Anxiety and depression in patients with prostate cancer and other urogenital cancer: A longitudinal study

Psychobiotics Ameliorate Depression and Anxiety Status in Surgical Oncology Patients: Results from the ProDeCa Study

Background: Psychological disorders are prevalent in patients having undergone gastrointestinal cancer surgery, and their emotional status may further deteriorate during subsequent chemotherapy. Psychobiotics are specific probiotics that have the unique characteristics of producing neuroactive substances that are thought to act on the brain-gut axis. The aim of the present study was to evaluate the benefits of a psychobiotic formula on depression and anxiety status, as well as on perceived stress, versus a placebo in patients on a chemotherapy course following gastrointestinal surgery for cancer. Patients: The enrolled patients, allocated to the psychobiotic and placebo groups, were assessed by means of these psychometric tests: Beck's Depression Inventory and the Hamilton Depression Rating 17-item Scale for depression; the General Anxiety Disorder-7 for anxiety; and the Perceived Stress Scale-14 Item for perceived stress at three time-points: upon allocation [T1], after one month of treatment [T2], and two months thereafter [T3]. Results: In total, 266 patients were included. One month of psychobiotic treatment improved [i] depression status by 60.4% [48 depressed patients at T1, reduced to 16 at T3]; [ii] anxiety by 57.0% [72 patients at T1, 26 at T3]; and [iii] stress by 60.4% [42 at T1, 14 at T3]. The placebo-treated patients experienced a deterioration in all parameters studied, i.e., depression increased by 62.9%, anxiety by 39.7%, and stress by 142.5%. Conclusions: Based on these findings, it can be recognized that psychobiotic treatment has great potential for every patient at risk of suffering from depression, anxiety, or stress during the course of surgery/chemotherapy for gastrointestinal cancer.

Increases in stress and adverse childhood experiences are associated with the co-occurrence of anxiety and depression in oncology patients

PURPOSE

Identify subgroups of patients with distinct joint anxiety AND depression profiles and evaluate for differences in demographic and clinical characteristics, as well as stress, resilience, and coping.

DESIGN

Longitudinal study.

PARTICIPANTS

Patients (n = 1328) receiving chemotherapy.

METHODS

Measures of state anxiety and depression were done six times over two cycles of chemotherapy. All of the other measures were completed prior to second or third cycle of chemotherapy. Latent profile analysis was used to identify the distinct joint anxiety and depression profiles.

FINDINGS

Three classes were identified (i.e. Low Anxiety and Low Depression (57.5%); Moderate Anxiety and Moderate Depression (33.7%), High Anxiety and High Depression (8.8%)). For all of the stress measures, a dose response effect was seen among the profiles. Two worst profiles reported higher occurrence rates for a number of adverse childhood experiences.

IMPLICATIONS FOR PROVIDERS

Patients need referrals for stress reduction techniques and mental health and social services.

Anxiety in patients with gastrointestinal cancer undergoing primary surgery

PURPOSE

Anxiety in the perioperative period is not only an unpleasant emotional state, but can also negatively affect the outcomes and quality of life of surgical patients. The present study investigated anxiety in patients with gastrointestinal cancer scheduled for primary surgery.

METHODS

A total of 101 patients in four non-university surgical departments were included. Anxiety (GAD-7), depression (PHQ-9), distress (Distress thermometer), and illness perception (Brief IPQ) were assessed at four time points: first outpatient contact before surgery (t1), preoperative inpatient contact (t2), postoperative inpatient contact before hospital discharge (t3), and postoperative outpatient follow-up contact after 30 days (t4).

RESULTS

56% of patients had an episode of mild or moderate anxiety and 5% had an episode of severe anxiety and/or depression. Subjectively perceived anxiety and depression were highest at t1, followed by t3. 30% of patients had elevated anxiety and depression scores at t1. Regression analyses showed that high subjectively perceived mental distress at t1 was associated with higher anxiety scores at t3 and t4. Women, and younger women in particular, were significantly more likely to experience stress than men. Higher levels of subjectively perceived stress at t1 were associated with higher levels of anxiety at t3 and t4. Sociodemographic factors were not relevant predictors of anxiety.

