Skip to main content
Top
Published in: Supportive Care in Cancer 8/2019

01-08-2019 | Affective Disorder | Original Article

Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit

Authors: Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Andrea Cortegiani, Alessandra Casuccio

Published in: Supportive Care in Cancer | Issue 8/2019

Login to get access

Abstract

Purpose

The aim of this study was to compare symptom expression in advanced cancer patients with depression and anxiety and in patients with no such symptoms.

Methods

Secondary analysis of a previous study assessing the role of an acute palliative supportive care unit (APSCU) in a comprehensive cancer center. Patients completed the Edmonton Symptom Assessment System (ESAS) at admission (T0) and 7 days after or at discharge (T7).

Results

Three hundred-fourteen consecutive cancer patients admitted to the APSCU were surveyed. Eighty-six and 66 patients improved their level of depression and anxiety, respectively (passing from ≥ 4 to 0–3, from T0 to T7), after that palliative care intervention resulted in a significant improvement of the other symptoms. Changes were statistically significant for both symptoms (P < 0.0005). Patients admitted for uncontrolled pain were more likely to be anxious, while patients admitted for other symptoms or end-of-life care were more likely to be depressed. The presence of anxiety and depression (≥ 4/10 on ESAS) was significantly associated with a higher level of symptom expression at admission and at T7 (P < 0.0005). In patients presenting both psychological symptoms, symptom expression was significantly more relevant in comparison with patients not reporting moderate-severe psychological symptoms. Pain and depression were independently associated with anxiety at T0. Variables independently associated with depression at T0 were drowsiness, appetite, and anxiety.

