Background: Psychological distress is frequently observed, however, it is underestimated in cancerpatients. The aimof thisstudyisto develop a simple battery for screening for psychological distress, adjustment disorderand majordepressive disorder in Japanese cancer patients. Methods: One hundred and twenty-eight cancer patients were interviewed by psychiatrists and tested using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses were performed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised. Results: Cronbach ex values of the Japanese version of the scale were 0.77 for the subscale for anxiety and 0.79 for depression. By a receiver operating characteristic analysis, we determined that an optimal cut-off point for screening for adjustment disorder and major depressive disorder was 10/11, which gave high enough sensitivity and specificity (91.5 and 65.4%, respectively). To screen for major depressive disorder alone, 19/20 was an optimal cut-off point with 82.4% sensitivity and 96.3% specificity. The subscales of HADS(anxiety and depression) also had high screening performance. Conclusions: The Japanese version of HADS is a sensitive and specific tool for screening for psychological distress in Japanese cancer patients. This scalecan be usedfor an earlydetection of patients' psychological distress which may be followed by psychiatric interventions.Key words: screening -anxiety -depression -psycho-oncology INTRODUCTIONCancer patients must face several stresses, and factors which cause their psychological distress, especially anxiety and depression. Previous reports indicated that the most frequent psychiatric diagnoses of cancer patients were adjustment disorder with anxiety and/or depression and they also suffered from major depressive disorder (1).Although patients with these psychiatric diagnoses need to take specific psychiatric therapies, including medication, they tend to be over-or underdiagnosed by medical staff (2,3). One reason for this tendency is that medical staff, even the family, take it for granted that cancer patients have some psychological distress so that it is not worthwhile taking psychiatric interventions (4), and Received November 6, 1997; accepted February 13, 1998 For reprints and all correspondence: Yosuke Uchitomi, Psycho-Oncology Division, National Cancer Center Research Institute East, 5-1, Kashiwanoha 6-chome, Kashiwa, 277-8577, Japan Abbreviations: HADS, Hospital Anxiety and Depression Scale; SCID, the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised; POMS, the Profile of Mood States; ROC, receiver operating characteristic; GFI, Goodness of Fit Index; PPV, positive predictive value the other is a difficulty in assessing their distress because of the physical symptoms (5,6). However, this psychological distress can disturb the patient's quality of life and affect their choice of treatments for cancer.Some screeni...

BACKGROUND High levels of distress are a concern regarding patients with head and neck cancer. Early detection of and intervention for such distress are needed to predict patients' adaptation to treatment or rehabilitation, but few studies have investigated the detection of their distress in a patient population of significant size. METHODS The authors examined 107 consecutive patients with head and neck cancer to assess their psychologic distress (adjustment disorders or major depression) or other psychiatric problems by structured psychiatric interview before the initial cancer treatment. They also evaluated predictive factors for psychologic distress and assessed the ability of a self‐rating questionnaire (Hospital Anxiety and Depression Scale, HADS) to screen for distress. RESULTS Of 107 subjects, 18 (16.8%) had an adjustment disorder or major depression. Thirty‐six (33.6%), 7 (6.5%), and 35 (32.7%) met criteria for alcohol dependence, alcohol abuse, and nicotine dependence, respectively. Logistic regression analysis revealed that having advanced stage cancer (odds ratio, 5.77; 95% confidence interval [CI], 1.41–39.7; P = 0.03) and living alone (odds ratio, 4.83; 95% CI, 1.04–22.2; P = 0.04) were significantly associated with having psychologic distress. The optimal cutoff point for the HADS screening for psychologic distress was 15. This cutoff point gave 72.2% sensitivity and 81.4% specificity. CONCLUSIONS Head and neck cancer patients who have advanced disease or live alone should be assessed so that psychologic distress can be detected and intervention made. HADS is a useful clinical instrument to screen for their distress. Cancer 2000;88:2817–23. © 2000 American Cancer Society.

Fatigue is one of the most frequent symptoms in cancer patients. However, the precise causes of this fatigue are still unknown, and this situation makes it difficult to combat the problem. The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients. A group of 134 randomly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated. They completed the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale, the Mental Adjustment to Cancer Scale, and an ad hoc questionnaire detailing physical symptoms, social support, and demographic variables at home and returned them by mail the following day. Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea, insufficient sleep, and depression, and that these three variables accounted for a total of 46% of variance in fatigue. Factors concerned with the cancer and treatment, such as disease stage, lymph node metastasis, number of days since operation, past intravenous chemotherapy, radiotherapy, current use of fluoropyrimidine compounds, and current use of tamoxifen citrate were not correlated with fatigue. The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments, and that the management of dyspnea, insomnia, and depression might be important in reducing fatigue in this population.

Although it has been indicated that patients with lung cancer experience higher level of fatigue than patients with other cancers, few published studies have focused on the characteristics of this fatigue and how it interferes with daily activities. The purpose of this study was to clarify fatigue prevalence and the factors correlated with fatigue, and to develop a screening method for fatigue in patients with advanced lung cancer. One hundred fifty-seven patients completed two fatigue scales (Cancer Fatigue Scale [CFS], and Fatigue Numerical Scale [FNS]) plus other measures, along with a self-administered questionnaire asking whether fatigue had interfered with any of 7 areas of daily activities. Fifty-nine percent of patients had experienced clinical fatigue, which was defined as fatigue that interfered with any daily activities. Logistic regression analysis demonstrated that symptoms of dyspnea on walking, appetite loss, and depression were significant correlated factors. Both CFS and FNS were found to have sufficient sensitivity and specificity for use as a screening tool. The results indicated that fatigue is a frequent and important symptom, which is associated with both physical and psychological distress in this population. The CFS and FNS were confirmed to have sufficient screening ability.

The Stroop test was performed before and after ergometer exercise for 15 min at 20, 40, and 60 % of maximum voluntary exercise (EXmax), in order to examine whether dynamic exercise is capable of improving cognitive function and whether the changes in regional cerebral blood flow of the prefrontal cortex are associated with the cognitive improvement. Subjects were asked to answer the displayed color of incongruent color words as quickly as possible. The total time period and the number of errors for the Stroop test were measured as an index of cognitive function. The concentrations of oxygenated-hemoglobin (Oxy-Hb) and deoxygenated-hemoglobin (Deoxy-Hb) in the cerebral prefrontal area were measured with near-infrared spectroscopy to determine the changes in regional cerebral blood flow. Ergometer exercise at 40 % of EXmax, but not 20 and 60 % of EXmax, shortened (P < 0.05) the total time period for the Stroop test by 6.6 ± 1.5 % as compared to the time control. In contrast, the number of errors was not altered by exercise at any intensity. The Oxy-Hb in bilateral prefrontal cortices increased during the Stroop test, while the Deoxy-Hb in those areas was unchanged. Ergometer exercise at 40 % of EXmax, but not at 20 and 60 % of EXmax, significantly augmented the response in the prefrontal Oxy-Hb during the Stroop test. The magnitude of the increased prefrontal Oxy-Hb response tended to correlate with the reduction in total time period for the Stroop test. Thus, it is likely that ergometer exercise at moderate intensity for 15 min may improve cognitive function through the increased neural activity in the prefrontal cortex.