CONCLUSION

Anxiety and depression appear to be a persistent problem during the perioperative course in patients with gastrointestinal tumors. Identifying patients at risk for clinically relevant anxiety and depression remains a particular challenge. The results confirm the relevance of repeated screening for mental distress.

Mental health, functional impairment, and barriers to mental health access among cancer patients in Vietnam

OBJECTIVE

This study evaluated the prevalence and severity of depression and anxiety symptomatology, barriers to mental health access, and correlates of functional impairment among cancer inpatients.

METHODS

This cross-sectional study recruited adult cancer patients (N = 300) in June and July 2022 at the largest oncological hospital in Vietnam. Multivariable linear regression analyses examined the association between demographics, clinical characteristics, and patients' functional impairment.

RESULTS

Approximately 46.3% and 27.0% showed some depression and anxiety symptomatology, while 8.0% and 3.0% experienced major depressive and anxiety symptoms, respectively. Patients reported the most impairment in mobility and capacity for life activities. More functional impairment was identified in patients with gastrointestinal cancers, those receiving radiation therapy alone, and those scoring higher on depression and anxiety than in those with cancers originating in the head, neck, or lung or those receiving chemotherapy alone. Reports of better overall health status were negatively associated with functional impairment. Patients reported extensive perceived barriers to seeking psychiatric care, including not knowing where to get mental health support (86.7%), wanting to manage mental health independently (73.7%), and thinking mental health will resolve on its own (73.7%), and denying mental health concerns (61.0%).

CONCLUSION

High frequency and severity of depression and anxiety symptomatology underscore the importance of integrating mental health services into existing oncological treatment protocols. Increasing mental health literacy and provision of psychoeducation is critical to addressing barriers to mental health service access. Integration of functional impairment evaluations into hospital admission and discharge planning is also needed.

Anxiety and Depression in Patients with Prostate Cancer, at Cancer Diagnosis and after a One-Year Follow-Up

Prostate cancer (PCa) is the most prevalent among men, and psychological symptoms may affect many patients. This study aims to describe the prevalence of probable anxiety and depression before PCa treatments and after one year and to identify sociodemographic and clinical factors associated with these outcomes. Between February 2018 and March 2020, 292 patients recently diagnosed with PCa were recruited at the Instituto Português de Oncologia—Porto. The Hospital Anxiety and Depression Scale (HADS) was used to define probable anxiety and depression (cutoff = 11). The prevalence of probable anxiety remained stable from baseline to one year (7.8% vs. 8.5%, p = 0.866) while there was an increase in probable depression (3.1% vs. 6.8%, p = 0.012). After one year, probable depression persisted in 55.6% of patients with probable depression at baseline and 47.8% of those with probable anxiety at the first assessment had normal anxiety scores. At baseline, anxiety was more frequent among dwellers in rural areas (adjusted odds ratio—aOR, 95%CI: 2.80, 0.91–8.58) and less frequent in patients with body mass index 25–29.9 kg/m² (aOR, 95%CI: 0.33, 0.12–0.91) compared to 18.5–24.9 Kg/m², while those living alone had higher odds of depression (aOR, 95%CI: 6.35, 1.43–28.30). The frequency of anxiety and depression fluctuated during the course of treatment. Monitoring these symptoms would identify the most affected patients, contributing for a better use of mental health services.

Age disparities in mental health during the COVID19 pandemic: The roles of resilience and coping

BACKGROUND

The COVID19 pandemic has caused a mental health crisis worldwide, which may have different age-specific impacts, partly due to age-related differences in resilience and coping. The purposes of this study were to 1) identify disparities in mental distress, perceived adversities, resilience, and coping during the COVID-19 pandemic among four age groups (18-34, 35-49, 50-64, and ≥65); 2) assess the age-moderated time effect on mental distress, and 3) estimate the effects of perceived adversities on mental distress as moderated by age, resilience and coping.

METHODS

Data were drawn from a longitudinal survey of a nationally representative sample (n = 7830) administered during the pandemic. Weighted mean of mental distress and adversities (perceived loneliness, perceived stress, and perceived risk), resilience, and coping were compared among different age groups. Hierarchical random-effects models were used to assess the moderated effects of adversities on mental distress.

