52.8%). This was higher and clinically relevant than observed in a comparable population (42.5%), although not significant. Cancer itself is the main factor of concern for cancer patients, above and beyond the emotional distress generated by COVID-19 pandemic.

1621P Emotional distress in cancer patients during the first wave of the COVID-19 pandemic in Madrid

The COVID-19 pandemic has emerged as the most important international health problem of the last decades. This study explores the psychopathological implications that Covid-19 has caused on cancer patients during the first wave of the pandemic in Spain.

Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study

BackgroundIn different cancer entities, several studies have shown the adverse effects of cancer on mental health, psychological well-being and the increased risk of high emotional distress in cancer patients. This study aims to analyze psychosocial distress levels and their relationship between sociodemographic parameters and selected items on the Distress Thermometer (DT) Problem List in head and neck squamous cell carcinoma (HNSCC) patients.Patients and methodsWe assessed a total of 120 HNSCC patients using the Distress Thermometer (DT) Problem List. Distress scores (DTS) of 90 patients were available. A DTS of ≥ 5 on the visual analogue scale represents clinically relevant distress. Data analysis consisted of descriptive statistics, comparison of mean values for different DTS subcategories and correlation between DTS scores and parameters of tumor classification, sociodemographic variables and selected problems.ResultsDistress was present in 57.7% of the sample, with a total of 52 patients with a DTS ≥ 5. The mean DTS was 4.7 (SD 2.4). Patients with newly diagnosed HNSCC had significantly higher DTS. Distress levels were significantly associated with sadness, general worries, anxiety, nervousness, sleeping disorders, mouth sores and fever. Out of the total sample, 6 patients and out of these 6 individuals, 5 patients with a DTS ≥ 5 requested referrals to psycho-oncological service.ConclusionHigh distress levels were common in HNSCC patients but only few patients desired psycho-oncological care. Addressing patients’ supportive care needs in routine clinical practice is essential to meet unmet needs of HNSCC patients and thus improve cancer care.

An Algorithm to Stratify the Risk of Postoperative Emotional Distress in Cancer Patients with Advanced Metastatic Spinal Disease.

PurposeWe wish (1) to assess what variables are significantly associated with postoperative emotional distress in patients with the metastatic spinal disease after surgery and (2) to develop and validate an algorithm to stratify patients at risk of postoperative emotional distress.Patients and MethodsWe retrospectively enrolled 171 patients with the metastatic spinal disease treated with surgery. Twelve potential variables were used to analyze postoperative emotional distress. Postoperative emotional well-being was measured using the Hospital Anxiety and Depression Scales (HADS). Significant variables were included in the algorithm and assigned scores based on odds ratios (ORs) from the multiple logistic regression analysis. The predictive performance of the risk algorithm was validated on the basis of discrimination and calibration.ResultsTwenty-six (15.20%) patients had a HADS of 19 points or more. Of all the 12 variables, age (P=0.06), marital status (P=0.02), primary cancer types (P=0.004), and physical well-being (P=0.006) were included in the algorithm. This algorithm ranged from 0 to 24. Higher scores represented higher rates of postoperative emotional distress. Patients were stratified into three risk groups: patients in the group A had scores of 0 to 9 and the rate of postoperative emotional distress was only 1.14%, patient in the group B had scores of 10 to 15 and the rate of postoperative emotional distress was 21.31%, and patient in the group C had scores of 16 to 24 and the rate of postoperative emotional distress was up to 54.55%. The area under the receiver operating characteristic curve (AUROC) for the algorithm was 0.84, and the correct classification rate was 81.3%.ConclusionPostoperative emotional distress is common in patients with the metastatic spinal disease after surgery. We propose and validate an algorithm that can be used as a potential screening tool to identify patients at high risk of postoperative emotional distress.

