Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients. A double-blind placebo-controlled study was therefore designed to assess the effectiveness of 20 mg fluoxetine. Of 115 cancer patients who fulfilled entry criteria for levels of distress, 45 patients were randomized to a fluoxetine treatment group (FA) and 46 patients to a placebo group (PA) after a 1-week placebo period designed to exclude placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS), the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index (SQOLI) were used to assess the efficacy of fluoxetine. The response rate, defined by a HADS score lower than 8 after 5 weeks of treatment, was not significantly higher in the FA group (11%) compared to the PA group (7%). Compared to the PA group, patients in the FA group showed a significantly greater decrease in SCL90-R mean total score after 5 weeks, but not a greater decrease in HADS mean score. No difference between the two groups was found in observer-reported assessments (MADRS, HAS and SQOLI). Significantly more drop-outs were observed in the FA group (n = 15) than in the PA group (n = 7), although the frequencies of side-effects were not significantly different.

This study demonstrates the feasibility and effectiveness of a psycho-educational intervention, which can accelerate the reduction of those negative affects which are present at the end of treatment. It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support, widely proposed in France, and should now be tested in groups with other types of cancer and at other disease phases.

Using the PDS appeared feasible, acceptable and effective for psychological distress screening in French ambulatory cancer care settings.

The Mental Adjustment to Cancer (MAC) scale was validated on a heterogeneous French sample of 317 cancer patients. Internal consistency was satisfactory for the original subscales (alpha coefficients=0.62-0.80), except for the Fatalism subscale (alpha=0.40). The intercorrelations of the subscales and the correlations between the subscales and Anxiety and Depression criteria were congruent with the values reported in the literature. Multidimensional Scaling revealed three positive and three negative subsets of items revealing adjustment to cancer. Congeneric factor analysis of the subsets was performed with LISREL 8.3 and only three of them (after discarding certain items) were retained: Fighting Spirit (FS) Hopelessness/Helplessness (HH) and Anxious Preoccupation (AP). A confirmatory hierarchical factor analysis on the 21 items included showed that FS measured positive adjustment to cancer and HH and AP measured negative adjustment. A differential adjustment hypothesis was proposed in order to explain the stability and instability of the measures of the diverse constructs. The three revised subscales showed the same validity pattern as the corresponding original scales, but the magnitude of the correlations was considerably improved with respect to the original subscales. The practical and the theoretical importance of FS, HH and AP are emphasized.

This study was designed to test a new rating observational scale for the diagnosis and grading of pain evoked by cancer in children aged 2-6 years. We began by collecting retrospective clinical findings consisting of descriptions of children in pain. From these descriptions, an item scale was built up comprising overall patterns of behavior specific to pain. Because depression and anxiety-like items occurred very frequently in the descriptions, they were included in the rating scale. The present preliminary report gives the results of the scale, which was tested in 80 children, chosen because they were liable to be in pain. Each child was evaluated by 2 nurses and 2 auxiliaries. Sensitivity and reproducibility were satisfactory. Factorial correspondence analysis showed that both depression and pain items contributed to the first axis, which accounted for 51% of the variance. A second axis was found, which contrasted anxiety and pain items, but it only accounted for 13% of the variance. These results suggest that in young children, pain evoked by severe disease leads to a depression-like reaction that correlates with that pain's intensity. They indicate that in children of pre-school age, pain can be assessed by observing its overall specific patterns.