A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy

doi:10.1016/j.jpsychores.2016.05.010

Journal of Psychosomatic Research

Volume 87, August 2016, Pages 14-21

https://doi.org/10.1016/j.jpsychores.2016.05.010 Get rights and content

Highlights

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Mental disorders were found to be rather frequent in patients with cancer undergoing radiotherapy.
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Anxiety disorders were the most prevalent, followed by adjustment disorders and depression.
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Besides being highly prevalent, these mental disorders were found to persist for at least a month after radiotherapy.
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At the start of radiotherapy treatment, cancer patients presented a high frequency of emotional distress.
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Sex, age, education status and previous surgery or chemotherapy were associated with the prevalence of mental disorders and distress.
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These findings point to the need for assessment and psychological intervention in cancer patients undergoing radiotherapy.

Abstract

Background

The aim of this study is to evaluate the presence of anxiety, depressive and adjustment disorders, suicide ideation, and symptoms of anxiety and depression in patients with cancer before (T1), and after radiotherapy (T2) and at the 1-month follow-up (T3).

Methods

A longitudinal study on 103 patients with cancer treated as outpatients undergoing radiotherapy was carried out, evaluating them three times (T1-T2-T3) according to DSM-IV criteria with the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale.

Results

Prevalence of the depressive disorders was: T1 = 6.8%, T2 = 3.9% and T3 = 3.9%; for anxiety disorders: T1 = 16.5%, T2 = 18.4% and T3 = 16.5%; for adjustment disorder: 10.7%, 5.8% and 7.8%; and for suicide ideation: T1 = 11.7%, T2 = 7.8% and T3 = 7.8%. In all, the presence of disorders was: T1 = 35%, T2 = 26.2%0.4% and T3 = 29.1%. At least one mental disorder was diagnosed in 46.6% of patients in one of the three times of the study.

In relation to the symptoms, the prevalence of the possible cases of clinical anxiety was: T1 = 35.9%, T2 = 18.4% and T3 = 22.3%; the prevalence of possible cases of clinical depression was 19.4%, 16.5% and 10.7%, respectively; and the prevalence of emotional distress was 27.2%, 17.5% and 18.4%, respectively. All symptoms decreased significantly from T1 to T2 and from T1 to T3, with moderate effect sizes. No changes were observed between the end of the radiotherapy and the follow-up period.

Conclusions

High prevalence of mental disorders and symptoms of anxiety, depression and distress were observed in the patients with cancer before finishing radiotherapy treatment and during the follow-up.

Funding

Basurto University Hospital and Basque Foundation for Innovation and Research in Health-BIOEF.

Introduction

More than 60% of cancer patients receive radiotherapy, in 70% of the cases with a curative intent [1]. However, research on the psychological impact of radiotherapy in patients is very scarce. Many cancer patients frequently present disorders of depression, anxiety, adjustment and suicide ideation/risk. A meta-analysis noted that, in patients with cancer, the prevalence of depressive disorders was 16%, with a prevalence of 10.3% of anxiety disorders, and a 19.4% of adjustment disorders [2]. Mehnert et al. reported a prevalence of 31.8% of psychopathological disorders in cancer patients; this included depressive disorders (6.5%), anxiety disorders (11.5%) and adjustment disorders (11.1%) [3]. Suicide ideation in cancer patients is greater than in the general population, and is thought to be around 12.3% [4]. Despite the numerous studies on psychopathology and emotional distress in cancer patients, only a small number of studies focused on the patients during treatment with radiotherapy [5], [6], [7]. In a study with cancer patients undergoing radiotherapy, Fritzsche et al. reported a prevalence of 3.4% of mood/depressive disorders, a 10.3% of anxiety disorders, and a 13.9% of adjustment disorders [8]. As a whole, half of the patients treated with radiotherapy in that study met criteria of psychopathological disorders. There are few longitudinal studies available on psychopathological disorders in patients undergoing radiotherapy, most of them using small samples focused on very specific cancers, which impedes generalization [5], [6].

