Psychiatric disorders in older adults with cancer referred to psycho-oncology service in a tertiary care cancer centre: a 7-year real world experience from India.

BACKGROUND: Cancer affects mental health in older adults with cancer (OAC), affecting almost 50% of the patients. There are only a few studies on psychiatric disorders in OAC, especially in low resource settings. We report on our real-world experience of prevalence of and factors associated with psychiatric disorders in OAC referred to a psycho-oncology service in an Indian tertiary care cancer institute. METHODS: We retrospectively analysed medical and psycho-oncology records of patients aged 60 + on cancer-directed treatment or follow-up for < 2 years after treatment completion, referred to psycho-oncology services in a tertiary care cancer centre in Mumbai, India, from Jan 2011-Dec 2017. We recorded sociodemographic, clinical, and treatment-related variables, as well as past psychiatric disorders. The ICD-10 was used to record current psychiatric disorder type and presence. IBM SPSS version 24 (Armonk, NY, USA) was used for descriptive measures, tests of association, and logistic regression analysis. The study protocol was approved by Institutional Ethics Committee and registered with the Clinical Trials Registry-India (CTRI/2020/06/026095). RESULTS: Of 763 patients included in the study, 475 (62.3%) were males and 436 (57.1%) were inpatients, with a median age of 65 years. 93% of the patients had a solid tumour and 207 (27.1%) had a history of psychiatric disorder. A current psychiatric diagnosis was noted in 556 patients (72.9%) on initial presentation, of which adjustment disorders, delirium and depression and anxiety disorders were most frequently seen in 25.2%, 21% and 11.1%, respectively. On univariate analysis, a past history of psychiatric disorders (χ2 = 34.6, p < 0.001), lower performance status (χ2 = 9.9, p = 0.002) and haematolymphoid malignancy (χ2 = 4.08, p = 0.04) significantly increased the risk of current psychiatric diagnosis. Logistic regression confirmed these variables as significant. CONCLUSION: Older adults with cancer referred to psycho-oncology services have high rates of psychiatric disorders at their initial presentation, mainly adjustment disorders, delirium and depression and anxiety. A past history of psychiatric disorders, lower performance status and haematolymphoid cancers significantly increased the risk of psychiatric disorders. Multidisciplinary psycho-oncology teams including a psychiatrist should be integrated in comprehensive care of this group of patients. Further research outcomes and effect of psycho-oncological interventions is required in older adults with cancer in LMIC settings.

Validation of the hospital anxiety depression scale - Marathi version in detecting anxiety and depression in cancer patients and caregivers.

Background: ">The Hospital and Anxiety Depression Scale (HADS) is useful for screening depression and anxiety in cancer. It has not been validated in the Marathi language, which is the third most common language in India. We aimed to examine the reliability and validity of the Marathi-translated version of HADS in cancer patients and their caregivers. Methods: In a cross-sectional study design, we administered the Hospital and Anxiety Depression Scale-Marathi version (HADS-Marathi) to 100 participants (50 patients and 50 caregivers) after obtaining their informed consent. The team Psychiatrist, who was blind to the HADS-Marathi scores, interviewed all participants and identified the presence of anxiety and depressive disorders using the diagnostic criteria of the International Classification of Diseases - 10th edition. We measured internal consistency using Cronbach's alpha, receiver operating characteristics, and factor structure. The study was registered with the Clinical Trials Registry-India (CTRI). Results: The internal consistency of HADS-Marathi was good with 0.815, 0.797, and 0.887 for anxiety and depression subscales and total scale, respectively. The area under curve figures were 0.836 (95% Confidence Interval [CI]: 0.756 - 0.915), 0.835 (95% [CI]: 0.749-0.921), and 0.879 (95% [CI] 0.806-0.951) for anxiety and depression subscales, and total scale, respectively. The best cutoffs identified were 8 (anxiety), 7 (depression), and 15 (total). The scale displayed a three-factor structure, with two depression subscale and one anxiety subscales items loading on to the third factor. Conclusion: We found that the HADS-Marathi version is a reliable and valid instrument for use in cancer patients. However, we found a three-factor structure, possibly reflecting a cross-cultural effect.