Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to screen anxious and depressive states in patients in non-psychiatric settings. In spite of its large use, no agreement exists in literature on HADS accuracy in case finding. The present research addresses the issue of HADS accuracy in cancer patients, comparing its two subscales (HADS-A and HADS-D) against tools not in use in psychiatry, which are able to detect prolonged negative emotional states. METHODS: 2121 consecutive adult cancer inpatients were administered the HADS together with the State Anxiety subscale of State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Scale on Depression. Receiver operating characteristic (ROC) curves were computed to identify a cut-off for anxious and depressive states in cancer patients. All indicators were computed together with their corresponding 95% confidence interval (95% CI). RESULTS: Data of 1628 and 1035 participants were used to assess the accuracy in case finding of HADS-A and HADS-D, respectively. According to the ROC analysis, the optimal cut-off was > 9 units for the HADS-A and > 7 units for the HADS-D. The area under the ROC curve was 0.90 for HADS-A (95% CI 0.88-0.91) and 0.84 for HADS-D (95% CI 0.81-0.86). CONCLUSIONS: This study suggested that risk scores of anxious and depressive states above specific HADS cut-offs are useful in identifying anxious and depressive states in cancer patients, and they may thus be applicable in clinical practice.

Emotional impact on the results of BRCA1 and BRCA2 genetic test: an observational retrospective study.

BACKGROUND: BRCA1 and BRCA2 mutations are associated with a higher risk of breast and ovarian tumors. This study evaluated the emotional states of women 1 month after having received the results of the genetic test and assessed eventual associations with the type of outcome, personal/familiar disease history and major socio-demographic variables. METHODS: The study, an observational retrospective one, involved 91 women, evaluated 1 month after receiving their results. Patients were administered the Hospital Anxiety and Depression Scale, the Profile of Mood States and emotional Thermometers. RESULTS: Anxiety was significantly higher than depression (p < 0.001), and 21.3% and 21.3% of the sample were, respectively, possible and probable cases for anxiety, whereas 13.5% and 10.1% were possible and probable cases for depression. Within the six mood states, Confusion-Bewilderment (M = 48.5) was the lowest, whereas Fatigue-Inertia (M = 52.3) was the highest. Differences were recorded within the ten assessed emotions too. Being a proband/nonproband and being or not a cancer patient were associated with many tested variables. CONCLUSION: The psycho-emotional screening of women undertaking genetic counseling is relevant and should cover a large range of dimensions.

Facilitating the integration of emotional states in patients' personal disease experience with cancer: a new brief intervention for managing psychological distress.

PURPOSE: This paper describes an intervention performed at an Italian oncological institute to manage psychological distress related to the oncological experience. Its objectives are to encourage and normalize awareness of the importance of emotional aspects of the cancer experience, to provide psycho-education to patients on the importance of psycho-social care in promoting well-being, and to introduce our psychology service and promote its usage. METHODS: The intervention consists of three consecutive steps: the psychological distress screening; the clinical interview, which is conducted according to Rogers' client-centered model; and the collection of data regarding the appreciation and usefulness of the initiative, performed through a feedback questionnaire and the codification of the interview contents. RESULTS: Between September 2011 and February 2012, the intervention was administered to 484 consecutive new inpatients. Among them, the prevalence of psychological distress and its components of anxiety and depression are comparable to those found in the literature. The low percentage of participants who refuse the screening (15.4 %) as well as of those who do not wish to have the results returned to them (3.1 %), together with the high scores regarding the usefulness and effectiveness given to the intervention (all >80/100), documents the positive reception of this activity. Lastly, the analysis of the contents of the exit interview shows that a wide range of themes, far more varied and heterogeneous than just anxiety and/or depression symptoms, was discussed. CONCLUSIONS: Even though this was a clinical and not a research activity, it still offers important descriptive data.

Intensity and Prevalence of Psychological Distress in Cancer Inpatients: Cross-Sectional Study Using New Case-Finding Criteria for the Hospital Anxiety and Depression Scale.