In relation to the symptoms of anxiety, depression and distress evaluated through the Hospital Anxiety and Depression Scale (HADS) [9] or similar measurements, in cancer patients undergoing radiotherapy, the following prevalence has been reported: 13%–24% of possible cases of clinical anxiety, 5%–21% of possible cases of clinical depression, and 9.5%–37% of cases of emotional distress [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. The symptoms increase from pre-radiotherapy to after radiotherapy, and decrease in the following months [5], [6], [16]. Depression symptoms increase over the course of radiotherapy and persist to the follow-up period [5], [14], [20], [21]. At the start of radiotherapy, there is a high level of anxiety symptoms, which improve afterwards [6], [7].

The objective of this present study is to determine the prevalence and evolution of anxiety, depression and adjustment disorders, and suicide ideation — evaluated through diagnostic interview — and the symptoms of anxiety, depression and emotional distress before radiotherapy treatment, one week after its conclusion, and at the 1-month follow-up.

Section snippets

Design of the study and participants

A longitudinal study on patients with cancer treated as outpatients undergoing radiotherapy was carried out. The criteria for inclusion in the sample were the following: be over 17 years of age, be capable of understanding and speaking Spanish, with a cognitive ability (Mini-Mental State Examination (MMSE) score > 26 [22]), and a Karnofsky Performance Status (KPS) score > 80 [23]. The purpose of radiotherapy was curative, not palliative. Individuals that — according to the medical charts — suffered

Statistical analysis

The descriptive data of frequencies and percentages were extracted for qualitative variables, and means and standard deviations for quantitative variables. The Kolmogorov-Smirnov test was applied to verify that the variables were normally distributed. The Friedman test was applied to check whether there were significant differences between the three measurement times for the variables HADS-A, HADS-D and HADS-T. The Wilcoxon test was used to verify the differences between each one of the

Results

Table 1 shows the socio-demographic and clinical data. The majority of patients were married, had undergone primary studies, suffered from stage II cancer and had undergone previous surgical treatment.

Table 2 shows the prevalence and evolution at the three times of the study of the disorders of depression, anxiety, adjustment, and suicide ideation/risk. More than a third (35%) of the patients were diagnosed with a psychopathological disorder at the beginning of radiotherapy, with the most

Discussion

In the present study, the prevalence of psychopathological disorders varied between 35% and 29.1%, throughout the radiotherapy treatment, while 53.4% were free of any mental disorder. It was clinically observed that more than 46.6% of the patients suffered some mental disorder at some time during the study, and 17.5% of them constantly presented a disorder. The remaining patients showed changes during the three measurements: 11.7% of the cases deteriorated their clinical state and 17.5%

Conclusions

Cancer patients, at the beginning of the radiotherapy treatment, were attributed with psychopathological diagnoses in a large percentage, which did not change significantly during the treatment; especially with regard to anxiety disorders. Almost half of the patients suffered from at least one disorder at some time during the present study. More than a third of patients showed the need of psychological attention for some of these disorders. Anxiety disorders were the most prevalent, followed by

Conflicts of interest

There was no conflict of interests for this study.

The authors do not have any financial relationship with the organisation that sponsored the research, authorship, etc.

The authors have full control of all primary data and agree to allow the journal to review them.

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A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy

Highlights

Abstract

Background

Methods

Results

Conclusions

Funding

Introduction

Section snippets

Design of the study and participants

Statistical analysis

Results

Discussion

Conclusions

Conflicts of interest

Lancet Oncol.

Patient Educ. Couns.

Radiother. Oncol.

Radiother. Oncol.

J. Affect. Disord.

Otolaryngol. Head Neck Surg.

Cancer Treat. Rev.

Int. J. Radiat. Oncol. Biol. Phys.

Ann. Oncol.

J. Affect. Disord.

Eur. J. Oncol. Nurs.

Libro blanco SEOR XXI. Análisis de la situación, necesidades y recursos de la oncología radioterápica. SEOR: Madrid

Four-week prevalence of mental disorders in patients with cancer across major tumor entities

J. Clin. Oncol.

Association between suicidal ideation and behavior, and depression, anxiety, and perceived social support in cancer patients

Med. Sci. Monit.

Measuring psychosocial functioning in the radiation oncology clinic: a systematic review

Psychooncology

The hospital anxiety and depression scale

Acta Psychiatr. Scand.

A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer

Psychooncology

Emotional distress and needs for psychosocial support among breast cancer patients at start of radiotherapy

Psychother. Psychosom. Med. Psychol.