Psychiatric disorders following first breast cancer recurrence: prevalence, associated factors and relationship to quality of life

OBJECTIVE: The purpose of this study was to investigate the prevalence of and factors associated with psychiatric disorders and the impact on quality of life (QOL) in patients with first breast cancer recurrence. METHODS: We analyzed the baseline data on 50 consecutively enrolled recurrent breast cancer patients, participating in a feasibility study of multifaceted psychosocial intervention. Psychiatric disorders, including major depressive disorder (MDD), dysthymic disorder, panic disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder and adjustment disorders (AD), were evaluated according to the Structured Clinical Interview for the DSM-III-R and IV. The patients' demographic data, biomedical factors, social support, mental adjustment to cancer, personality traits and QOL were also evaluated. RESULTS: Eleven (22%) met the DSM-III-R and IV criteria for MDD, PTSD or AD (MDD, 2%; PTSD, 2%; AD, 20%). Univariate analysis indicated that current doxorubicin/cyclophosphamide, presence of a confidant, past history of MDD, helplessness/hopelessness and neuroticism were significantly associated with psychiatric disorders. On multivariate logistic regression analysis, past history of MDD and helplessness/hopelessness were significant associated factors. Psychiatric disorders were significantly associated with lower functional scales ('emotional functioning', 'body image' and 'future perspective') and higher symptom scales ('appetite loss', 'diarrhea', 'fatigue' and 'nausea-vomiting') in QOL. CONCLUSIONS: The result suggests that asking about history of depression and appropriate intervention, including psycho-education, are needed for patients with first breast cancer recurrence in order to detect and manage psychological distress. Although further studies are needed to clarify causal links between psychiatric disorders and QOL, patients' psychiatric disorders were associated with QOL.     

Quality of life measurement in the head and neck cancer radiotherapy clinic: is it feasible and worthwhile?

Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort study was to assess the practical issues surrounding the collection of QOL data in a non-trial setting, and to determine whether it is feasible and worthwhile. Ninety-two patients attending clinics before, or at least 3 months after radiotherapy for head and neck cancer were asked to complete the University of Washington QOL questionnaire (Version 4) and the Hospital Anxiety and Depression Scale. The three most important QOL domains cited by patients after radiotherapy related to saliva production, swallowing and taste. Most patients were able to complete both questionnaires in less than 10 min and reported little difficulty in understanding and completing them. The questionnaires indicated possible clinically significant levels of anxiety and depression in 31% and 16%, respectively. We perceived several benefits of routine QOL data collection in the clinic and this has now been adopted in our own practice.     

Unmet supportive care needs,psychological well‐being and quality of life in patients living with multiple myeloma and their partners

Purpose: The aim of this project was to identify the nature and range of needs, as well as levels of quality of life (QOL), of both patients living with myeloma and their partners. Methods: A cross‐sectional survey was used, recruiting patients and their partners from 4 hospitals in the United Kingdom at a mean time post‐diagnosis of 5 years. Patients completed a scale exploring their Supportive Care Needs, the Hospital Anxiety and Depression Scale (HADS) and the EORTC QOL scale with its Myeloma module. The partners completed the partners' version of the Supportive Care Needs scale and HADS. Results: A total of 132 patients and 93 of their partners participated. One‐quarter of the patients and one‐third of the partners reported unmet supportive care needs. About 27.4% of patients reported signs of anxiety and 25.2% reported signs of depression. Almost half the partners (48.8%) reported signs of anxiety and 13.6% signs of depression. Anxious/depressed patients had more than double unmet needs than non‐anxious/depressed patients (P<0.05). QOL was moderate, with key areas of impairment being physical, emotional, social and cognitive functioning, and patients complained of several symptoms, including tiredness (40.7%), pain (35.9%), insomnia (32.3%), peripheral neuropathies (28.3%) and memory problems (22.3%). About 40.8% were worried about their health in the future. Conclusion: Long‐term supportive care services should provide support to both patients and their partners in relation to their unmet needs, screening them for psychological disorders, referring them appropriately and timely, and optimising symptom management in order to improve the patients' QOL. Copyright © 2010 John Wiley & Sons, Ltd.     