RESULTS

The youngest age group (18-34) reported the highest mental distress at baseline with the mean (standard error) as 2.70 (0.12), which showed an incremental improvement with age (2.27 (0.10), 1.88 (0.08), 1.29 (0.07) for 35-49, 50-64, and ≥65 groups respectively). The older age groups reported lower levels of loneliness and perceived stress, higher perceived risk, greater resilience, and more relaxation coping (ps < .001). Model results showed that mental distress declined slightly over time, and the downward trend was moderated by age group. Perceived adversities, alcohol, and social coping were positively,whereas resilience and relaxation were negatively associated with mental distress. Resilience and age group moderated the slope of each adversity on mental distress.

CONCLUSIONS

The youngest age group appeared to be most vulnerable during the pandemic. Mental health interventions may provide resilience training to combat everyday adversities for the vulnerable individuals and empower them to achieve personal growth that challenges age boundaries.

Induced photo-cytotoxicity on prostate cancer cells with the photodynamic action of toluidine Blue ortho

BACKGROUND

Photodynamic therapy (PDT) has become an advantageous therapeutic approach for the treatment of select cancers and microbial infections. PDT generates toxic reactive oxygen species as an end product of the interaction between the photosensitizer and light with an appropriate wavelength. Toluidine blue ortho is a photosensitizer that is commonly used in the photodynamic treatment of bacterial infection and a promising photosensitizer for cancer treatment. This study aims to evaluate the potential photo-cytotoxicity of toluidine blue ortho-mediated photodynamic therapy on PC-3 prostate cancer cells.

METHODS

In this study toluidine blue ortho-mediated photodynamic therapy was assessed on PC-3 cancer cells with various photosensitizer concentrations and light energy densities of the 655-nm diode laser. MTT analysis was used for the determination of the cytotoxicity on the cells and viability/cytotoxicity assay was used for live/dead cell staining after the applications. The mechanism of this application was further analyzed with the determination of intracellular reactive oxygen species and nitric oxide release.

RESULTS

The light applications and the photosensitizer alone did not inhibit the cell viability of PC-3 cells. 20 J/cm² laser energy density together with 100 μM photosensitizer concentration resulted in maximum cancer cell death with a rate of approximately 89 %. The level of intracellular reactive oxygen species increased with the increasing parameters of the applications that resulted in more cell death.

CONCLUSION

This study showed the successful anticancer activity of toluidine blue ortho upon irradiation with 655 nm of laser light against PC-3 cancer cells and it was mediated with the production of reactive oxygen species.

Anxiety Among Inpatients With Cancer: Findings From a Hospital-Based Cross-Sectional Study in Vietnam

Anxiety, a condition which is commonly found in patients with cancer, has negative impacts on their quality of life and treatment outcome. This study aimed to determine the level of anxiety in patients with cancer and explore sociodemographic, disease-related, and hospital-related factors associated with anxiety in those patients. A cross-sectional study was conducted on 510 inpatients with cancer at Thanh Hoa Oncology Hospital, Vietnam. Data were collected from self-administered questionnaire forms on hospital depression anxiety-A, interviews with patients, and patient medical records. The univariate and multivariate linear regression analyses were performed using STATA ver. 14.0. Our finding that the patients' mean anxiety score (standard deviation) was 7.22 (3.8); 27.6% of the patients had an anxiety score between 8 and 10 points, and 15.5% had an anxiety score of ≥11 points. In the multivariate model, in more advanced stages of cancer, and patients with metastasis were more likely to have higher levels of anxiety than those who presented no sign of metastasis. The longer the patients had cancer, the less anxious they became. Lower levels of anxiety were observed in patients who stated that hospital facilities were adequate or had trust in health workers. Patients with cancer need to be provided with psychological support in the early stage of cancer detection and when metastases form. A strong patient-health-care provider relationship after diagnosis may help reduce distress among patients with cancer with higher levels of medical mistrust.

