Top

Supportive Care in Cancer

Published in:

01-05-2009 | Original Article

Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting

Authors: Marvin Delgado-Guay, Henrique A. Parsons, Zhijun Li, J. Lynn Palmer, Eduardo Bruera

Published in: Supportive Care in Cancer | Issue 5/2009

Abstract

Background

Mood disorders are among the most distressing psychiatric conditions experienced by patients with advanced cancer; however, studies have not shown a direct association of physical symptoms with depression and anxiety.

Purpose

The purpose of this study is to determine the relationship between the frequency and intensity of patients’ physical symptoms and their expressions of depression and anxiety.

Patients and methods

We retrospectively reviewed the records of 216 patients who had participated in three previous clinical trials conducted by our group. We assessed patients’ demographic data using descriptive statistics. We analyzed physical symptom frequency and intensity using the Edmonton Symptom Assessment System (ESAS) and anxiety and depression using the respective subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D).

Results

Sixty-two percent were male; the median age was 59 years (range 20–91 years). Seventy nine (37%) of the patients had depressive mood (HADS-D ≥ 8), and 94 (44%) had anxiety (HADS-A ≥ 8). Patients with depressive mood expressed higher frequency of drowsiness (68/78, 64%; p = 0.0002), nausea (52/79, 66%; p = 0.0003), pain (74/79, 94%; p = 0.0101), dyspnea (68/79, 86%; p = 0.0196), worse appetite (72/79, 91%; p = 0.0051), and worse well-being (78/79, 99%; p = 0.0014) and expressed higher intensity of symptoms (ESAS ≥ 1) [median (Q1–Q3)] including drowsiness [4 (3–7), p = 0.0174], fatigue [7 (5–8), p < 0.0001], and worse well-being [6 (5–7), p < 0.0001]. Patients with anxiety expressed higher frequency of nausea (59/94, 57%; p = 0.0006), pain (88/94, 89%; p = 0.0031), and dyspnea (84/94, 96%, p = 0.0002) and expressed a higher intensity of pain [6 (3–8), p = 0.0082], fatigue [6 (5–8), p = 0.0011], worse appetite [6 (4–8), p = 0.005], and worse well-being [5 (3–7), p = 0.0007]. Spearman’s correlation showed a significant association between HADS-A and HADS-D and other symptoms in the ESAS. Spearman’s correlations of HADS with ESAS-Anxiety and ESAS-Depression were 0.56 and 0.39, respectively (p < 0.001).

Conclusion

Expression of physical symptoms may vary in frequency and intensity among advanced cancer patients with anxiety and depression. Patients expressing high frequency and intensity of physical symptoms should be screened for mood disorders in order to provide treatment for these conditions. More research is needed.

Andrews B, Hejdenberg J, Wilding J (2006) Student anxiety and depression: comparison of questionnaire and interview assessments. J Affect Disord 95:29–34. doi:10.1016/j.jad.2006.05.003 PubMedCrossRef

Aragones E, Labd A, Piñol J, Lucena C, Alonso Y (2005) Somatized depression in primary care attenders. J Psychosom Res 58:145–151. doi:10.1016/j.jpsychores.2004.07.010 PubMedCrossRef

Asbury FD, Madlensky L, Raich P et al (2003) Antidepressant prescribing in community cancer care. Support Care Cancer 11:278–285

Block S (2000) Assessing and managing depression in the terminally ill patient. Ann Intern Med 32:209–218

Bruera E, Kuehn N, Miller M, Selmser P, Macmillan K (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9PubMed

Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton symptom assessment scale. Cancer 88:2164–2171. doi:10.1002/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>3.0.CO;2-5 PubMedCrossRef

Chen ML, Chang HK (2004) Physical symptom profiles of depressed and nondepressed patients with cancer. Palliat Med 18:712–718. doi:10.1191/0269216304pm950oa PubMedCrossRef

Dantzer R (2005) Somatization: A psychoneuroimmune perspective. Psychoneuroendocrinology 30:947–952. doi:10.1016/j.psyneuen.2005.03.011 PubMedCrossRef

Drayer R, Mulsant B, Lenze E, Rollman B (2005) Somatic symptoms of depression in elderly patients with medical comorbidities. Int J Geriatr Psychiatry 20:973–982. doi:10.1002/gps.1389 PubMedCrossRef

10.