Anxiety Disorders in Family Caregivers of Breast Cancer Patients Receiving Oncologic Treatment in Malaysia

Background: Anxiety is recognized as a normal psychological reaction of those caring for cancer patients. However, anxiety disorders in caregivers may interfere with their care-giving role and require further clinical attention. Objectives: To determine the prevalence and associated factors of anxiety disorders among caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital. Methodology: A cross-sectional study was conducted on 130 caregiver-patient dyads, recruited by non-random sampling at Kuala Lumpur Hospital. Data were collected in 2 stages: 1) the caregivers were screened for psychological distress using the Depression, Anxiety, Stress, Scale (DASS-21) while other related factors for the patients and their caregivers were obtained; 2) the identified distressed caregivers (n=64) were then administered the Mini International Neuropsychiatric Interview (MINI) to diagnose anxiety disorders. Results: A total of 11.5% (n=15) of the caregivers reported suffering from anxiety disorders. Bivariate analysis found duration of caregiving (OR=3.31; CI=2.21-11.93), shared caregiving (OR=4.07; CI=1.34-12.36), and patients’ treatment type (OR=3.42; CI=1.92-12.76) were significantly associated with anxiety disorders (p value <0.05), with shared caregiving and patient’s treatment type remaining significant using logistic regression (p value < 0.05, R2 = 0.255). Conclusions: Every one in ten of the caregivers in this study had a diagnosable anxiety disorder, associated with certain care-giving factors and patients’ treatment. This should alert clinicians to such risk and indicates psychological support needs for family caregivers.     

Prospective assessment of emotional distress, cognitive function, and quality of life in patients with cancer treated with chemotherapy

BACKGROUND: The current study sought to delineate prospectively the rates and clinical course of emotional distress, cognitive impairment, and quality of life (QOL) in chemotherapy-naive patients with cancer and to consider the determinants of global QOL. METHODS: Patients who consented to participate were administered the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, the Mini-Mental State Examination (MMSE), and the Hospital Anxiety and Depression Scale before and at the end of treatment (EOT). RESULTS: Of the 102 patients initially assessed, 80 (78.4%) completed the study. Most aspects of QOL did not change considerably over time. At EOT, patients reported only significant increases in fatigue and significant decreases in sleep disturbance. Although no significant changes emerged in the rates of anxiety or depression throughout chemotherapy, nearly one-third of the patients experienced severe emotional distress at both points in time. In addition, the authors observed neither significant alteration in the cognitive performance over time nor reliable associations between scores on the MMSE and subjective cognitive function, emotional distress, or QOL. Finally, depression proved to be the leading predictor of global QOL at baseline and at EOT. CONCLUSIONS: The results indicated that a significant proportion of Greek patients with cancer experienced intense anxiety and depression throughout chemotherapy and confirmed the importance of depression as a strong predictor of global QOL. Routine screening of emotional distress across all phases of cancer is mandatory because it will contribute to the identification of patients who are in need of pharmaceutical and/or psychologic intervention.     

Screening for psychological distress in Japanese cancer patients

BACKGROUND: Psychological distress is frequently observed, however, it is underestimated in cancer patients. The aim of this study is to develop a simple battery for screening for psychological distress, adjustment disorder and major depressive disorder in Japanese cancer patients. METHODS: One hundred and twenty-eight cancer patients were interviewed by psychiatrists and tested using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses were performed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised. RESULTS: Cronbach alpha values of the Japanese version of the scale were 0.77 for the subscale for anxiety and 0.79 for depression. By a receiver operating characteristic analysis, we determined that an optimal cut-off point for screening for adjustment disorder and major depressive disorder was 10/11, which gave high enough sensitivity and specificity (91.5 and 65.4%, respectively). To screen for major depressive disorder alone, 19/20 was an optimal cut-off point with 82.4% sensitivity and 96.3% specificity. The subscales of HADS (anxiety and depression) also had high screening performance. CONCLUSIONS: The Japanese version of HADS is a sensitive and specific tool for screening for psychological distress in Japanese cancer patients. This scale can be used for an early detection of patients' psychological distress which may be followed by psychiatric interventions.      

Prevalence and etiology of mental problems in tumor patients

Data obtained from a questionnaire completed by 177 cancer patients were analyzed for prevalence of depressive and anxiety disorders and aspects of coping behavior. We found a high correlation between frequency of depressive symptoms and the period time after which cancer was diagnosed. According to data reported by other authors, prevalence of depression ranged between 21% and 32%. Anxiety disorders were found in about 40% of all cancer patients. Chemotherapy seems to be very stressing: During the course of therapy, we found a duplication of depressive symptoms, severe depression increases from 0% to 17%. Personality-traits possibly predict anticipated nausea and vomiting (ANV). Patients with ANV show higher values in depression, anxiety, fatalism, but lower ones in internal control measured before chemotherapy.     

