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A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses

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Abstract

Objective

The objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for English-speaking adults with heterogenous cancer diagnoses.

Methods

A systematic review was conducted to identify all PROMs used to assess anxiety, depression and general distress in randomised controlled trials (RCTs) of psychosocial interventions for people with cancer published between 1999 and May 2009. Candidate PROMs were evaluated for content, evidence of reliability and validity, clinical meaningfulness, comparison data, efficiency, ease of administration, cognitive burden and track record in identifying treatment effects in RCTs of psychosocial interventions. Property ratings were weighted and summed to give an overall score out of 100.

Results

The Hospital Anxiety and Depression Scale (HADS) scored highest overall (weighted score = 77.5), followed by the unofficial short-form of the Profile of Mood States (POMS), the POMS-37 (weighted score = 60), and the Centre for Epidemiological Studies Depression Scale (CES-D) and original POMS (weighted score = 55 each).

Conclusions

The HADS’ efficiency and substantial track record recommend its use where anxiety, mixed affective disorders or general distress are outcomes of interest. However, continuing controversy concerning the HADS depression scale cautions against dependence where depressive disorders are of primary interest. Where cost is a concern, the POMS-37 is recommended to measure anxiety or mixed affective disorders but does not offer a suitable index of general distress and, like the HADS, emphasises anhedonia in measuring depression. Where depression is the sole focus, the CES-D is recommended.

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The authors declare no conflict of interest relating to this manuscript.

No Ethics approval was required to conduct the systematic review or analysis.

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Authors and Affiliations

  1. Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Brennan MacCallum Building (A18), Camperdown, Sydney, Australia

    Tim Luckett, Phyllis N Butow, Madeleine T King, Mayumi Oguchi, Nicole Rankin & Melanie A Price

  2. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Camperdown, Sydney, Australia

    Phyllis N Butow, Mayumi Oguchi & Melanie A Price

  3. Cancer Institute New South Wales, Eveleigh, Sydney, Australia

    Gaynor Heading & Nadine A Hackl

  4. Clinical Education and Training Institute, New South Wales Health, Gladesville, Australia

    Gaynor Heading

  5. Centre for Health Service Development, University of Wollongong, Wollongong, Australia

    Nicole Rankin

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  1. Tim Luckett
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Luckett, T., Butow, P.N., King, M.T. et al. A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer 18, 1241–1262 (2010). https://doi.org/10.1007/s00520-010-0932-8

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