Brief emotional screening in oncology: Specificity and sensitivity of the emotion thermometers in the Portuguese cancer population

This study aimed to determine the cutoff and the specificity and sensitivity of the Emotion Thermometers (ET) in a Portuguese sample of cancer patients. A total of 147 patients (mean age = 49.2; SD = 12.6) completed the ET, the Brief Symptom Inventory (BSI), and the Subjective Experiences of Illness Suffering Inventory. Data were collected in a cancer support institution and in a major hospital in the North of Portugal. The optimal cutoff for the Anxiety Thermometer was 5v6 (until 5 and 6 or more), which identified 74% of the BSI-anxiety cases and 70% of noncases. The Depression Thermometer cutoff was 4v5 (until 4 and 5 or more), which identified 85% of BSI-depression cases and 82% of noncases. Cutoff for the Anger Thermometer was 4v5 (until 4 and 5 or more), which identified 83% of BSI-hostility cases and 73% of noncases; for the Distress Thermometer, the optimal cutoff was 4v5 (until 4 and 5 or more), which identified 84% of the suffering cases and 73% of noncases. Finally, for the Help Thermometer, it was 3v4 (until 3 and 4 or more), which helped to identify 93% of the suffering cases and 64% of noncases. Results supported the Portuguese version of the ET as an important screening tool for identifying the emotional distress in cancer patients.

Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the Neuro Emotional Technique for traumatic stress symptoms.

A growing number of research studies have implicated the cerebellum in emotional processing and regulation, especially with regard to negative emotional memories. However, there currently are no studies showing functional changes in the cerebellum as a result of treatment for traumatic stress symptoms. The Neuro Emotional Technique (NET) is an intervention designed to help improve symptoms related to traumatic stress using an integrative approach that combines emotional, cognitive, and motor processing, with a particular focus on autonomic nervous system regulation. In this study, we evaluated whether the NET intervention alters functional connectivity in the brain of patients with traumatic stress symptoms associated with a cancer-related event. We hypothesized that the NET intervention would reduce emotional and autonomic reactivity and that this would correlate with connectivity changes between the cerebellum and limbic structures as well as the brain stem. We enrolled patients with a prior cancer diagnosis who experienced distressing cancer-related memories associated with traumatic stress symptoms of at least 6months in duration. Participants were randomized to either the NET intervention or a waitlist control. To evaluate the primary outcome of neurophysiological effects, all participants received resting-state functional blood oxygen level-dependent (BOLD) magnetic resonance imaging (rs-fMRI) before and after the NET intervention. In addition, autonomic reactivity was measured using heart rate response to the traumatic stimulus. Pre/post comparisons were performed between the NET and control groups. The results demonstrated significant changes in the NET group, as compared to the control group, in the functional connectivity between the cerebellum (including the vermis) and the amygdala, parahippocampus, and brain stem. Likewise, participants receiving the NET intervention had significant reductions in autonomic reactivity based on heart rate response to the traumatic stimulus compared to the control group. This study is an initial step towards establishing a neurological signature of treatment effect for the NET intervention. Specifically, functional connectivity between the cerebellum and the amygdala and prefrontal cortex appear to be associated with a reduction in autonomic reactivity in response to distressing cancer-related memories. This study contributes to the understanding of possible mechanisms by which interventions like NET may help reduce emotional distress in cancer patients who suffer from traumatic stress symptoms.

Effects of stepped psychooncological care on referral to psychosocial services and emotional well‐being in cancer patients: A cluster‐randomized phase III trial

Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well-being. We examined whether stepped psychooncological care improves referral to consultation-liaison (CL) services and improves well-being. In a cluster-randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well-being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed-effects multivariate regression modeling. Thirteen wards were randomized; 1012 patients participated. With stepped care (N=570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N=442; 6 wards; odds ratio [OR] 10.0; P<.001). Well-being 6months after baseline was 9.5 after stepped care (N=341) and 9.4 after standard care (N=234, β -0.3; P=.71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P=.05) and to psychiatrists (OR 2.3, P=.12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P=.04) than in standard care. Stepped care resulted in better referral to CL services. The patients' emotional well-being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without.

The prospective relationship between satisfaction with information and symptoms of depression and anxiety in breast cancer: A structural equation modeling analysis.

Previous research has demonstrated associations between satisfaction with information and reduced emotional distress in cancer patients. However, as most studies were cross-sectional, the direction of this relationship remained unclear. We therefore aimed to test whether information satisfaction predicted subsequent depression and anxiety levels, and, reciprocally, depression and anxiety levels predicted subsequent information satisfaction, thus clarifying the direction of impact. We performed a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51years). We measured information satisfaction with 2 self-developed items, symptoms of depression with the 2-item Patient Heath Questionnaire and symptoms of anxiety with the 2-item Generalized Anxiety Disorder Scale. We created 2 structural equation models, 1 for depression and 1 for anxiety, that examined the prediction of 1-year depression (or anxiety) levels by baseline information satisfaction and, in the same model, 1-year information satisfaction by baseline depression (or anxiety) levels (cross-lagged panel analysis). Baseline information satisfaction predicted 1-year levels of both depression (beta=-0.17, P<.01) and anxiety (beta=-0.13, P<.01), adjusting for the baseline scores of the outcome variables. Conversely, baseline levels of depression (beta=-0.12, P<.05) and anxiety (beta=-0.16, P<.01) predicted 1-year information satisfaction, adjusting for its baseline score. Our results suggest a bidirectional relationship between information satisfaction and symptoms of depression and anxiety. Thus, provision of information may reduce subsequent depression and anxiety, while reducing depression and anxiety levels may increase satisfaction with received information. Combining the provision of information with emotional support may be particularly beneficial.

