Wednesday, June 19, 2013

Mood Disorders May Persist After Cancer Dx

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Mood Disorders May Persist After Cancer Dx

By Sarah Wickline, Contributing Writer, MedPage Today
Published: June 18, 2013
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

In the year following a cancer diagnosis, some patients showed lingering or late-onset anxiety and/or depression, although most appeared to cope relatively well, researchers found.
Among 1,154 patients followed from initial cancer diagnosis, about 20% met criteria for clinically relevant anxiety and roughly 10% were found to have depression 6 and 12 months later, according to Allison W. Boyes, PhD, of the University of Newcastle in Australia, and colleagues.
Significant predictors of development of late-onset or persistent mood disorders in the prospective study included high levels of such disorders 6 months after diagnosis, but also such factors as gender, type of cancer, and certain coping styles, the researchers reported online in the Journal of Clinical Oncology.
"This is one of the first studies to examine the prevalence and predictors of the short-term courses of anxiety and/or depression among a diverse sample of cancer survivors in early survivorship," the researchers wrote.
They noted that most cancer survivors in this group showed psychological resilience, with either no mood disruption or only transient anxiety or depression.
Boyes and colleagues asserted that targeted screening and early intervention should be considered for more vulnerable patients to prevent or reduce the severity of psychological disorders.
Participants were recruited from the ongoing Cancer Survival Study, each having been diagnosed in the past 6 months with one of the top eight incident cancer types in Australia: prostate, colorectal, female breast, lung, melanoma, non-Hodgkin's lymphoma, leukemia, or head and neck cancer.
Along with a detailed questionnaire, each participant filled out the 14-item Hospital Anxiety and Depression Scale (HADS) initially at 6 months after diagnosis and again 12 months after diagnosis. Participants were designated as anxiety or depression cases at a particular assessment if HADS scores at in the relevant domains reached at least 8 on the 21-point scales.
The personal questionnaires assessed patient health behaviors, psychological history and social support systems. Up-to-date medical and treatment records were available for each patient.
Among those asked to participate in the study, 43% agreed. Sample retention between the two assessments was 95%. Participants were 18 to 80 years old and 58% were male.
Odds ratios were adjusted based on information obtained from the patient questionnaires concerning: marital status, education, employment, health insurance coverage, size of household, geographic location, the use of complementary therapies for cancer-related purposes, and the presence of physical comorbidities and/or significant life events that could have been a source of stress.
At the 6-month assessment, 22% (95% CI 20%-25%) qualified as anxiety, and after 12 months, 21% (95% CI 19%-24%) persisted.
At both 6 and 12 months, 13% (95% CI 11%-14%) qualified as depression, and 9% (95% CI 7%-10%) had comorbid anxiety and depression.
Overall, 70% (95% CI, 68%-73%) did not develop anxiety at any time, 82% (95% CI, 79%-84%) did not develop depression, and 87% (95% CI, 85%-89%) did not develop comorbid anxiety-depression.
Boyes and colleagues found that, among patients showing anxiety or depression during the study period, the trajectories varied. About half of patients qualifying as mood disorder cases had the conditions at both assessments. The remainder were about equally divided between those who qualified for case status only at the 12-month evaluation and those who met case criteria at month six but not at month 12.
Significant predictors of anxiety at 12 months included the following:
  • Anxiety at 6 months (relative to no anxiety at 6 months): OR 10.7, 95% CI 7.2-15.0
  • Depression at 6 months (relative to no depression at 6 months): OR 1.9, 95% CI 1.2-3.1
  • Female gender (relative to male): OR 1.8, 95% CI 1.3-2.6
  • "Fighting spirit" coping (relative to other coping styles): OR 1.7, 95% 1.1-2.8
For depression, the following factors were significantly associated with case status at 12 months:
  • Depression at 6 months: OR 6.9, 95% CI 4.0-12.2
  • Anxiety at 6 months: OR 2.6, 95% CI 1.6-4.4
  • Low physical activity but not sedentary (relative to "sufficiently active"): OR 2.1, 95% CI 1.2-3.6
  • Cancer not in remission (relative to remission): OR 1.8, 95% CI 1.1-2.9
  • Lung cancer diagnosis (relative to melanoma): OR 5.3, 95% CI 1.9-15.1
  • "Cognitive avoidance" coping: OR 1.7, 95% CI 1.1-2.8
Patients with comorbid anxiety-depression also had physical inactivity as a significantly predictor, along with both current and past smoking, with odds ratios ranging from 1.6 to 3.7.
"Given that feelings of vulnerability are common when active treatment is completed, it may be reassuring to give survivors in late treatment the message that most will adjust well and require only low-intensity supportive care, including information and self-management support," Boyes and colleagues wrote.
Routine psychological screening may not be necessary for all cancer survivors, the researchers suggested.
Instead, they advocated "targeted screening" of survivors with the risk factors for mood disorders identified in the study.
"Intervention trials focusing on psychological functioning, coping style, and health behaviors are warranted," Boyes and colleagues concluded.
The study was funded by the National Health and Medical Research Council, Cancer Council of New South Wales, Hunter Medical Research Institute, Honda Foundation and the University of Newcastle.
Study authors declared they had no relevant financial interests.
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