The impact of perceived stage of cancer on carers' anxiety and depression during the patients' final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann–Whitney U‐test. The chi‐square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29–0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate–severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate–severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end. Copyright © 2008 John Wiley & Sons, Ltd.     

The impact of optimism on anxiety,depression and quality of life in urogenital cancer patients

Objective: The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health‐related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level. Methods: A total of 427 urogenital cancer patients were asked to complete the Life Orientation Test (LOT), the Hospital Anxiety and Depression Scale (HADS) and the health survey SF‐8 during their stay in the hospital (T1), two weeks later (T2) and three months later. Results: Finally, 275 patients (64.4%) completed all questionnaires. Optimism at T1 was significantly associated with anxiety (r=?0.35), depression (r=?0.41) and HRQOL (physical: r=0.29; mental: r=0.27) and can predict outcome variables three months later. After controlling for the base levels of anxiety, depression and HRQOL, the predictive value of optimism remained significant but small. The incrementally variance explained by the LOT varied between 2.1% in anxiety and 8.2% in physical HRQOL. Conclusion: Especially patients with a low level of optimism and a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered HRQOL. Copyright © 2009 John Wiley & Sons, Ltd.     

Effects of individual and partner factors on anxiety and depression in Taiwanese prostate cancer patients: A longitudinal study

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients’ threat appraisals and affective‐oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients’ most recent prostate‐specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients’ harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective‐oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.     

The association of depression and anxiety with health‐related quality of life in cancer patients with depression and/or pain

Objectives: Depression is known to be a major problem in cancer patients, and evidence is emerging about the importance of anxiety. Because the disorders are highly comorbid, we examined the relationship of anxiety and depression with health‐related quality of life (HRQL) in cancer patients. Methods: Sample included 405 adult oncology patients participating in a randomized controlled trial of telecare management for pain and depression. This secondary cross‐sectional analysis of baseline data examined independent and additive effects of anxiety and depression on HRQL, disability, and somatic symptom severity. Results: In 397 patients who screened positive for either pain or depression or both, 135 had comorbid anxiety and depression, 174 had depression but not anxiety, and 88 had neither. Differences existed across all nonphysical HRQL domains and were more pronounced incrementally across the three groups in the expected direction. In GLM modeling, anxiety and depression were each associated with all the domains when modeled separately (p<0.0001). When modeled together, anxiety and depression had independent and additive effects on the mental health domains of HRQL and on somatic symptom burden. In other domains (vitality, perceived disability, overall quality of life, and general health perceptions), only depression had an effect. Conclusion: Anxiety and depression have strong and independent associations with mental health domains and somatic symptom burden in cancer patients. However, depression has a more pervasive association with multiple other domains of HRQL. Paying attention to both anxiety and depression may be particularly important when addressing mental health needs and somatic symptom distress. Copyright © 2009 John Wiley & Sons, Ltd.     

An analysis of the psychometric profile and frequency of anxiety and depression in Australian men with prostate cancer

Zung's Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to collect data from 195 Australian men who had received a diagnosis of prostate cancer. Analysis was via separate scales and also by combining both scales into a single unit to assess anxiety-depression and then analysing the underlying component structure of that unit. Applying Zung's recommended cutoff scores, 12% of the sample were classified as having clinically significant levels of anxiety and 16% had similar levels of depression. Factor analysis of the combined SAS and SDS indicated four major components which reflected a process of: loss of functional capacity, worthlessness and hopelessness, fear and somatic symptomatology. Implications for the effective assessment and treatment of anxiety and depression in prostate patients are discussed.     

心理干预对癌痛患者疗效及焦虑抑郁的影响

目的 观察心理干预联合止痛药物对癌痛患者治疗效果和焦虑抑郁的影响.方法 选取200例伴有疼痛的肿瘤患者,采用随机数字表法分为干预组和对照组,每组各100例.所有患者均进行癌痛规范化治疗,干预组在癌痛规范化治疗的基础上联合心理干预,4周后采用数字评分法(NRS)及医院焦虑抑郁量表(HAD)对患者的疼痛程度进行评定.结果 干预组患者治疗后的癌痛缓解率为92%,高于对照组的81%,差异有统计学意义(P﹤0.05);干预组患者治疗后的焦虑、抑郁评分低于对照组,差异均有统计学意义(P﹤0.05);干预组患者治疗后便秘的发生率为41%,明显低于对照组的62%,差异有统计学意义(P﹤0.01).结论 心理干预联合止痛药物可缓解癌痛程度,减轻患者的焦虑和抑郁,降低便秘的发生率.