Factors Associated with Emotional Distress in Children and Adolescents during Early Treatment for Cancer.

PurposeChildren and adolescents diagnosed with cancer experience emotional distress, such as sadness, worrying, and irritability. However, there is little information about the psychological well-being of parents at the time of their child's diagnosis. We sought to identify factors that were associated with emotional distress in cancer patients as a basis for developing innovative psychological interventions.Materials and MethodsA retrospective chart review was performed on patients newly diagnosed with cancer at a single center in Korea from 2014 to 2016. Eighty-five patients and their mothers completed psychological inventories. To determine factors associated with emotional distress in patients, we assessed the psychological inventory results using multiple linear regression after performing correlation analysis.ResultsThe maternal Beck Depression Inventory-II (BDI-II) score was positively correlated with total problem scores and externalizing scores in patients aged less than 7 years. In patients aged 7–12 years, there was no significant association between the patient's emotional distress and other variables. In contrast, the maternal BDI-II score was the strongest factor associated with patient depression in adolescents.ConclusionWe suggest that the most important factor affecting emotional distress in children and adolescents with cancer is maternal depression, especially in patients aged 1–6 years and aged 13–17 years. Understanding the factors associated with emotional distress of cancer patients allows us to develop early psychiatric interventions for patients and their parents at the initial psychological crisis.

Emotions and Emotion Regulation in Breast Cancer Survivorship.

Emotional distress in cancer patients is an important outcome; however, emotional experience does not begin and end with emotion generation. Attempts to regulate emotions may lessen their potentially negative effects on physical and psychological well-being. Researchers have called for the study of emotion regulation (ER) in health psychology and psycho-oncology. Thus, this review has three aims. First, we discuss current understandings of emotion and ER across the cancer trajectory, including the principles of ER and methods for its assessment. Second, we present a model for examining the mediating effects of ER on psychosocial outcomes. Third, we “round out” the discussion with an example: new data on the role of ER in recurrent breast cancer. Taken together, these aims illustrate the impact of affective regulatory processes on cancer patients’ long-term outcomes. As survival rates increase, long-term follow-up studies are needed to characterize the dynamic, reciprocal effects of emotion and ER for cancer survivors. Further research on ER may help women with breast cancer better manage the challenges associated with diagnosis and treatment.

La teoría del estrés crónico como modelo científico en neurociencia cognitiva

El estudio científico del estrés presenta serias limitaciones teóricas y metodológicas, las cuales incluyen restricciones conceptuales relacionadas con el antiguo principio de homeostasis como noción central del proceso de adaptación. Un nuevo modelo de estudio acerca del estrés crónico, alostasis y carga alostática explican las interacciones entre el cerebro y los sistemas nervioso e inmune en la causalidad de enfermedades físicas y mentales. Este nuevo marco metodológico de investigación científica refleja el avance empírico observado en el campo de las neurociencias cognitiva y del comportamiento. El impacto negativo del estrés crónico en la salud del individuo pone énfasis en el rol central que cumple el distrés emocional percibido. Se examina la eficacia y efectos de la terapia de reducción de estrés basada en mindfulness (MBSR) a través del diseño de un cuidadoso estudio piloto como una alternativa de tratamiento en el campo de reducción del estrés crónico en pacientes con cáncer y los familiares responsables de su cuidado

Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients.

The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally associated with higher levels of emotional well-being. Two hundred fifty-three breast cancer patients and 211 healthy female controls completed four psychological questionnaires. Measures comprised the Connor-Davidson Resilience Scale, the Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and two happiness items. Cancer patients were assessed after diagnosis and surgery. Cancer patients reported higher levels of anxiety, depression, and negative affect and lower levels of positive affect and current happiness compared with control women. There was no difference between the two groups in level of resilience. Higher levels of resilience were related to better emotional adjustment both in women with breast cancer and in control women, but this association was stronger within the sample of cancer patients. In fact, patients scoring high on resilience seemed to experience similar levels of anxiety, depression, and current happiness as healthy women. Our results confirm that resilience may at least partially protect against emotional distress in cancer patients. Our findings suggest that resilience may be a relatively stable trait that is not affected by adversity.

Effect of a structured psycho-oncological screening and treatment model on mental health in cancer patients (STEPPED CARE): study protocol for a cluster randomized controlled trial.

BackgroundHigh levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients.Methods/DesignThis study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards.DiscussionMental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective.Trial registrationClinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.

Prevalence of Emotional Distress in Cancer Patients

Background: Emotional distress in cancer patients may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment. This in turn causes significant increase in psychiatric morbidity leading to poor outcome in the patients. Objective: To assess prevalence of anxiety and depression and to study effects of socio demographic and cancer variables causing emotional distress. Materials and Methods: The present cross-sectional hospital based study was conducted at Oncology department of tertiary care hospital after an approval from institutional ethical committee. The participants were included by random sampling method. Total 100 patients diagnosed by oncology physician or surgeon were interviewed after obtaining informed consent. The detailed information of study was given to every participant. Hospital Anxiety Depression Scale (HADS), a well validated, easy to administer and acceptable scale was used for measuring anxiety & depression level. On HADS cut off score of >07 was taken as possible cases. Data collected was compiled, tabulated in Microsoft excel sheet and analyzed by SPSS software 16.0 versions with the help of a statistician. Results: Thus 100 consecutive consenting diagnosed patients of cancer attending oncology department were studied. On Hospital Anxiety & Depression Scale the mean anxiety and depression scores were 7.73 (SD 4.57) & 6.63 (SD 4.23) respectively. The range of scores on anxiety subscale was 0-18 & 0-16 on depression subscale. 47% had anxiety & 39% were having depression with cut off score of >07 on each subscales. 23% of cancer patients were having scores in moderate to severe category on both HAD subscales. Total HADS score had range of 0-34 with mean of 14.21. 42% cases were having emotional distress on HADS score (Total Score of HADS >15). Conclusion: On the basis of the study we would recommend that cancer patients require not only medical treatment approach but psychological measures as well to cope up with associated emotional distress. Early recognition and management of emotional distress will significantly decrease the burden on health care cost and improve the quality outcome in cancer treatment.

Psychological resilience contributes to low emotional distress in cancer patients

Although a considerable number of cancer patients suffer from emotional distress which may have an impact on their quality of life, it still remains poorly understood which psychosocial factors contribute to individual vulnerabilities to emotional distress of cancer patients. Recently, resilience has been suggested as the capacity to cope with adversities like cancer. In this study, we investigated the relationships between resilience and emotional distress in cancer patients. One hundred fifty-two cancer patients who were consecutively hospitalized for their scheduled treatments at the Seoul St. Mary's Hospital were enrolled and completed the Connor-Davidson Resilience Scale and Hospital Anxiety Depression Scale to measure resilience and emotional distress. The relationships between the levels of psychological resilience and emotional distress were evaluated using univariate and multivariate logistic regression analyses. Psychological resilience levels were negatively associated with emotional distress after controlling for relevant covariates. The highest quartile of resilience level was associated with a 90% (adjusted odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.03-0.34, P < 0.001) reduction in the risk for emotional distress compared to the lowest quartile. Among metastatic cancer patients, resilience was also found to be a significant protective factor for emotional distress (adjusted OR = 0.14, 95% CI = 0.02-0.79, P = 0.02). The present study suggests that psychological resilience may independently contribute to low emotional distress in cancer patients. The relationship between resilience and emotional distress was also significant in the subgroup of metastatic cancer patients. Psychosocial interventions to enhance resilience might provide useful approaches to overcome cancer-related emotional distress.

