Longitudinal observation of anxiety and depression among palliative care cancer patients

Abstract

Background: Anxiety and depressive symptoms are commonly reported to have a high prevalence in advanced cancer patients. However, whether the severity of the symptoms change during a stay in a palliative care unit (PCU) and after discharge home has not been studied thus far. This prospective, longitudinal, single-center study screened for anxiety and depression as measured on the German version of Hospital Anxiety and Depression Scale (HADS-D) in a palliative care (PC) cancer cohort at three different time points.Methods: Consecutive patients (N=206) admitted to a PCU were evaluated of whom N=102 could be enrolled. Patients were screened for anxiety and depression using the HADS-D questionnaire: 24 h after admittance (P1), within 24 h before discharge (P2) and 2 weeks after discharge (P3). Longitudinal changes and influencing factors were determined.Results: Nearly 80% of all patients had at least at one time point a HADS score ≥8 indicating a clinically meaningful symptom burden. The P1 mean scores were 7.1±3.3 (anxiety) and 8.9±4.6 (depression).Depression was associated with underlying cancer type (P<0.05). Anxiety and depression stabilized during hospitalization (P2). However, a significant deterioration after discharge (P3) was observed (anxiety P=0.046; depression P=0.003), in particular in older patients (>65 years) and higher ECOG status (≥3). Patients with a short time since first diagnosis (<1 year) had significantly higher symptom burden compared to patients with a longer disease course. Participation was 50% emphasizing the difficulty to study PC patients. Most patients had advanced cancers (99%). Underlying cancer types consisted of a broad variety of solid tumors including 15% hematological cases. Median survival was 1.1 months. Conclusions:The high prevalence of anxiety and depressive symptoms points to the need for psychological support. All PC patients should be screened for psychological distress to identify those in need of further assessment and treatment. The deterioration at home suggests the need for improved outpatient management, including home-based psychological support. Caregivers should be aware of the psychological vulnerability of newly diagnosed cancer patients, patients with lower functional status and higher age.

Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial

“…The lack of maintenance of this effect may be a reflection of the vulnerability of terminally ill patients to psychological stress at the end of life. Indeed, patients with progressed disease often suffer from anxiety and depression 37. The apparent paradox of maintaining a sense of peace and not improving in psychological distress may be due to the fact that the peace subscale specifically measured peace with themselves.…”

Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients

“…Furthermore, the data suggest that patients, although more physically limited than their relatives, felt cared for well in the hospital. Different data show that an in-patient environment with appropriate medical presence and participatory decision-making processes can contribute to anxiety reduction and higher satisfaction ( 2 , 3 , 28 ).…”

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“…Acute stress can activate the HPA axis [24]. Research by Sewtz et al (2020) [25] reported that there was no significant relationship between the type of malignancy and anxiety and depression. Solid tumors can cause depression directly due to the presence of pro-inflammatory cytokines produced by the tumor, which then activates the HPA axis ultimately reducing serotonin levels, causing depression [26,27].…”