Grassi L, Indelli M, Marzola M et al (1996) Depressive symptoms and quality of life in home-care-assisted cancer patients. J Pain Symptom Manage 12:300–307. doi:10.1016/S0885-3924(96)00181-9 PubMedCrossRef

11.

Holland JC, Jacobsen PB, Riba MB (2001) NCCN distress management. Cancer Control 8(6):88–93PubMed

12.

Hotopf M, Chidgey J, Addington-Hall J, Lan Ly K (2002) Depression in advanced disease: a systematic review. Part 1: prevalence and case finding. Palliat Med 16:81–97. doi:10.1191/02169216302pm507oa PubMedCrossRef

13.

Katon W, Lin E, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29:147–155. doi:10.1016/j.genhosppsych.2006.11.005 PubMedCrossRef

14.

Komaroff AL (2001) Symptoms: in the head or in the brain? Ann Intern Med 134:783–785PubMed

15.

Kurtz M, Kurtz J, Stommel M, Given C, Given B (2001) Physical functioning and depression among older persons with cancer. Cancer Pract 9:11–18. doi:10.1046/j.1523-5394.2001.91004.x PubMedCrossRef

16.

Lloyd-Williams M, Friedman T, Rudd N (1999) A survey of antidepressant prescribing in the terminally ill. Palliat Med 13:243–248. doi:10.1191/026921699676753309 PubMedCrossRef

17.

Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18:558–563. doi:10.1191/0269216304pm923oa PubMedCrossRef

18.

Love A, Grabasch B, Clarke D, Bloch S, Kissane D (2004) Screening for depression in women with metastatic breast cancer: a comparison of the beck depression inventory short form and the hospital anxiety and depression scale. Aust N Z J Psychiatry 38:526–531. doi:10.1111/j.1440-1614.2004.01385.x PubMedCrossRef

19.

Lowe B, Spitzed RL, Grafe K, Kroenke K et al (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78:131–140. doi:10.1016/S0165-0327(02)00237-9 PubMedCrossRef

20.

Maguire P (2000) The use of antidepressants in patients with advanced cancer. Support Care Cancer 8:265–267. doi:10.1007/s005200000170 PubMedCrossRef

21.

Massie MJ (2000) Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 32:57–71

22.

Massie MJ, Gagnon P, Holland JC (1994) Depression and suicide in patients with cancer. J Pain Symptom Manage 9:325–340. doi:10.1016/0885-3924(94)90192-9 PubMedCrossRef

23.

Ng K, von Gunten C (1998) Symptoms and attitudes of 100 consecutive patients admitted to an acute hospice/palliative care unit. J Pain Symptom Manage 16:307–316. doi:10.1016/S0885-3924(98)00097-9 PubMedCrossRef

24.

Olsson I, Mylketun Am Dahl Alv A (2005) The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 5:46. doi:10.1186/1471-244X-5-46 PubMedCrossRef

25.

Pascoe S, Edelman S, Kidman A (2000) Prevalence of psychological distress and the use of support services by cancer patients at Sydney hospitals. Aust N Z J Psychiatry 34:785–791. doi:10.1046/j.1440-1614.2000.00817.x PubMedCrossRef

26.

Payne SA (1992) A study of quality of life in cancer patients receiving palliative chemotherapy. Soc Sci Med 35:1505–1509. doi:10.1016/0277-9536(92)90053-S PubMedCrossRef

27.

Perry MC (ed) (2000) An algorithm for rapid assessment and referral of distressed patients. American Society of Clinical Oncology, Alexandria

28.