No evidence of association between psychological distress and pain relief in patients with bone metastases from castration-resistant prostate cancer treated with 223Radium

OBJECTIVE

Painful bone metastases cause reduced quality of life (QoL) in patients with castration-resistant prostate cancer (CRPC). Alpha-emitter 223Radium is associated with a clear survival benefit and significant bone pain palliation in CRPC patients with symptomatic bone metastases. The aim of this study was to evaluate the association between pain relief and psychological distress during the time course of therapy in patients treated with 223Radium.

METHODS

A total of 63 patients with mCRPC undergoing 223Radium treatment in our Nuclear Medicine Unit, carefully instructed on the possibility of improving the pain and increasing the survival by the treatment, were retrospectively evaluated. Pain response during treatment was assessed with the Brief Pain Inventory Numeric Rating Scale. Psychological distress was evaluated through the analysis of specific items from EORTC QoL questionnaires C30 and BM22, submitted to patients at baseline and after each 223Radium cycle.

RESULTS

Pain intensity showed a significant decrease after first 223Radium administration (-1.03 points, p = 0.0032), with a subsequent stability through the course of treatment (-1.30 points, p = <0.001). Psychological status did not show significant variations during 223Radium treatment, and no association was found between psychological status and pain relief in our population.

CONCLUSIONS

In our experience, bone pain palliation provided by 223Radium do not correlate with an improved psychological status in patients with advanced PC. This observation emphasises the role of the psychological aspect in the evaluation of the QoL and the necessity of a multidisciplinary approach in which the emotional aspect of the patient is carefully evaluated.

The experiences of mine workers with cancer

Background

Cancer is a disease that instils a fear of death in the minds of most people. For South African mine workers, the fear of death is compounded by a fear of being unable to fulfil work obligations in an industry where employment is central to the miners’ identity.

Aim

The purpose of this research was to explore and describe the experiences of mine workers experiencing a cancer diagnosis requiring radiation therapy.

Setting

Mining towns in the Limpopo province, Thabazimbi and Lephalale.

Methods

A qualitative, descriptive and exploratory study design was utilised. The purposeful sample consisted of 11 mine workers receiving treatment at a radiotherapy centre in the North West province. Data were collected using an open-ended questionnaire and individual in-depth telephonic interviews. Data were analysed using open coding to identify themes.

Results

The themes identified were the emotional experience resulting from the diagnosis, changing family dynamics and information needs from radiotherapy professionals. The psychosocial support required by this group of patients is unique and radiation therapists need to provide wholistic support that is tailored to address the contextual needs of this group of patients.

Conclusions

Mine workers often live far away from their family and are forced to face the cancer journey alone without family support. Oncology professionals, therefore, need to create supportive structures, including emotional and financial counselling, to ensure compliance with treatment protocols, thus facilitating a positive treatment outcome.

The validity of the Distress Thermometer in female partners of men with prostate cancer

Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer-specific (Impact of Events Scale-Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2-4 years post-treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71-0.92 and 0.83-0.94 for general and cancer-specific distress, respectively), sensitivity, specificity and optimal DT cut-offs for partner distress varied for general (range: ≥2 to ≥5) and cancer-specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.

Trajectories of quality of life, life satisfaction, and psychological adjustment after prostate cancer

Background

To describe trajectories of health‐related quality of life (QoL), life satisfaction, and psychological adjustment for men with prostate cancer over the medium to long term and identify predictors of poorer outcomes using growth mixture models.

Methods

One‐thousand sixty‐four (82.4% response) men diagnosed with prostate cancer were recruited close to diagnosis and assessed over a 72‐month (6‐year) period with self‐report assessment of health‐related QoL, life satisfaction, cancer‐related distress, and prostate specific antigen anxiety. Urinary, bowel, and sexual function were also assessed using validated questionnaires.

Results

Poorer physical QOL was predicted by older age, lower education, lower income, comorbidities, and receiving hormone therapy. Lower life satisfaction was related to younger age, lower income, not being partnered, and comorbidities. Poorer psychological trajectories were predicted by younger age, lower income, comorbidities, and receiving radical prostatectomy or brachytherapy. Better urinary, bowel, and sexual function were related to better global outcomes over time. Anxiety about prostate specific antigen testing was rare.