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires.

Eighty-one patients with advanced breast cancer completed the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL) to determine how well these questionnaires identified patients suffering from an anxiety state or depressive illness, compared with an independent interview by a psychiatrist who used the Clinical Interview Schedule. A threshold score was defined for each questionnaire which gave the optimal sensitivity and specificity. Seventy-five per cent of patients were correctly identified as suffering from an affective disorder by both the Rotterdam Symptom Checklist and by the Hospital Anxiety and Depression Scale. Twenty-one per cent of ''normal'' patients were misclassified by the Rotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale. When the HADs anxiety and depression subscales were analysed separately, the performance of the anxiety items was superior to that of the depression items. Both questionnaires were found to have good predictive value and could be used in patients with advanced cancer to help screen out those with an affective disorder.     

Anxiety disorders in breast cancer: Prevalence,types, and determinants

ABSTRACT

The coexistence of anxiety disorders among women with breast cancer has been linked with delay in diagnosis, treatment abandonment, and poor quality of life. This study investigated anxiety disorders with their determinants among 200 participants with histological diagnosis of breast cancer. A questionnaire was designed to elicit sociodemographic and clinical factors, while the schedule for clinical assessment in neuropsychiatry (SCAN) was used to ascertain the presence of anxiety disorders. The mean age of participants was 49.6 years (SD = 11.2) and more than half (54%) presented with advanced cancers (stages 3 and 4). Anxiety disorder was observed in 38 (19%) of the participants. Low income, absence of previous history of breast cancer, and early stage of breast cancer were the significant determinants of anxiety disorders (p < 0.05). However, only absence of previous history of breast cancer (odds ratio [OR] = 3.460, 95% confidence interval [CI] = 1.200–6.960) and early stage of breast cancer (OR = 1.560, 95% CI = 1.120–2.174) were the determinants of anxiety disorders following logistic regression. We advocate for public awareness to promote early screening. Similarly, there is need to improve access to care and integrate culturally appropriate psychosocial intervention into breast cancer care using the available knowledge on vulnerability factors. Further study on anxiety disorders in breast cancer is indicated.     

晚期恶性肿瘤患者心理状况初步分析

背景与目的：晚期肿瘤患者的生活质量、心理状况等正在受到广泛的关注和重视,本研究初步评估晚期恶性肿瘤患者的心理状况,并分析其影响因素。方法：对2011年9月-2013年3月于复旦大学附属肿瘤医院综合治疗科住院治疗的晚期肿瘤患者,在家属陪同及医师的指导下,分别完成焦虑自评量表(self-ratinganxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、生活质量调查问卷(EORTCQLQ-C30)、社会支持评定量表、90项症状清单(symptom checklist 90,SCL-90)等调查量表,并对各量表的结果进行统计学分析。结果：共56例患者入组。所有患者中,18例有抑郁倾向,24例有焦虑倾向,16例焦虑合并抑郁。分析显示,有心理障碍组,除认知功能外,躯体、角色、情绪、社会功能评分明显较无心理障碍组低,而SCL-90评分及疲倦、疼痛、呼吸困难、失眠、食欲丧失、经济困难等方面,有心理障碍组评分较无心理障碍组明显升高。患者SAS、SDS评分与整体生活质量呈负相关,而与患者的症状评分呈正相关。结论：晚期恶性肿瘤患者中,存在心理障碍的患者比例较高,且心理障碍会严重影响患者的生活质量。对于主诉症状较多或者自觉生活质量较差的患者,需要更多地关注其心理状况,必要时进行一定的干预,以缓解症状,提高生活质量。     

Factors Associated with Altered Long‐Term Well‐Being After Prophylactic Salpingo‐Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

Background.

Prophylactic bilateral salpingo-oophorectomy (PBSO) might alter several components of well-being, such as sexual functioning and endocrine symptoms, in women at high risk for hereditary breast and/or ovarian cancer, compared with the general population. We searched for factors associated with altered long-term well-being in this population (lower quality of life [QOL], altered sexual functioning, greater anxiety, more endocrine symptoms).

