Anxiety Disorders in Cancer Patients: Their Nature, Associations, and Relation to Quality of Life

Cancer Research UK Clinical Centre at Leeds, St James's University Hospital, and Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom.
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2002; 20(14):3137-48. DOI: 10.1200/JCO.2002.08.549
Source: PubMed


We aimed to estimate the prevalence and types of anxiety disorders diagnosed according to standardized criteria in cancer patients, to compare screening tools in detecting them, and to examine their demographic, oncologic, and psychosocial associations.
In this cross-sectional observational study of 178 subjects with lymphoma, renal cell carcinoma, malignant melanoma, or plasma cell dyscrasia, we related responses to questionnaires (administered by computer touch-screen) measuring psychological symptoms, quality of life (QOL), and social support to standardized psychiatric interviews and cancer management.
Forty-eight percent of subjects reported sufficient anxiety for anxiety disorder to be considered. At subsequent diagnostic interview, 18% fulfilled International Classification of Disorders, 10th Revision criteria for anxiety disorder, including 6% of patients who reported low levels of anxiety by questionnaire. When subjects reported anxiety by questionnaire, if disruptive somatic anxiety was present, this increased the probability of diagnosable anxiety disorder from.31 to.7. The most accurate screening questionnaires were the trait scale of the State-Trait Anxiety Inventory and the Hospital Anxiety and Depression scale. Female sex and negative aspects of social support were associated with anxiety disorder in multivariate analyses. Anxiety disorder was independently associated with a deficit in QOL, particularly insomnia.
Anxiety symptoms are common in cancer patients. Screening by questionnaire seems to assess anxiety symptoms adequately but discriminates abnormal anxiety inadequately. To improve this, we may need to use criteria such as disruption from anxiety, as illustrated by the impact of anxiety disorders on QOL. There seem to be few oncologic variables that could target screening for anxiety disorders.

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    • "Anxiety, a predictable response to a cancer diagnosis, occurs in varying degrees and may increase as the disease progresses or as treatment becomes more aggressive or more debilitating (Breitbart, 1995). Investigators have found that 44% of patients reported some form of anxiety and 23% reported significant anxiety (Schag & Heinrich, 1989; Stark et al., 2002). The risk of developing anxiety disorders may represent a threat to patients' social roles, relationships, and ideas about future health, plans, and goals. "
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    ABSTRACT: Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
    Clinical journal of oncology nursing 12/2014; 18:5-16. DOI:10.1188/14.CJON.S3.5-16 · 0.91 Impact Factor
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    • "Cancer is usually stamped as a death sentence, and the patients are highly vulnerable to suffer from the psychosocial impact of this dreadful disease as well.[67] Thus, efficient use of behavioral therapy and pharmacological intervention is necessary, especially in patient receiving palliative care.[8] "
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    ABSTRACT: Background: After 4 months of the establishment of palliative care center (PCC) in our institute, we present an audit of the sociodemographic parameters of admitted patients. Such an audit can help to recognize the lacuna in the management and thus help to identify the specific requirements of cancer patients that might be overlooked in a busy cancer center. Materials and Methods: A total of 234 patients were admitted in our PCC since its inception in October 2013. The study design was retrospective, collecting the data from the medical records of the patients. The descriptive statistics of all these data were calculated in terms of frequencies and percentage of categorical variables. Results: Out of 234 patients admitted in PCC, 156 (66%) were male. The median age of the patients was 54 years. A total of 44% patients had primary malignancy of head and neck, 14% of cervical, 17% of lung cancer, 6% of breast, and 5% of colon, respectively. Metastatic disease was present in 76% of the patients admitted in the PCC. Liver was the most common (46%) metastatic site. Total 13 symptoms were identified with mean number of symptoms per patient at admission in PCC being 5.17. Conclusions: Palliative care services are an indispensable part of a tertiary regional cancer care center. The oncologists should be made aware of the requirement of better relief of pain and other distressing symptoms to provide better quality of life to the patients suffering from advanced cancer.
    Indian Journal of Palliative Care 09/2014; 20(3):220-3. DOI:10.4103/0973-1075.138399
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    • "The high prevalence of anxiety disorders in cancer patients is well documented [39, 40]. There are many types of anxiety disorders, and all are relatively common in the population, with prevalence data varying from 10 to 15% for the Greek population [41, 42]. "
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    ABSTRACT: Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient's quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger's State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain.
    Pain Research and Treatment 07/2014; 2014. DOI:10.1155/2014/312941
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