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Screening and Assessment of Distress, Anxiety, and Depression in Cancer Patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims and Methods The overall aim was to evaluate methods of screening and assessment of distress, anxiety, and depression in cancer patients. Further, to evaluate effects of a psychosocial intervention and to explore changes of distress, anxiety, depression, and HRQoL during six months. Study I included 495 consecutive patients screened with the Hospital Anxiety and Depression Scale (HADS) at their first visit to an Oncology Department. Half of the patients with >7 on any of HADS subscales received standard care (SCG), and half received a psychosocial intervention (IG). To compare HADS with a thorough clinical assessment (CA), Study II included 171 identified patients representing both sexes, <65/≥65 years, and curative/palliative treatment intention.

Results Screening with HADS identified anxiety or/and depression symptoms in 36% of the 495 patients. Thirty-six (43%) of 84 IG patients attended CA, resulting in support for 20 (24%) of them. There were no differences between SC and IG during follow-up, anxiety and depression decreased and HRQoL increased, although anxiety was still present and HRQoL impaired at six months. The Distress Thermometer (DT) ≥4 (sensitivity 87%, specificity 73%) is valid for screening of distress; its ability to measure changes over time is comparable to HADS. Of 319 patients screened with <8 on both HADS subscales, 196 (80%) were stable non-cases with HRQoL comparable to that of the general population and 49 (20%) patients were unstable non-cases, with deteriorated anxiety, depression, and HRQoL. >4 on HADS subscales may be useful for early detection of unstable non-cases. In Study II, HADS identified 49 (34%) and the CA 71 (49%) patients as having distress, anxiety or depression. CA identified more men and more young patients with distress than HADS did.

Conclusion Screening and assessment identifies patients with persistent symptoms and increases access to CA and support. The DT may be used routinely in oncology care. When HADS is used, healthcare professionals should be aware of psychosocial problems perceived by patients but not covered by HADS. Most patients identified with distress seem to have resources to manage problems without needing additional support. Patients screened as non-cases indicate no need for re-assessment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1006
Keyword [en]
Screening and assessment, anxiety, depression, psychosocial intervention, health-related quality of life, hospital anxiety and depression scale, distress thermometer, cancer
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-221956ISBN: 978-91-554-8965-6 (print)OAI: oai:DiVA.org:uu-221956DiVA: diva2:714000
Public defence
2014-06-12, Uppsala universitet, sal IX, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-05-22 Created: 2014-04-07 Last updated: 2014-06-30
List of papers
1. Anxiety and depression in oncology patients: a longitudinal study of a screening, assessment and psychosocial support intervention
Open this publication in new window or tab >>Anxiety and depression in oncology patients: a longitudinal study of a screening, assessment and psychosocial support intervention
2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 1, 118-127 p.Article in journal (Refereed) Published
Abstract [en]

Background. Anxiety and depression in cancer patients are associated with poor health-related quality of life (HRQOL). Clinical interventions to detect and support patients with these symptoms need to be developed and evaluated. We investigated the feasibility of screening with the Hospital Anxiety and Depression Scale (HADS) in a clinical oncology setting. In patients with anxiety or depression symptoms (HADS >7) we explored the use of clinical assessment and psychosocial support and described the development of anxiety, depression and HRQOL during a six-month period. Material and methods. Four hundred and ninety-five consecutive patients were screened for anxiety and depression at the time of their first visit at an oncology department (baseline). Half of the patients with HADS >7 on any of the two HADS subscales were referred to clinical assessment and psychosocial support (intervention group, IG) and half received standard care (SCG) using a historical control group design. HADS and EORTC QLQ-C30 were completed at baseline and after one, three and six months. Results. One hundred and seventy-six (36%) of 495 patients had anxiety or depression symptoms at screening, HRQOL at baseline was clearly impaired for them. Thirty-six (43%) of 84 IG patients attended clinical assessment, resulting in subsequent psychosocial support for 20 (24%) of them. In the SCG, only five (5%) patients attended clinical assessment after self referral, two received subsequent psychosocial support. Anxiety and depression decreased and HRQOL increased statistically significantly over time although anxiety was frequent and HRQOL impaired during the entire six month period. There were no differences between the SCG and IG regarding anxiety, depression or HRQOL at any time point. Conclusion. Systematic screening with HADS is feasible for oncology patients in clinical settings; it identifies patients with persistent symptoms and increases referral to clinical assessment and utilisation of psychosocial support.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-178192 (URN)10.3109/0284186X.2012.707785 (DOI)000312505900015 ()
Available from: 2012-07-30 Created: 2012-07-30 Last updated: 2017-12-07Bibliographically approved
2. Validation of the Distress Thermometer in a Swedish population of oncology patients: accuracy of changes during six months
Open this publication in new window or tab >>Validation of the Distress Thermometer in a Swedish population of oncology patients: accuracy of changes during six months
Show others...
2013 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 5, 625-631 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

