Psychiatric morbidity in patients with advanced cancer of the breast: prevalence measured by two self-rating questionnaires

Abstract

Summary Two hundred and twenty-two women with advanced cancer of the breast were asked to complete two previously validated self-assessment questionnaires (Hospital Anxiety and Depression Scale (HADS) There has been extensive investigation into the psychological sequelae of early breast cancer and its treatment (Maguire et al., 1978;Maguire et al., 1980;Morris et al., 1977;Robert et al., 1972) but there are few data concerning the prevalence of depression and anxiety in patients with advanced disease. There is a need to determine the extent and severity of affective disorder in patients receiving palliative treatment for breast cancer and to find out whether such disorder is transient or warrants intervention. Plumb and Holland (1981) reported that 20-30% of patients admitted to hospital for the treatment of a variety of advanced cancers developed clinically significant depression and 15% had severe anxiety. In a study of 215 cancer inpatients and outpatients Derogatis and co workers (1983) found 47% met criteria for psychiatric disorder, and of these 13% had a major affective disorder, mainly depression. The majority were described as suffering 'adjustment disorder' that is a less severe form of mood disorder. In a number of other studies (Bukberg et al., 1980;Craig & Abeloff, 1974;Farber et al., 1982;Plumb & Holland, 1977) self report questionnaires have been used to assess psychological morbidity in heterogeneous cancer patient groups. Two such questionnaires were deemed suitable for use for the present study. The Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983) was designed to measure depression and anxiety in medical outpatients and avoids the use of somatic symptoms, which may also be attributed to disease and treatment. It has been shown to be a valid measure of the severity of disorders of mood. The Rotterdam Symptom Checklist (de Haes et al., 1990) was designed as a multidimensional scale for use in quality of life assessment: it contains a subscale of eight items relating to psychological symptoms.The authors validated these two questionnaires in a series of 81 patients with advanced breast cancer (Hopwood et al., 1991), to establish appropriate cut-off values for the identification of 'cases' of affective disorder. Both questionnaires identified 75% of patients diagnosed as cases by a psychiatric interview. The scales were able to correctly identify one in evey two high scorers as a case and, although this predictive power was high in relation to 'screening' for affective disorder, it will inevitably mean that prevalence rates using self-rating scales are an estimate of morbidity rather than an accurate measure of disorder. Nevertheless, scales such as the HADS and RSCL are being used increasingly to evaluate 'quality of life' in cancer patients and their Correspondence: P. Hopwood.Received 16 February 1990; and in revised form 2 April 1991.performance in the measurement of psychological disorder in a homogeneous population of patients warrants evaluation.The aim of the study ...

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens

“…For 'borderline cases' the percentages for anxiety were 22% and 9% for patients with post-treatment and anticipatory symptoms respectively, and for depression were 18% and 27%. Combining the number of borderline and clear cases for both groups experiencing some nausea and emesis the percentages in the group as a whole for anxiety (20%) are similar, and for depression (22%) higher, than levels reported elsewhere in a survey of recently diagnosed patients taken from the same hospital (Greer et al, 1992), but both are slightly lower than the numbers observed in breast cancer patients with advanced disease (Hopwood et al, 1991). However, it is clear that patients without the nausea and emesis side-effects experience an extremely low level of psychological morbidity.…”

The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation

“…The fact that the same pattern was not found in the CT group where the side-effects from treatment were less intensive, that the discrepancies in mean depression scores were so great when the 'fatigue' item was taken out from the analyses, and the significant correlation between depression and the Karnofsky scores when the patients scored lowest regarding performance status, lends support to this. The relationship between the depression scale of the HADS and physical symptoms has been mentioned by other, 15,17 and warrants further investigation. Thus, the higher levels of psychiatric distress reported from other studies might be explained by the use of questionnaires such as the BDI, which includes more somatic symptoms than the HADS.…”

“…All ASCT patients had received combination chemotherapy according to standard treatment protocols prior to transplant, compared with 30 SCT patients (49%), those suffering from AML or ALL. Thirty SCT patients with CML had received hydroxyurea; as monotherapy (17), or in combination with interferon ␣2b (11), or busulphan (two), while one patient had received no treatment. One SCT patient (2%) had received additional radiotherapy to the central nervous system as part of primary treatment, compared with 19 (28%) of the ASCT patients (P Ͻ 0.0001).…”

“…4,10 The Hospital and Anxiety Depression scale (HADS) 11 has been developed for evaluation of anxiety and depression in physically ill patients and has been frequently used in various cancer populations, both with in patients and outpatients. [12][13][14][15][16][17][18][19] We identified six studies which have employed the HADS in SCT and ASCT patients; two crosssectional, 20,21 one retrospective 22 and three prospective. [23][24][25] No significant differences in anxiety or depression were found between 53 SCT and 38 ASCT patients at a mean of 40 months post transplant, but they were significantly less depressed when compared to 73 patients receiving maintenance chemotherapy.…”

Prevalence and risk of depressive symptoms 3–4 months post-surgery in a nationwide cohort study of Danish women treated for early stage breast-cancer

“…Some studies only include patients with early stages of breast cancer [35,36], while others have investigated more advanced breast cancer [11,23,37]. Stage of disease and tumor grade have been reported inconsistently related to psychological problems in cancer and is generally uncorrelated with depression in breastcancer [38][39][40][41].…”