Conclusions

Distinct trajectories exist for medium‐ to long‐term QoL, life satisfaction, and psychological adjustment after prostate cancer; with age and socioeconomic deprivation playing a differential role in men's survivorship profile and the impact of functional status on outcomes increasing over time. These results reinforce the need for an appraisal of men's life course in addition to treatment side effects when planning survivorship care after cancer.

Psychosocial, clinical and demographic features related to worry in patients with melanoma

The aim of this study was to investigate clinical, demographic and psychosocial predictors of melanoma-related worry. A questionnaire-based study in a population-ascertained cohort of individuals diagnosed with melanoma in the previous 3-6 months was carried out to identify factors associated with worry about melanoma shortly after diagnosis. A total of 520 patients felt worried about their future with respect to melanoma and 1568 patients felt confident about their future with respect to melanoma. Worry was less likely in men with partners than women with partners [adjusted odds ratio (OR)=0.51, 95% confidence interval (CI) (0.39-0.67)], and increasing age was protective against worry [adjusted OR=0.96 per year, 95% CI (0.95-0.97)]. Worry was more likely for patients with stage III/IV melanoma [adjusted OR=1.90, 95% CI (1.41-2.56) compared with stages IB-IIC], melanoma arising in sun-protected sites (compared with a limb), no occupation (compared with workers), those who reported insufficient emotional support from healthcare providers [adjusted OR=2.20, 95% CI (1.56-3.09) compared with sufficient support], lower knowledge of melanoma [adjusted OR=4.50, 95% CI (2.82-7.18) compared with well informed], perceived financial hardship compared with no financial hardship and over three previous negative life events compared with none/one. Worry about melanoma outcomes after diagnosis is multifactorial in origin.

Assessment of depression severity with the PHQ-9 in cancer patients and in the general population

BACKGROUND

The Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions.

METHODS

A sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients.

RESULTS

While the reliability (Cronbach's alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients' sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden.

CONCLUSIONS

The results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.

Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study

PURPOSE

A multi-centre, longitudinal study was conducted to assess the prevalence of fatigue amongst men with localized prostate cancer, to describe several dimensions of fatigue and to explore the predictability of fatigue by psychological distress and physical function.

METHODS

The prevalence of fatigue was evaluated using the Multidimensional Fatigue Inventory in 329 prostate cancer patients before, 3, 6 and 12 months after surgery. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Physical function was measured using the EORTC QLQ-C30.

RESULTS

After surgery, about 14 % of the patients were screened with chronic fatigue. For all dimensions of fatigue, only small longitudinal changes could be observed. Psychological distress could be identified as a good predictor of fatigue after but not before surgery.

CONCLUSIONS

Radical prostatectomy has no or little impact on the prevalence of fatigue. However, about 14 % of patients with chronic fatigue could possibly benefit from psychosomatic interventions. Interventions should consider the simultaneous appearance of fatigue and psychological distress and a reduced physical function.

Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

The association of resilience and age in individuals with colorectal cancer: an exploratory cross-sectional study

BACKGROUND

Studies generally report lower emotional distress in older patients with cancer than in younger patients with cancer. The personality construct of resilience was previously found to be higher with age, but has not been assessed in relation to emotional distress in older patients with cancer.

OBJECTIVE

To assess the mediating effect of resilience on the associations between age and emotional distress in patients with colorectal cancer (CRC).

PATIENTS AND METHODS

An exploratory cross-sectional study of 92 individuals, aged 27-87 years, diagnosed with CRC stage II-III, 1-5 years prior to enrollment in the study. They completed the Wagnild and Young's resilience scale and Brief Symptoms Inventory-18, cancer-related problem list, and demographic and disease-related details.

RESULTS

Older age, male gender, and less cancer-related problems were associated with higher resilience and lower emotional distress. A Structural Equation Modeling (SEM) analysis and mediation tests showed that, while controlling for cancer-related problems, resilience mediated the effects of age and gender on emotional distress.

