Mental disorder screening on cancer patients before and after radiotherapy and at the 1-month follow-up.

BACKGROUND: The aim was to study the accuracy of different screening tests to detect psychopathological disorders in cancer patients treated with radiotherapy before (T1) and after radiotherapy (T2), and at the 1-month follow-up (T3). METHODS: The Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS), and the distress thermometer (DT) (0-10) were administered, together with a depression scale (DEPQ) (1-5), an anxiety scale (ANSQ) (1-5), and a physical symptoms questionnaire, to patients treated with radiotherapy at T1 (232 participants), T2 (130 participants), and T3 (130 participants). RESULTS: The accuracy of the screening tests was higher at T2, with the HADS-T test (cut-off ≥ 10) yielding the best results: sensitivity = 0.80, specificity = 0.92, with an excellent AUC (0.91). The DT test (cut-off ≥ 4) showed a sensitivity = 0.66, a specificity = 0.91, and an AUC = 0.825, and the DEPQ (cut-off > 1) yielded a sensitivity = 0.74, a specificity = 0.78, and an AUC = 0.776. The ANSQ (cut-off > 1) showed a sensitivity = 0.60, a specificity = 0.97, and an AUC = 0.831. At T1 and T3, the sensitivity tests were unsatisfactory. The increase in sensitivity at T2 may be due to an increase of physical symptoms at such time, which occurred more frequently in those patients who scored higher on screening tests and showed mental disorders. CONCLUSIONS: The diagnostic accuracy of the screening tests was higher at T2. At this time, HADS-T proved to be a good screening instrument; whereas at T1 and T3, screening instruments were only useful to detect cases without mental disorders, but not to identify those who suffer from them.

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

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.

Depresión y cáncer: una revisión orientada a la práctica clínica / Depression and cancer: a review oriented to clinical practice

La depresión es una entidad que afecta a una proporción del 15-25% de los pacientes con cáncer. A pesar de su elevada incidencia, es un trastorno habitualmente infradiagnosticado y que no recibe tratamiento adecuado. Este hecho conduce a una mala calidad de vida, una inadecuada adherencia al tratamiento y una menor tasa de supervivencia en esta población médica. Existe evidencia sobre la eficacia de abordajes tanto farmacológicos como psicoterapéuticos en pacientes oncológicos con depresión. El objetivo de este artículo es aportar una visión sobre aquellas intervenciones con demostrada eficacia que permiten a los pacientes con cáncer desarrollar un mejor afrontamiento de su enfermedad y lograr una mejor calidad de vida.

Depression is an entity that concerns about the15-25% of the patients with cancer. In spite of his high incident, it is habitually an under diagnosed disorder and do not receive adequate treatment. This fact drives to a worse quality of life, a worse adherence to the treatment and a minor rate of survival. There is evidence of the efficiency of pharmacological and psychological boardings in the patients with cancer and depression. The aim of this paper is to have a vision on those interventions with demonstrated efficiency. This treatment allows to the patients with cancer to develop a better confrontation of his disease and to achieve a better quality of life.