Conclusions

Psychological symptoms of ESAS concur to hyper-express some symptoms and make symptom control more difficult. A clear association between anxiety and depression exists.
Literature
1.
go back to reference Lloyd-Williams M, Shiels C, Taylor F, Dennis M (2009) Depression--an independent predictor of early death in patients with advanced cancer. J Affect Disord 113:127–132CrossRefPubMed Lloyd-Williams M, Shiels C, Taylor F, Dennis M (2009) Depression--an independent predictor of early death in patients with advanced cancer. J Affect Disord 113:127–132CrossRefPubMed
2.
go back to reference Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28:3084–3089CrossRefPubMed Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28:3084–3089CrossRefPubMed
3.
go back to reference Cheung WY, Barmala N, Zarinehbaf S, Rodin G, le LW, Zimmermann C (2009) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manag 37:297–304CrossRef Cheung WY, Barmala N, Zarinehbaf S, Rodin G, le LW, Zimmermann C (2009) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manag 37:297–304CrossRef
4.
go back to reference Ciaramella A, Poli P (2001) Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 10:156–165CrossRefPubMed Ciaramella A, Poli P (2001) Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 10:156–165CrossRefPubMed
5.
go back to reference Chochinov HM, Wilson KG, Enns M, Lander S (1997) “Are you depressed?” screening for depression in the terminally ill. Am J Psychiatry 154:674–676CrossRefPubMed Chochinov HM, Wilson KG, Enns M, Lander S (1997) “Are you depressed?” screening for depression in the terminally ill. Am J Psychiatry 154:674–676CrossRefPubMed
6.
go back to reference Katon W, Lin EHB, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29:147–155CrossRefPubMed Katon W, Lin EHB, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29:147–155CrossRefPubMed
7.
go back to reference Kroenke K, Rosmalen JGM (2006) Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 90:603–626CrossRefPubMed Kroenke K, Rosmalen JGM (2006) Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 90:603–626CrossRefPubMed
8.
go back to reference O'Connor M, Weir J, Butcher I et al (2012) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manag 43:29–38CrossRef O'Connor M, Weir J, Butcher I et al (2012) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manag 43:29–38CrossRef
9.
10.
go back to reference Zaza C, Baine N (2002) Cancer pain and psychosocial factors:a critical review of the literature. J Pain Symptom Manag 24:526–542CrossRef Zaza C, Baine N (2002) Cancer pain and psychosocial factors:a critical review of the literature. J Pain Symptom Manag 24:526–542CrossRef
11.
go back to reference Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH, the European Palliative Care Research Collaborative (EPCRC) (2009) Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 23:739–753CrossRefPubMed Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH, the European Palliative Care Research Collaborative (EPCRC) (2009) Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 23:739–753CrossRefPubMed
12.
go back to reference Fitzgerald P, Lo C, Li M, Gagliese L, Zimmermann C, Rodin G (2015) The relationship between depression and physical symptom burden in advanced cancer. BMJ Support Palliat Care 5:381–388CrossRefPubMed Fitzgerald P, Lo C, Li M, Gagliese L, Zimmermann C, Rodin G (2015) The relationship between depression and physical symptom burden in advanced cancer. BMJ Support Palliat Care 5:381–388CrossRefPubMed
13.
go back to reference 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 21:341–346CrossRefPubMed 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 21:341–346CrossRefPubMed
14.
go back to reference Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 17:573–579CrossRefPubMed Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 17:573–579CrossRefPubMed
15.
go back to reference Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Viganò A, Larkin P, de Conno F, Hanks G, Kaasa S, Steering Committee of the European Association for Palliative Care (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations- a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248CrossRefPubMed Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Viganò A, Larkin P, de Conno F, Hanks G, Kaasa S, Steering Committee of the European Association for Palliative Care (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations- a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248CrossRefPubMed
16.
go back to reference Austin P, Wiley S, McEvoy PM, Archer L (2011) Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. Palliat Support Care 9:393–400CrossRefPubMed Austin P, Wiley S, McEvoy PM, Archer L (2011) Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. Palliat Support Care 9:393–400CrossRefPubMed
17.
go back to reference Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A (2016) The palliative-supportive care unit in a Comprehensive Cancer Center as crossroad for patients’ oncological pathway. PLoS One 11:e0157300CrossRefPubMedPubMedCentral Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A (2016) The palliative-supportive care unit in a Comprehensive Cancer Center as crossroad for patients’ oncological pathway. PLoS One 11:e0157300CrossRefPubMedPubMedCentral
18.
go back to reference Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9CrossRefPubMed Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9CrossRefPubMed
19.
go back to reference Hui D, Bruera E (2017) The Edmonton Symptom Assessment Scale remains useful for depression screening. Palliat Med 31:483–484CrossRefPubMed Hui D, Bruera E (2017) The Edmonton Symptom Assessment Scale remains useful for depression screening. Palliat Med 31:483–484CrossRefPubMed
20.
go back to reference Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171CrossRefPubMed Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171CrossRefPubMed
21.
go back to reference Rhondali W, Yennurajalingam S, Ferrer J, Chisholm G, Filbet M, Bruera E (2014) Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients. Support Care Cancer 22:871–879CrossRefPubMed Rhondali W, Yennurajalingam S, Ferrer J, Chisholm G, Filbet M, Bruera E (2014) Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients. Support Care Cancer 22:871–879CrossRefPubMed
22.
go back to reference Ripamonti CI, Bandieri E, Pessi MA, Maruelli A, Buonaccorso L, Miccinesi G (2014) The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up. Support Care Cancer 22:783–793CrossRefPubMed Ripamonti CI, Bandieri E, Pessi MA, Maruelli A, Buonaccorso L, Miccinesi G (2014) The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up. Support Care Cancer 22:783–793CrossRefPubMed
23.
go back to reference Modonesi C, Scarpi E, Maltoni M, Derni S, Fabbri L, Martini F, Sansoni E, Amadori D (2005) Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manag 30:367–373CrossRef Modonesi C, Scarpi E, Maltoni M, Derni S, Fabbri L, Martini F, Sansoni E, Amadori D (2005) Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manag 30:367–373CrossRef
24.
go back to reference Wakefield CE, Butow PN, Aaronson NA, Hack TF, Hulbert-Williams NJ, Jacobsen PB, International Psycho-Oncology Society Research Committee (2015) Patient-reported depression measures in cancer: a meta-review. Lancet Psychiatry 2:635–647CrossRefPubMed Wakefield CE, Butow PN, Aaronson NA, Hack TF, Hulbert-Williams NJ, Jacobsen PB, International Psycho-Oncology Society Research Committee (2015) Patient-reported depression measures in cancer: a meta-review. Lancet Psychiatry 2:635–647CrossRefPubMed
25.
26.
go back to reference Zweers D, de Graaf E, de Graeff A et al (2017) The predictive value of symptoms for anxiety in hospice inpatients with advanced cancer. Palliat Support Care 16(5):602–607CrossRefPubMed Zweers D, de Graaf E, de Graeff A et al (2017) The predictive value of symptoms for anxiety in hospice inpatients with advanced cancer. Palliat Support Care 16(5):602–607CrossRefPubMed
27.
go back to reference Brown LF, Kroenke K, Theobald DE, Wu J, Tu W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19:734–741CrossRefPubMedPubMedCentral Brown LF, Kroenke K, Theobald DE, Wu J, Tu W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19:734–741CrossRefPubMedPubMedCentral
28.
go back to reference Nipp RD, El-Jawahri A, Moran SM et al (2017) The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 123:4720–4727CrossRefPubMedPubMedCentral Nipp RD, El-Jawahri A, Moran SM et al (2017) The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 123:4720–4727CrossRefPubMedPubMedCentral
Metadata
Title
Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit
Authors
Sebastiano Mercadante
Claudio Adile
Patrizia Ferrera
Andrea Cortegiani
Alessandra Casuccio
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 8/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4624-0

Other articles of this Issue 8/2019

Supportive Care in Cancer 8/2019 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

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