CONCLUSIONS

The study enlarges the explanation for the consistent previous findings on the better adjustment of older patients with cancer. Increased professional support should be provided for patients with low resilience levels.

Does quality of life of prostate cancer patients differ by stage and treatment?

BACKGROUND

The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient's quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample.

METHODS

The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model.

RESULTS

Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Between cancer stages, statistically significant differences were observed only in scales of emotional functioning (p<0.001) and social functioning (p<0.001). Between treatment groups, statistically significant differences were observed in scales of physical functioning (p<0.001), role functioning (p<0.001), emotional functioning (p<0.001), and social functioning (p<0.001).

CONCLUSIONS

Our study highlighted statistically significant differences in QoL between cancer stages and treatment. Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient when exist several alternatives.

First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment

OBJECTIVE

The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment.

MATERIAL AND METHODS

A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics.

RESULTS

Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning.

CONCLUSIONS

Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.

Response shift in the assessment of anxiety, depression and perceived health in urologic cancer patients: an individual perspective

The assessment of quality of life in cancer patients is hampered because patients may change their frames of reference during the course of the disease. The aim of this study was to test individual differences in these response shift effects. Urologic cancer patients (n= 275) were examined during the stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Furthermore, at T3 they were asked to retrospectively assess their situation at T1 (then-test). The difference between this retrospective assessment and the original assessment at T1 was used to determine the response shift effect (recalibration). Anxiety (Generalized Anxiety Disorder Questionnaire-2), depression (Patient Health Questionnaire-2) and health dissatisfaction (Questionnaire on Life Satisfaction) were obtained at all points in time. The effect sizes of the mean response shift effects (recalibration) ranged between 0.26 and 0.48. Nevertheless, a large proportion of the sample showed no response shift (22-38%) or even negative response shift effects (20-30%). There were significant correlations among the response shift measures of the domains (anxiety, depression and health dissatisfaction) with coefficients between 0.29 and 0.51. The results indicate that response shift should not only be assessed on the mean score level, since it is also a dimension of individual difference.

Prevalence and predictors of anxiety and depression among cervical cancer survivors in Korea

PURPOSE

With increasing survival rates of women with cervical cancer, quality of life of the survivors becomes a more important issue. However, little is known about the mental health of cervical cancer survivors (CCSs). This study investigated the prevalence of anxiety and depression in CCSs compared with healthy controls and identified factors associated with multidimensional model including sociodemographic, clinical, functioning and well-being, and symptom variables.

METHODS

The participants included 828 CCSs (mean time since treatment, 6.9 years) enrolled at 6 tertiary hospitals from 1983 to 2004 and 500 control subjects selected randomly from a representative sample of Korean women. Subjects completed the following questionnaires: the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire-C30, its Cervical Cancer module, and the McGill Quality of Life Questionnaire.

RESULTS

Hospital Anxiety and Depression Scale-defined anxiety in CCSs did not differ from that in healthy controls (39.5% and 32.2%, respectively; P = 0.218). Anxiety was significantly more prevalent in younger CCSs (< or = 50 years) than in controls (40% vs 26.4%, respectively; P < 0.001). Hospital Anxiety and Depression Scale-defined depression was even lower in CCSs than in controls (34.6% vs 48.0%, respectively; P < 0.001). In multivariate analyses, the Hospital Anxiety and Depression Scale-defined anxiety and depression in CCSs were commonly associated with financial difficulty, poor body image, sexual inactivity, and low existential well-being. Low support and insomnia were uniquely related to anxiety, with older age and decrement role function uniquely related to depression. However, disease-related clinical factors were not related to either anxiety or depression.

CONCLUSIONS

Cervical cancer survivors showed relatively good mental health compared with healthy controls; however, women who have low functioning and well-being could be at high risk of anxiety or depression or both.

Predictors of depression among older African American cancer patients

BACKGROUND

Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients.

OBJECTIVE

This study explores the demographic and illness-related risk factors in older African American cancer patients.

METHODS

Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. chi2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample.

RESULTS

The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression.

CONCLUSION

This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors.

IMPLICATIONS FOR PRACTICE

An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.