Porzio G, Ricevuto E, Aielli F et al (2005) The supportive care task force at the university of L’Aquila: 2-years experience. Support Care Cancer 13:351–355. doi:10.1007/s00520-004-0772-5 PubMedCrossRef

29.

Radbruch L, Nauck F, Ostgathe C et al (2003) What are the problems in palliative care? Results from a representative survey. Support Care Cancer 11:442–415. doi:10.1007/s00520-003-0472-6 PubMedCrossRef

30.

Rajagopal A, Bruera ED (2003) Improvement in sexual function after reduction of chronic high-dose opioid medication in a cancer survivor. Pain Med 4:379–383. doi:10.1111/j.1526-4637.2003.03041.x PubMedCrossRef

31.

Rajagopal A, Vassilopoulou-Sellin R, Palmer JL, Kaur G, Bruera E (2004) Symptomatic hypogonadism in male survivors of cancer with chronic exposure to opioids. Cancer 100:851–858. doi:10.1002/cncr.20028 PubMedCrossRef

32.

Reddy S, Elsayem A, Palmer L, Kaur G, Zhang T, Bruera E (2005) The characteristics and correlates of dyspnea (D) in advanced cancer patients. J Clin Oncol 23:8019, ASCO Annual Meeting Proceedings [Abstract #8019 (poster discussion)]

33.

Rees E, Hardy J, Ling J, Broadley K, A’Hern R (1998) The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK. Palliat Med 15:213–214

34.

Reuben D, Mor V, Hiris J (1998) Clinical symptoms and length of survival in patients with terminal cancer. Arch Intern Med 148:1586–1591. doi:10.1001/archinte.148.7.1586 CrossRef

35.

Roy-Byrne PP, Davidson KW, Kessler R et al (2008) Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 30:208–225. doi:10.1016/j.genhosppsych.2007.12.006 PubMedCrossRef

36.

Sharpe M, Strong V, Allen K et al (2004) Major depression in outpatients attending a regional cancer center: screening, prevalence and unmet treatment needs. Br J Cancer 90:314–320. doi:10.1038/sj.bjc.6601578 PubMedCrossRef

37.

Smith EM, Gomm SA, Dickens CM (2003) Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliat Med 17:509–513. doi:10.1191/0269216303pm781oa PubMedCrossRef

38.

Stromgren AS, Groenvold M, Peterson MA et al (2004) Pain characteristics and treatment outcome for advanced cancer patients during the first week of specialized palliative care. J Pain Symptom Manage 27:104–113. doi:10.1016/j.jpainsymman.2003.06.011 PubMedCrossRef

39.

Teunissen SCCM, de Graeff A, Voest EE, de Haes JCJM (2007) Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliat Med 21:341–346. doi:10.1177/0269216307079067 PubMedCrossRef

40.

Teunissen SCCM, Wesker W, Kruitwagen C et al (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 34:94–103. doi:10.1016/j.jpainsymman.2006.10.015 PubMedCrossRef

41.

Vignaroli E, Pace E, Willey J et al (2006) The Edmonton symptom assessment as a screening tool for depression and anxiety. J Palliat Med 9:296–303. doi:10.1089/jpm.2006.9.296 PubMedCrossRef

42.

Wilson KG, Chochinov HM, Skirko MG et al (2007) Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage 33:118–129. doi:10.1016/j.jpainsymman.2006.07.016 PubMedCrossRef

Title: Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting
Authors: Marvin Delgado-Guay
Henrique A. Parsons
Zhijun Li
J. Lynn Palmer
Eduardo Bruera
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 5/2009
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-008-0529-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2009

Quality of life of men treated for localized prostate cancer: outcomes at 6 and 12 months

Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research

Nurses’ knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer—a comparative cross-sectional study of fatigue intensity and characteristics

Nurse-led rehabilitation after gynaecological cancer surgery

Hospitalizations for infection in cancer patients: impact of an aging population

Keynote webinar | Spotlight on antibody–drug conjugates in cancer