Methods.

All high-risk women who had undergone PBSO during the past 15 years in a single cancer center were contacted by mail. Upon acceptance, they were sent five questionnaires: (a) general social questions, (b) the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, (c) Sexual Activity Questionnaire, (d) Functional Assessment of Cancer Therapy – Endocrine Symptom, and (5) State-Trait Anxiety Inventory. Logistic analyses were used to identify factors associated with altered results. Because of multiple testing, only p-values ≤ .01 were considered significant.

Results.

One hundred twelve of 175 women (64%) returned the completed questionnaires at a mean duration (standard deviation) of 6.0 (5.1) years after PBSO. QOL was positively influenced by two baseline factors: a high educational level and occupying an executive position. However, younger age at PBSO was associated with lower social functioning and greater anxiety. At the time of the study, practicing a sport and the avoidance of weight gain (≥10%) were highly related to QOL, sexual pleasure, endocrine symptoms, and anxiety in the univariate analysis and predictive of better QOL and lower anxiety in the multivariate analysis.

Conclusions.

Younger women and women with a low educational level and no occupation appear to be at higher risk for altered long-term well-being. After surgery, practicing a sport and stable weight may help maintain overall well-being.     

Prospective studies on mental status and quality of life in patients with head and neck cancer treated by radiation

Factors affecting the quality of life (QOL) in patients undergoing radiation therapy for head and neck cancer were determined in a prospective study. Full psychiatric interviews and self-report questionnaires concerning patients' QOL, pain, anxiety, mood, coping style and personality were administered to 35 patients with Stage I or II head and neck cancer before radiation therapy (week 0), and approximately one month (week 4) and two months (week 8) after starting of radiation. Anxiety, depression and pain were more severe at week 4 than at baseline. Anxiety was less at week 8, but depressive symptoms remained remarkable. Stepwise regression analyses revealed that changes in depressed mood and pain partially accounted for changes in disease-specific QOL. General health QOL related to a premorbid personality of openness and an emotional aspect of a coping style. Therapeutic interventions including psychiatric management of depression and physical management of pain appear to be crucial for preserving QOL during radiation treatment of patients with head and neck cancer.     

Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study

Levels of anxiety were assessed through questionnaires completed by 1781 screen-positive (PSA > or = 3 ng/mL) men attending the European Randomised Study of Screening for Prostate Cancer in Gothenburg, Sweden. During the first visit (clinical examination, including biopsies), no anxiety whilst awaiting the PSA test results was reported by 66% and 2% reported high levels of anxiety. A multinomial logistics model for repeated measurements, adjusted for age, PSA level, heredity, biopsy finding and urinary symptoms, revealed that anxiety awaiting the PSA was only influenced (increased) by the existence of previously elevated PSA tests (p<.0001). No anxiety associated with biopsy was reported by 45%, while 6% experienced high levels of anxiety. Levels of anxiety decreased significantly with subsequent rounds of examinations (p<0.0001) and with increasing age (p=0.0016). Anxiety associated with prostate cancer screening in general is low to moderate, even in men with elevated PSA, and severe anxiety affects a smaller group of susceptible men.     

Symptom Severity,Anxiety, Depression,Self- Efficacy and Quality of Life in Patients with Cancer

Background: Despite advances in cancer disease prevention, diagnosis, and treatment patients with cancer suffer from a variety of sometimes severe physical and psychological symptoms regardless of the stage of the disease. The aim is to determine the relationship of antecedent factors and mediating variables to the quality of life (QOL) of patients with cancer. Materials and Methods: The study included 341 patients with cancer and symptoms. Data collection used the Cancer Symptom Scale, State-Trait Anxiety Inventory, Centers for Epidemiologic Study-Depression, Cancer Behavior Inventory, Multidimensional Quality of Life Index, and a Demographic Form. Results: A multiple regression equation containing all the variables explained 68% of the variance in QOL. Overall four variables accounted for the majority of the total variance: anxiety, depression, self-efficacy, and symptom severity. Three of these variables were mediating variables. Of the antecedent factors symptom severity had a significant indirect effect on QOL through the mediating variables. Symptom severity also had direct effect on QOL. Conclusion: Data indicate that anxiety, depression, and self-efficacy play major roles in determining the perception of QOL of cancer patients. These mediating variables either buffered or enhanced the impact of the antecedent factors of symptom severity on QOL. Nursing interventions should focus on enhancing self-efficacy. Nurses can use health promoting programs to assist patients who are physically impaired. Further research should be aimed at identifying other influential variables, with the ultimate goal of developing interventions to aid patients in their efforts to maintain their QOL while living with cancer.     

Reassurance and the anxious cancer patient

Many cancer patients are anxious even when disease is in remission. Anxiety about health, 'health anxiety', has distinct features, notably seeking medical reassurance about symptoms. Doctors may then communicate that these symptoms are not due to serious illness, a process known as 'reassurance'. However, reassurance may inadvertently perpetuate some patients' anxiety. We aimed to observe the relation between symptoms, anxiety and reassurance in consultations with cancer patients. A total of 95 outpatients, with breast or testicular cancers in remission, completed questionnaires measuring health anxiety at study entry, then general anxiety - before a consultation, immediately afterwards, 1 week later, and before their next consultation. We examined symptoms reported and reassurance by oncologists from audio recordings of consultations, and the outcome of subjects' anxiety. The results showed that substantial health anxiety was reported by one-third of the patients. Patients with higher levels of health anxiety reported more symptoms during consultations. Reassurance was ubiquitous, but not followed by an enduring improvement in anxiety. Certain forms of reassurance predicted increased anxiety over time, particularly for subjects who were most anxious. In conclusion, health anxiety can be a problem after cancer. Reassurance may not reduce patients' anxiety. Some reassurance was counterproductive for the most anxious patients. Oncologists may need to use reassurance as a procedure, balancing risk, and benefits, and patient selection and to manage cancer patients in remission.     

Knowledge of cancer symptoms and anxiety affect patient delay in seeking diagnosis in patients with heterogeneous cancer locations

Purpose: This research was aimed at identifying factors that predict patient delay in treatment initiation in patients with suspected cancer disease. We sought to determine the differences between delaying and nondelaying patients with reference to their knowledge of cancer symptoms, sociodemographic variables, and the levels of state anxiety and trait anxiety.MethodsThe study involved 301 randomly selected patients with suspected cancer disease before their first oncology appointment at a regional oncology center in Poland. Data were collected by means of a semistructured interview conducted by a trained psychologist. To evaluate the knowledge of cancer symptoms, the symptoms mentioned by subjects were compared to the list of symptoms from cancer awareness measure. Anxiety levels were assessed using the State-Trait Anxiety Inventory.ResultsIn the course of logistic regression analysis a model was developed, in which knowledge of cancer symptoms and state anxiety allowed to predict patient delay. Knowledge of every additional cancer symptom decreased the chance of patient delay by 16.4% point [95% CI: 1.4–29.2]. An increase in state anxiety for every point of the scale decreased the chance of delay by 2.5% points [95% CI: 0.2–4.6]. Trait anxiety and the studied sociodemographic variables proved to be nonsignificant predictors of patient delay.ConclusionsKnowledge of cancer symptoms and the level of state anxiety allowed to predict patient delay in the initiation of treatment. Owing to the heterogeneity of the tumor locations within the sample, the obtained model can be used in large scale prevention programs designed for the whole population.     

Health-related quality of life among long-term survivors of colorectal cancer: a population-based study

Background.

The number of long-term colorectal cancer survivors is increasing. Cancer and its treatment can cause physical and psychological complications, but little is known about how it impacts quality of life (QOL) over the long term—5, 10, and 15 years after diagnosis.

Methods.

Cancer survivors were randomly selected from three tumor registries in France, diagnosed in 1990 (±1 year), 1995 (±1 year), and 2000 (±1 year). Controls were randomly selected from electoral rolls, stratifying on gender, age group, and residence area. Participants completed two QOL questionnaires, a fatigue questionnaire, an anxiety questionnaire, and a life conditions questionnaire. An analysis of variance was used to compare QOL scores of cancer survivors by period of diagnosis (5, 10, and 15 years) with those of controls, adjusted for sociodemographic data and comorbidities.

Results.

We included 344 colon cancer and 198 rectal cancer survivors and 1,181 controls. In a global analysis, survivors reported a statistically and clinically significant lower score in social functioning 5 years after diagnosis and higher scores in diarrhea symptoms 5 and 10 years after diagnosis. In subgroup analyses, rectal cancer affected QOL in the physical dimensions at 5 years and in the fatigue dimensions at 5 and 10 years.

Conclusion.

Survivors of colorectal cancer may experience the effects of cancer and its treatment up to 10 years after diagnosis, particularly for rectal cancer. Clinicians, psychologists, and social workers must pay special attention to rectal cancer survivors to improve overall management.     

Study of anxiety disorder and depression in long-term survivors of testicular cancer.

PURPOSE: To increase our knowledge of the prevalence of anxiety disorder and depression in long-term testicular cancer survivors (TCSs), and to identify variables associated with such caseness. PATIENTS AND METHODS: Participants were 1,408 TCSs treated between 1980 and 1994 in Norway. Participants provided information about their medical, social, and familial situation on a questionnaire. They also completed the Hospital Anxiety and Depression Scale (HADS). Anxiety disorder and depression were defined by a score >/= 8 on the HADS subscales. The prevalence rates were compared with age-adjusted norm data. RESULTS: HADS-defined anxiety disorder was more prevalent in TCSs (19.2%; 95% CI, 17.2% to 21.3%) than in the norm sample (13.5%; 95% CI, 13.1% to 13.9%; P < .001), whereas the prevalence of HADS-defined depression did not differ from the norm (TCSs, 9.7%; 95% CI, 8.1% to 11.2% v norm, 10.1%, 95% CI, 9.5 to 10.5; P = .56). The relative risk for anxiety disorder was 1.49 (95% CI, 1.31 to 1.69) and for depression the relative risk was 0.96 (95% CI, 0.81 to 1.14) in TCSs compared with norm. In multivariate analyses, HADS-defined anxiety disorder in TCSs was associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, relapse anxiety, and having been treated for mental problems. CONCLUSION: Long-term TCSs have an increased risk of HADS-defined anxiety disorder that warrants clinical attention. Checking easily available demographic and TC-related data and use of a simple screening test such as HADS assists the identification of TCSs with anxiety disorder.     

Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase.

BACKGROUND: Limited research has been done on mental health and health-related quality of life (QOL) of primary caregivers (PCs) to patients staying at home with advanced cancer. This study examines anxiety, depression, and QOL in PCs of patients with cancer in the late palliative phase. PATIENTS AND METHODS: The sample consisted of 49 PCs of women with breast cancer and 47 PCs of men with prostate cancer. QOL was rated with the Medical Outcome Study Short Form (SF-36), and mental health with the Hospital Anxiety and Depression Scale (HADS). The findings were compared with age-adjusted norm data (norm). RESULTS: Physical QOL was significantly higher than norm in both genders, while mental QOL was significantly lower in male PCs. The level of anxiety was significantly higher than norm in both genders. No significant difference for level of depression was found in either gender, while caseness of HADS-defined depression was significantly more prevalent in female PCs compared with norm. CONCLUSION: PCs of both genders had significantly more anxiety than norm samples. Health care personnel in contact with PCs should consider screening them for mental symptoms and QOL and, if necessary, recommend further evaluation by their doctors.     

Evaluation of the quality of life between inpatients and outpatients receiving cancer chemotherapy in Japan

A quality of life (QOL) assessment has become increasingly common in cancer clinical trials. Seventy-four consecutive patients treated for cancer between August 2005 and January 2006 at the Cancer Chemotherapy Center in the University of Occupational and Environmental Health, Japan, were examined. The 8-Short form health survey (SF-8) was utilized as a comprehensive scale and quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD) as disease specific scale for the QOL evaluation. The QOL for outpatients was investigated in comparison with that for inpatients. All questionnaires were collected and baseline questionnaires were filled in by 98.1% of the subjects. The physical comprehensive score (PCS) of SF-8 for the outpatients was higher than that for the inpatients. The physical condition of the outpatients was better than that of inpatients. There was no difference in the baseline scores of the QOL-ACD scales in daily activity, psychological condition, social attitude, and face scale of the analyzed domains between the two groups. Furthermore, a longitudinal study from admission to outpatient was carried out on 27 patients who were treated on an outpatient basis in our clinic. No difference in the baseline scores of the SF-8 and QOL-ACD scales were observed in any of the analyzed domains. These data suggest that the present QOL study has a sufficient feasibility for the outpatients evaluated in our study, and QOL of outpatients after discharge is equal to that of inpatients receiving cancer chemotherapy.