What Proportion of Patients With Musculoskeletal Sarcomas Demostrate Symptoms of Depression or Anxiety?

Abstract

Background It is estimated that the 12-month prevalence of depression in the United States is 8.6%, and for anxiety it is 2.9%. Although prior studies have evaluated depression and anxiety in patients with carcinoma, few have specifically evaluated patients with sarcoma, who often have unique treatment considerations such as mobility changes after surgery. Questions/purposesWe evaluated patients with sarcoma seen in our orthopaedic oncology clinic to determine (1) the proportion of patients with depression symptoms, symptom severity, how many patients triggered a referral to mental health professionals based upon our prespecified cutoff scores on the nine-item Patient Health Questionnaire (PHQ-9), and if their symptoms varied by disease state; (2) the proportion of patients with anxiety symptoms, symptom severity, how many patients triggered a referral to mental health professionals based upon our prespecified cutoff scores on the seven-item Generalized Anxiety Disorder Scale (GAD-7), and if they symptoms varied by disease state; (3) whether other factors were associated with the proportion and severity of symptoms of anxiety or depression, such as tumor location in the body (axial skeleton, upper extremity, or lower extremity), general type of tumor (bone or soft tissue), specific diagnosis, use of chemotherapy, length of follow-up (less than 1 year or greater than 1 year), and gender; and (4) what proportion of patients accepted referrals to mental health professionals, when offered. Methods This study was a cross-sectional survey study performed at a single urban National Cancer Institute-designated Comprehensive Cancer Center from April 2021 until July 2021. All patients seen in the orthopaedic clinic 18 years of age and older with a diagnosis/presumed diagnosis of sarcoma were provided the PHQ-9 as well as the GAD-7 in our clinic. We did not track those who elected not to complete the surveys. Surveys were scored per survey protocol (each question was scored from 0 to 3 and summed). Specifically, PHQ-9 scores the symptoms of depression as 5 to 9 (mild), 10 to 14 (moderate), 15 to 19 (moderately severe), and 20 to 27 (severe). The GAD-7 scores symptoms of anxiety as 5The institution of one or more of the authors (YA, REB, JHH, MKB) has received, during the study period, funding from the NIH/NCI Cancer Center (Support Grant P30 CA008748). One author (EMP) is an employee of the US Government. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Psychological outcomes in patients with rare cancers: a systematic review and meta-analysis

“…The remaining 4249 studies were excluded after removing irrelevant studies with the wrong study design or population and duplicates. 23 studies 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 investigated patients diagnosed with sarcoma, eight studies 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 investigated patients diagnosed with various rare cancers, while one study 50 investigated patients diagnosed with cholangiocarcinoma. 57,470 patients with rare cancers out of 1,287,082 participants were included.…”

“…20 studies 19 , 21 , 22 , 23 , 26 , 27 , 28 , 33 , 34 , 35 , 36 , 38 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 50 were included to evaluate the prevalence of depression amongst patients with rare cancers. 1222 out of 6113 patients with rare cancers were assessed to have depression.…”

Team Approach: Extremity Soft Tissue Sarcoma

“…In instances of Referral to supervised physical therapy and to a physiatrist specializing in cancer rehabilitation may also ensure improvements in functional status over time 49 . Unsurprisingly, a cancer diagnosis is disruptive and causes many patients and families psychosocial stress 50 . Social workers, case managers, survivorship specialists, psychologists, and patient support groups can be invaluable resources.…”

CORR Insights®: What Proportion of Patients With Musculoskeletal Sarcomas Demonstrate Symptoms of Depression or Anxiety?

“…Enter Polfer et al [9] in this month’s Clinical Orthopaedics and Related Research ® , who screened 190 patients with a diagnosis or history of sarcoma presenting to their orthopaedic outpatient clinic using the nine-item Patient Health Questionnaire for depression and the seven-item Generalized Anxiety Disorder Scale for anxiety. Even though most were in remission at the time of these visits (only about one in five were actively undergoing initial diagnostics or treatments for their tumors), more than one-third of the patients evaluated in this study had serious symptoms of emotional distress—anxiety or depression—and about half of those had symptoms severe enough to warrant referral to mental health professionals [9]. Based on these results, the training of surgical and orthopaedic oncologists should be expanded to cover recognizing psychiatric comorbidities in patients with sarcoma, and sarcoma centers should strongly consider implementing regular screening of patients with sarcoma.…”

“…And yet, it has long been known that patients with cancer, in particular, are at a high risk of concomitant psychiatric disorders [2], which in turn have been associated with increased and longer hospitalizations, higher healthcare costs, more morbidity, and a greater risk of death [1,6,10]. To complicate matters further, anxiety and depression are not always easy to recognize in patients with cancer because their symptoms may be confused with the symptoms of the disease or treatment-related complications [9]. Despite this, very few studies I'm aware of have evaluated the psychosocial morbidity of patients with sarcoma, until now.…”