To validate the Swedish version of the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS) for screening of distress and to explore how well DT measures changes of distress during six months in a population of heterogeneous oncology patients.

Methods

The DT was translated into Swedish according to the forward- and back-translation procedure. HADS total score ≥15 was used as gold standard. Consecutive patients were invited to participate at their first visit to the Oncology department. The HADS and the DT were completed at baseline and after 1, 3 and 6 months.

Results

462 baseline and 321 six-month assessments were completed. The patients had a variety of cancer diagnoses (n = 42). Most patients (95%) received active treatment. The DT compared favourably with the HADS. The area under the curve was 0.86 (95% CI, 0.82–0.90). DT ≥ 4 showed a sensitivity of 87%, a specificity of 73%, a positive predictive value (PPV) of 52% and a negative predictive value (NPV) of 95% at baseline. The results from the 1, 3 and 6 months assessments were equivalent baseline results. The DT means changed in the same direction as HADS at all points of assessment. Patients with distress reported statistically significantly more problems in all categories on the associated ‘Problem List’ compared to non-distressed patients.

Conclusion

The Swedish version of the DT with a score ≥4 is valid for screening of distress in heterogeneous oncology patients. Its ability to measure changes in distress over time is comparable to HADS.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-178198 (URN)10.1016/j.ejon.2012.12.005 (DOI)000325600800016 ()
Available from: 2012-07-30 Created: 2012-07-30 Last updated: 2017-12-07Bibliographically approved
3. Identification of distress in oncology patients: a comparison of the Hospital Anxiety and Depression Scale and a thorough clinical assessment
Open this publication in new window or tab >>Identification of distress in oncology patients: a comparison of the Hospital Anxiety and Depression Scale and a thorough clinical assessment
2016 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 39, no 2, E31-E39 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Screening is recommended to identify cancer patients with distress,anxiety, and depression. The ability of current methods to identify distress inoncology patients is of high importance.

Objective:

We compared the HospitalAnxiety and Depression Scale (HADS) with a thorough clinical assessment.Furthermore, we explored the agreement of HADS with clinical assessment outcomesas a function of age, sex, and treatment intention.

Methods:

One hundredforty-six oncology patients, representing both sexes, different ages (<65/Q65 years),and treatment intention (curative/palliative), completed the HADS before the clinicalassessment. Two study team members (blind to the HADS results) completedclinical assessments of anxiety, depression, and distress analogous to categoriesused in the HADS.

Results:

The HADS identified 49 participants and the clinicalassessment 71 participants as having anxiety, depression, or distress. The overall agreement between the HADS and the clinical assessment was moderate. The greatest differences were found to be a function of participant sex and age.Agreement between the methods was better for females than for males in relation to distress and anxiety and better for the older (Q65 years) than younger participants in relation to depression. By treatment intention, agreement was equal for alldomains.

Conclusion:

Especially male and young participants appear to have potential problems that the HADS fails to identify.

National Category
Cancer and Oncology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-222016 (URN)10.1097/NCC.0000000000000267 (DOI)000371546700004 ()
Funder
Swedish Cancer Society
Available from: 2014-04-23 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
4. Stability and changes of anxiety, depression, and health-related quality of life over six months in oncology patients scoring as non-cases according to Hospital Anxiety and Depression Scale (HADS) at initial assessment
Open this publication in new window or tab >>Stability and changes of anxiety, depression, and health-related quality of life over six months in oncology patients scoring as non-cases according to Hospital Anxiety and Depression Scale (HADS) at initial assessment
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-221961 (URN)
Available from: 2014-04-23 Created: 2014-04-07 Last updated: 2014-06-30

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