Psychological distress includes all negative subjective experiences elicited by a disease and its treatments. Since psychological distress in oncology is associated with negative outcomes, its detection and description are helpful for designing tailored supportive interventions. This study used the Hospital Anxiety and Depression Scale (HADS) to assess the intensity and prevalence of psychological distress (i.e., anxiety and depression) in cancer inpatients and examined the relationships between these variables and sociodemographic and clinical factors. An existing dataset of HADS results, from 2021 consecutive adult cancer inpatients at a single hospital, was analyzed. Only those questionnaires with complete responses were used. The intensity of anxiety and depression was determined from HADS sub-scores. The prevalence of anxiety and depression was calculated using, as case-finding criteria, cut-offs of ≥ 10 and ≥ 8, respectively. The mean HADS scores describing intensity were 7.3 for anxiety (n = 1,990) and 5.8 (n = 1,970) for depression. The prevalence rates for anxiety and depression were 26.6 and 28.6%, respectively. Among the 1,916 patients who completed both subscales, 17.2% had both anxiety and depression, 21.0% had either anxiety or depression, and 61.7% had neither. Gender, age, occupational status, and cancer diagnosis were associated with anxiety intensity or prevalence, while age, occupational status, and cancer diagnosis were associated with depression intensity or prevalence. Anxiety intensity was affected by the interaction effect between gender and diagnosis. Our study showed anxiety and depression being distinct entities, with more intense anxiety overall. From a research perspective, it reaffirms the usefulness for assessing both intensity and prevalence concurrently to gain a more detailed description of anxiety and depression.

The revised piper fatigue scale (PFS-R) for Italian cancer patients: a validation study.

BACKGROUND AND AIM: Fatigue is one of the most frequently reported symptoms by cancer patients. In recent years, much effort has been directed to designing fatigue measures which are psychometrically appropriate as well as easily administered. Among these, the Revised Piper Fatigue Scale (PFS-R) is widely used in assessing fatigue in cancer patients and other populations. Despite its large utilization in different national contexts and with different populations, its structure appears to vary across cultures, suggesting the need for its validation before use. The main aim of the present work was to verify the validity (i.e., dimensional structure and construct validity) and reliability (i.e., internal consistency) of an Italian translation of the PFS-R to reassure Italian oncology practitioners about its appropriate usage in practice and research. METHODS AND STUDY DESIGN: One-hundred ten Italian oncological inpatients were administered an Italian translation of the PFS-R together with a form for the collection of personal identification and clinical data and other fatigue and quality of life measures (POMS and EORTC QLQ-C30) already validated for Italy. RESULTS: Principal component exploratory factor analysis revealed a four-factor structure quite similar to (although not overlapping) the original described by Piper and colleagues; all four factors proved to be reliable and to correlate with one another and with previous validated measures of fatigue and quality of life. Preliminary descriptive statistics were also provided for data comparisons. CONCLUSIONS: Despite the discussed limitations, PFS-R seems a valid and reliable multidimensional fatigue measure also adequate in Italian oncological settings.

Fatigue, quality of life, and mood states during chemotherapy in Italian cancer patients.

AIMS AND BACKGROUND: In cancer patients, fatigue interferes with the individual's functioning and quality of life (QoL). We investigated the association between fatigue and the main QoL dimensions and mood states as well as the main sociodemographic and clinical variables. METHODS: A total of 105 inpatients undergoing chemotherapy were administered the Revised Piper Fatigue Scale and the EORTC QLQ-C30 and POMS questionnaires, along with a form for collecting personal and clinical data. RESULTS: Compared with patients reporting lower fatigue levels, patients with higher levels showed worse functioning (P <0.001) in every QoL domain (i.e., physical, role, emotional, social, cognitive functioning, pain, and general health) as well as in the assessed mood states (depression-dejection, tension-anxiety, confusion-bewilderment). Moreover, both QoL and mood states in the subgroup reporting intermediate fatigue levels were worse than those of the subgroup with lower fatigue levels (P <0.02), except for emotional functioning, general health and QoL, and tension-anxiety. In addition, fatigue was significantly associated with gender, age, education, performance status, but not with marital status, survival rate of cancer type, and current chemotherapy cycle. CONCLUSIONS: The associations observed between fatigue, the main QoL domains, and negative mood states call for further active interventions to prevent and reduce fatigue.