Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

Nauman A Jadoon, Waqar Munir, Mohammad A Shahzad, Zeshan S Choudhry, Nauman A Jadoon, Waqar Munir, Mohammad A Shahzad, Zeshan S Choudhry

Abstract

Background: The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients.

Methods: This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group).

Results: The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer.

Conclusions: This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.

References

    1. Pirl WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004;32:32–9. doi: 10.1093/jncimonographs/lgh026.
    1. National comprehensive cancer network (NCCN) Standards of care and management of distress penal. Distress management version 1. 2007.
    1. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10(1):19–28. doi: 10.1002/1099-1611(200101/02)10:1<19::AID-PON501>;2-Y.
    1. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71. doi: 10.1093/jncimonographs/lgh014.
    1. Powe BD, Finne R. Cancer fatalism: the state of the science. Cancer Nurs. 2003;26:454–465. doi: 10.1097/00002820-200312000-00005.
    1. Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L. Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life. Qual Life Res. 2005;14:1825–33. doi: 10.1007/s11136-005-4324-3.
    1. Costantin M, Musso M, Viterboli P. Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer. 1999;7:121–127. doi: 10.1007/s005200050241.
    1. Montazeri A, Milroy R, Hole D, McEwean J, Gills CR. Anxiety and depression in patients with lung cancer before and after diagnosis: findings from a population in Glasgow, Scatland. J Epidemiol Community Health. 1998;52:203–204. doi: 10.1136/jech.52.3.203.
    1. Lloyd-Williams M. Difficulties in diagnosing and treating depression in the terminally ill cancer patient. Postgrad Med J. 2000;76:555–8. doi: 10.1136/pmj.76.899.555.
    1. Lynch ME. The assessment and prevalence of affective disorders in advanced cancer. J Palliat Care. 1995;11:10–8.
    1. Donovan KA, Jacobsen PB. Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer. Semin Oncol Nurs. 2007;23:127–35. doi: 10.1016/j.soncn.2007.01.004.
    1. Hirschfeld RMA. Comorbidity of major depression and anxiety disorders: recoginition and management in primary care. Primary Care Companion J Clin Psychiatry. 2001;3:244–254. doi: 10.4088/PCC.v03n0609.
    1. Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin. 2008;58:214–30. doi: 10.3322/CA.2008.0003.
    1. Pandey M, Sarita GP, Devi N, Thomas BC, Hussain BM, Krishnan R. Distress, anxiety, and depression in cancer patients undergoing chemotherapy. World J Surg Oncol. 2006;4:68. doi: 10.1186/1477-7819-4-68.
    1. Capuron L, Ravaud A, Dantzer R. Early depressive symptoms in cancer patients receiving interleukin 2 and/or interferon alfa-2b therapy. J Clin Oncol. 2000;18:2143–51.
    1. Keller M, Sommerfeldt S, Fischer C, Knight L, Riesbeck M, Löwe B, Herfarth C, Lehnert T. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol. 2004;15:1243–9. doi: 10.1093/annonc/mdh318.
    1. Singer S, Bringmann H, Hauss J, Kortmann RD, Köhler U, Krauss O, Schwarz R. Prevalence of concomitant psychiatric disorders and the desire for psychosocial help in patients with malignant tumors in an acute hospital. Dtsch Med Wochenschr. 2007;132:2071–6. doi: 10.1055/s-2007-985643.
    1. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797–810. doi: 10.1017/S0033291709992285.
    1. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349–61. doi: 10.1002/cncr.24561.
    1. O'Mahony S, Goulet J, Kornblith A, Abbatiello G, Clarke B, Kless-Siegel S, Breitbart W, Payne R. Desire for hastened death, cancer pain and depression: report of a longitudinal observational study. J Pain Symptom Manage. 2005;29:446–57. doi: 10.1016/j.jpainsymman.2004.08.010.
    1. Bui QU, Ostir GV, Kuo YF, Freeman J, Goodwin JS. Relationship of depression to patient satisfaction: findings from the barriers to breast cancer study. Breast Cancer Res Treat. 2005;89(1):23–8. doi: 10.1007/s10549-004-1005-9.
    1. Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biol Psychiatry. 2003;54(3):269–82. doi: 10.1016/S0006-3223(03)00566-3.
    1. Frick E, Tyroller M, Panzer M. Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. Eur J Cancer Care (Engl) 2007;16:130–6. doi: 10.1111/j.1365-2354.2006.00720.x.
    1. Ahn SH, Park BW, Noh DY, Nam SJ, Lee ES, Lee MK, Kim SH, Lee KM, Park SM, Yun YH. Health-related quality of life in disease-free survivors of breast cancer with the general population. Ann Oncol. 2007;18:173–82. doi: 10.1093/annonc/mdl333.
    1. Grov EK, Dahl AA, Moum T, Fosså SD. Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase. Ann Oncol. 2005;16:1185–91. doi: 10.1093/annonc/mdi210.
    1. Uitterhoeve RJ, Vernooy M, Litjens M, Potting K, Bensing J, De Mulder P, van Achterberg T. Psychosocial interventions for patients with advanced cancer--a systematic review of the literature. Br J Cancer. 2004;91:1050–1062.
    1. Carlson LE, Bultz BD. Benefits of psychosocial oncology care: Improved quality of life and medical cost offset. Health and Quality of Life Outcomes. 2003;1:8. doi: 10.1186/1477-7525-1-8.
    1. Dogar IA, Azeem MW, Kiran M, Hussain I, Mehmood K, Hina I. Depression and anxiety in cancer patients in outpatient department of a tertiary care hospital in Pakistan. Pak J Med Sci. 2009;25(5):734–737.
    1. Ali BS, Reza H, Khan MM, Jehan I. Development of an indigenous screening instrument in Pakistan: the Aga Khan University Anxiety and Depression Scale. J Pak Med Assoc. 1998;48:261–5.
    1. Ahmer S, Faruqui RA, Aijaz A. Psychiatric rating scales in Urdu: a systematic review. BMC Psychiatry. 2007;7:59. doi: 10.1186/1471-244X-7-59.
    1. Tavoli A, Mohagheghi MA, Montazeri A, Roshan R, Tavoli Z, Omidvari S. Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter? BMC Gastroenterol. 2007;7:28. doi: 10.1186/1471-230X-7-28.
    1. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S. WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291(21):2581–90. doi: 10.1001/jama.291.21.2581.
    1. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ. 2004;328:794. doi: 10.1136/bmj.328.7443.794.
    1. Redeker NS, Lev EL, Ruggiero J. Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract. 2000;14:275–90.
    1. Matsushita T, Matsushima E, Maruyama M. Psychological state, quality of life, and coping style in patients with digestive cancer. Gen Hosp Psychiatry. 2005;27:125–32. doi: 10.1016/j.genhosppsych.2004.10.006.
    1. Van't Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med. 1997;59:280–93.
    1. Matsushita T, Matsushima E, Maruyama M. Anxiety and depression of patients with digestive cancer. Psychiatry Clin Neurosci. 2005;59:576–83. doi: 10.1111/j.1440-1819.2005.01417.x.
    1. Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauss O, Lehmann A, Schwarz R. Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer. 2009;100:908–12. doi: 10.1038/sj.bjc.6604952.
    1. Pitceathly C, Maguire P, Fletcher I, Parle M, Tomenson B, Creed F. Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Ann Oncol. 2009;20:928–34. doi: 10.1093/annonc/mdn708.
    1. NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network. Oncology (Williston Park) 1999;13:113–47.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren