Psychological Distress Affects One Third of Cancer Patients

Roxanne Nelson

October 06, 2014

A significant percentage of cancer patients experience some type of mental health challenge, and this prevalence is higher than seen in the general population, a group of researchers report from Germany.

The results were published online October 6 in the Journal of Clinical Oncology.

Anja Mehnert, PhD, a professor of psychosocial oncology at the University of Leipzig in Germany, and colleagues conducted face-to-face interviews with 2141 patients with cancer (aged 18-75 years) at 30 hospitals, cancer care clinics, and rehabilitation centers in Germany. The most common cancer type was breast (20.6%), followed by prostate (14.9%) and colon/rectum cancer (13.7%). The average time since current cancer diagnosis was 13.5 months (range, 0 - 126 months).

"One third of all patients had high levels of mental or emotional distress that meets the strict diagnostic criteria for mental disorders, including anxiety, depressive, and adjustment disorders during the prior 4 weeks," Dr Mehnert reported. The team found a 31.8% prevalence for any mental disorder, with anxiety disorders (11.5%) and adjustment disorders (11.1%) being most common.

The results also showed that about 6% of patients were diagnosed with two mental disorders, and about 1.5% had three or more disorders. When looking at comorbidities, the authors found that anxiety disorders most frequently co-occurred with any mental disorder owing to general medical condition and mood disorders. Overall, approximately 29% of cancer patients were diagnosed with at least one mental disorder, excluding alcohol and/or nicotine abuse or dependence.

On the basis of these data, Dr Mehnert believes that cancer patients should be more closely assessed for their mental health status. "We believe that cancer patients and family caregivers as well face a continuum of distress, reaching from high emotional distress, subthreshold disorders to mental disorders that need to be addressed adequately," she told Medscape Medical News. "Therefore, repeated psychosocial distress screening and assessment is important."

Oncologists need to be aware of the mental health issues that affect patients, she added. "Screening for emotional distress is important," Dr Mehnert said. "It is also important to create a patient-centered atmosphere in modern cancer clinics where patients feel comfortable to talk openly about their concerns. Communication training programs for the healthcare team are important as well."

Varies by Cancer Type

The authors found that the prevalence of mental health issues varied considerably according to cancer type.

The highest prevalence was observed among patients with breast cancer (42%) and head and neck cancer (41%), followed by malignant melanoma (39%). The lowest prevalence was seen among patients with prostate cancer (22%), stomach cancers (21%), and pancreatic cancer (20%).

When the results were compared with the 4-week prevalence rates of mental disorders in the general German population, the team found that there was an overall higher prevalence as well as slightly higher rates for any anxiety disorder (11.5% vs 9%) and any mental disorder resulting from general medical condition (2% vs 0.5%), but similar rates for any mood disorder (6.5% vs 6%).

Dr Mehnert noted that it was interesting that patients with a more treatable cancer, such as breast cancer, experienced more distress than those with cancers that are more challenging to treat, such as stomach and pancreatic cancers. "We need to analyze our data ― which we're about to do ― to answer that question more precisely," she said. "We believe there might be multiple factors, including age, gender, treatment stressors, and so on."

The authors note that prior studies have reported elevated levels of distress among cancer patients as well as long-term survivors. However, they point out that previous studies have varied in quality, owing to small cohorts, different diagnostic criteria and assessment standards, and an overrepresentation of women with breast cancer. Prevalence rates for psychosocial distress were based on self-reports, which are prone to overestimation, they add.

Low Rates of Alcohol Dependence

The prevalence rates for alcohol abuse/dependence (0% vs 2.5%) and for somatoform disorders (5.2% vs 7.5%) were slightly lower among cancer patients than the rates seen in the general population.

Of note, the prevalence rates of alcohol abuse/dependence in populations such as those with head and neck cancer were "remarkably low," considering that alcohol abuse is a known risk factor for several cancer types. However, the authors pointed out that the 12-month and lifetime prevalence rates in those cancer populations are considerably higher, although these statistics were not included in the article.

"We have always assumed that the diagnosis of cancer is hard on our patients, but these findings indicate how common these feelings may be," said Don S. Dizon, MD, a specialist in medical gynecologic oncology at Massachusetts General Hospital, Boston, in a statement.

"They also stress the importance that providers keep in mind that mental health issues are common across cancer types," added Dr. Dizon, who is an expert spokesperson for the American Society of Clinical Oncology and was not involved in the study.

The study was funded by the German Cancer Aid. The authors have reported no relevant financial relationships.

J Clin Oncol. Published online October 6, 2014. Abstract

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