La evaluación del malestar emocional percibido: la faceta desatendida de la atención del cáncer

The purpose of this research was to present the latest development of the The Perceived Emotional Distress Inventory (PEDI) as a brief 15-item self-report measure intended to be used for the assessment of psychological distress in cancer patients. Factor Analyses of Principal Components with promax rotations were performed with a combined male and female sample of 481 cancer patients at St. Joseph’s hospital Cancer Institute in Tampa, Florida, to provide further evidence of construct validity. The factor structure, internal consistency, and Pearson correlation coefficients of the PEDI are presented in this report. The factor analysis identified three factors comparable to those found in previous samples in USA: The first factor, anxiety/depression; second factor, hopelessness; and third factor, anger expression. Global alpha coefficient of 0.92 for the inventory indicates strong internal consistency. Pearson correlations between the subscales of the instrument is impressive for such a brief measure. This study emphasizes the need for a brief, self-report instrument to assess anger expression, anxiety, depression and hopelessness as components of perceived emotional distress in cancer patients, while explicitly excluding the potentially confounding effects of somatic symptoms commonly associated with cancer treatments. Further research will be needed to provide information about the PEDI’s use in populations other than cancer patients including attempts to replicate these findings in more heterogeneous populations.

Incidence and drug treatment of emotional distress after cancer diagnosis: a matched primary care case–control study

Background:Emotional distress is common in cancer patients. This study aimed to describe, in the year after a cancer diagnosis: the incidence of anxiety, depression and excessive alcohol use; the pattern of these diagnoses and treatment over time; and the nature and duration of the prescribed treatment.Methods:A matched case–control study was conducted using routinely collected primary care data from 173 Scottish general practices. A presumptive diagnosis of emotional distress (anxiety, depression and/or excessive alcohol use) was based on prescription data or diagnostic code. Prescriptions for psychotropic drugs were described in terms of drug class, volume and treatment duration.Results:In total, 7298 cancer cases and 14 596 matched-controls were identified. Overall, 1135 (15.6%) cases and 201 (1.4%) controls met criteria for emotional distress (odds ratio 13.7, 95% confidence interval 11.6–16.1). Psychotropic drugs were prescribed in the 6 months following initial cancer diagnosis for 1066 (14.6%) cases and 161 (1.1%) controls. The volume and duration of anxiolytic and antipsychotic prescribing was significantly different between cases and controls.Conclusion:This study quantified the higher incidence of new emotional distress in cancer patients in the first year post diagnosis. Clinicians should be aware of the possibility of emotional distress at any time in the year after cancer diagnosis.

Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age

Reported prevalence of emotional distress in cancer patients varies widely across studies. The present study determined prevalence of anxiety and depression (separated for presence of symptoms versus clinical levels) in a large, representative sample of cancer patients after diagnosis. During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centers. Patients' mean age was 59 years and 45% were men. Across cancer types, 19.0% of patients showed clinical levels of anxiety and another 22.6% had subclinical symptoms. Further, 12.9% of patients reported clinical symptoms of depression and an additional 16.5% described subclinical symptoms. Analyses by cancer type revealed significant differences such that patients with lung, gynecological, or hematological cancer reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either subclinical or clinical levels of anxiety in over 50% of cases. Findings describe levels of emotional distress after diagnosis but cannot inform about trajectories of anxiety and depression over time. Given that levels of anxiety and depression varied widely by cancer type, gender, and age, these results inform which cancer patients are most likely in need of psychosocial support.

Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis

The Hospital Anxiety and Depression Scale (HADS) is the most extensively validated scale for screening emotional distress in cancer patients. However, thresholds for clinical decision making vary widely across studies. A meta-analysis was conducted with the aim of identifying optimal, empirically derived cut-offs. PubMed, Embase, and PsycINFO databases were searched for studies that compared the HADS total and its subscale scores against a semi-structured or structured clinical interview as a reference standard with regard to its screening efficacy for any mental disorders and depressive disorders alone. Separate pooled analyses were conducted for single or two adjacent thresholds. A total of 28 studies (inter-rater agreement, κ = 0.86) were included. The best thresholds for screening for mental disorders were 10 or 11 on the HADS total (sensitivity 0.80; specificity 0.74), 5 on the HADS depression subscale (sensitivity 0.84; specificity 0.50), and 7 or 8 on the HADS anxiety subscale (sensitivity 0.73; specificity 0.65). Respective thresholds for depression screening were 15 for the HADS total (sensitivity 0.87; specificity 0.88), 7 for the HADS depression subscale (sensitivity 0.86; specificity 0.81), and 10 or 11 for the HADS anxiety subscale (sensitivity 0.63; specificity 0.83). The HADS anxiety subscale performed worse than the total and the depression subscales for both indicators. Diagnostic accuracy varied widely by threshold but was consistently superior for depression screening than for screening of any mental disorder.