Intensity and Prevalence of Psychological Distress in Cancer Inpatients: Cross-Sectional Study Using New Case-Finding Criteria for the Hospital Anxiety and Depression Scale.

Psychological distress includes all negative subjective experiences elicited by a disease and its treatments. Since psychological distress in oncology is associated with negative outcomes, its detection and description are helpful for designing tailored supportive interventions. This study used the Hospital Anxiety and Depression Scale (HADS) to assess the intensity and prevalence of psychological distress (i.e., anxiety and depression) in cancer inpatients and examined the relationships between these variables and sociodemographic and clinical factors. An existing dataset of HADS results, from 2021 consecutive adult cancer inpatients at a single hospital, was analyzed. Only those questionnaires with complete responses were used. The intensity of anxiety and depression was determined from HADS sub-scores. The prevalence of anxiety and depression was calculated using, as case-finding criteria, cut-offs of ≥ 10 and ≥ 8, respectively. The mean HADS scores describing intensity were 7.3 for anxiety (n = 1,990) and 5.8 (n = 1,970) for depression. The prevalence rates for anxiety and depression were 26.6 and 28.6%, respectively. Among the 1,916 patients who completed both subscales, 17.2% had both anxiety and depression, 21.0% had either anxiety or depression, and 61.7% had neither. Gender, age, occupational status, and cancer diagnosis were associated with anxiety intensity or prevalence, while age, occupational status, and cancer diagnosis were associated with depression intensity or prevalence. Anxiety intensity was affected by the interaction effect between gender and diagnosis. Our study showed anxiety and depression being distinct entities, with more intense anxiety overall. From a research perspective, it reaffirms the usefulness for assessing both intensity and prevalence concurrently to gain a more detailed description of anxiety and depression.

A Textual Analysis for Understanding the Relations and the Identity Construction in Adolescent Oncology Patients: Retrospective Personal Views in Order to Educate Health Professionals.

Patient input is critical for all aspects of value-based healthcare design. This contribution describes the following: the specifics of communications with doctors regarding the disease in adolescents and young adults with cancer; the patients' thoughts, emotions and changes in self-perception; "other meanings" taking shape along the treatment pathway; and reacting modes to the disease and treatments. Thirty-five Italian AYA patients in follow-up (age 18-24) were involved in a plenary interview on the cited aspects of their oncological experience. The answers were analyzed by MADIT (Analysis Methodology of Computerized Textual Data) with the software SPAD. MADIT allowed us to perform text analysis, describe the graphical outcomes and discuss the results. Respondents took a first-person perspective and their personal narrative recall had objective and unequivocal connotations. Experience was narrated mainly by maintenance repertoires that fix the reality of disease, its treatments and personal identity. The account focused on the tumor and on an agreed approach to it. The time "after" was described as a distressing space that defines them. Making sense of the events was considered a significant help. Professionals need to focus on the discursive repertoires of communication with which the inner and outer reality are built. Lastly, these patients required a two-way dialogue throughout the entire caring process.

Discussing communication issues and needs with adolescents with cancer.

Adolescents with cancer face unique medical and psychosocial challenges and it is important for their doctors to understand the psychological manifestations of cancer diagnosis and treatment in this age group. Using patient dialogues, we describe how simultaneous participation of physicians and patients could help to give voice to patient needs, in particular concerning communication.

Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients.

BACKGROUND: Despite the possible traumatic significance of cancer and of the incidence, prevalence, and survival of young women with breast cancer, these patients are underrepresented in multidimensional research. In the present survey, QoL and psychological distress were studied in a sample of young female breast cancer patients during the first year of their disease. More in detail, the study was firstly aimed to assess if QoL of 18-45 years old female breast cancer patients was different from QoL of women from the general population and if it changed over time. Secondly, it described the psychological distress and its change over time. Finally, it assessed if QoL registered 1 year post-surgery may be explained by QoL and/or psychological distress registered during the hospitalization. METHODS: One hundred six, consecutive 18-45 years old, female primary breast cancer patients undergoing anticancer surgery filled out the Short Form 36 Health Survey Questionnaire, the Hospital Anxiety and Depression Scale and a socio-demographic and clinical form during hospitalization to receive surgery (T0), and again at 12 months post-surgery (T1). RESULTS: At T0, participants showed a better physical functioning (p = 0.001) than the female normative sample, whereas their mental functioning was worse (p < 0.001). In this time, mental functioning within our sample was weaker than physical functioning (p < 0.001). Over time, physical functioning decreased (p < 0.001), whereas mental functioning increased (p < 0.001). Both at T0 and T1, anxiety was higher than depression (p < 0.05). Both distress dimensions decreased over time (p < 0.001). Nevertheless, at T0 the 25.5 and 26.4% of the sample were respectively possible and probable cases of anxiety, whereas the 17.9 and 9.4% were possible and probable cases of depression. At T1, the percentages were 17.9 and 18.9% for anxiety, and 8.5 and 6.6% for depression. In both considered times, a better QoL corresponded to less psychological distress. However, QoL and psychological distress assessed at T0 did not predict the QoL at T1. CONCLUSIONS: This study documented as QoL and psychological distress may change during the first year after surgery for a primary breast cancer in young women; therefore, they should be monitored over time to detect and treat women with alarming levels on them.

Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to screen anxious and depressive states in patients in non-psychiatric settings. In spite of its large use, no agreement exists in literature on HADS accuracy in case finding. The present research addresses the issue of HADS accuracy in cancer patients, comparing its two subscales (HADS-A and HADS-D) against tools not in use in psychiatry, which are able to detect prolonged negative emotional states. METHODS: 2121 consecutive adult cancer inpatients were administered the HADS together with the State Anxiety subscale of State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Scale on Depression. Receiver operating characteristic (ROC) curves were computed to identify a cut-off for anxious and depressive states in cancer patients. All indicators were computed together with their corresponding 95% confidence interval (95% CI). RESULTS: Data of 1628 and 1035 participants were used to assess the accuracy in case finding of HADS-A and HADS-D, respectively. According to the ROC analysis, the optimal cut-off was > 9 units for the HADS-A and > 7 units for the HADS-D. The area under the ROC curve was 0.90 for HADS-A (95% CI 0.88-0.91) and 0.84 for HADS-D (95% CI 0.81-0.86). CONCLUSIONS: This study suggested that risk scores of anxious and depressive states above specific HADS cut-offs are useful in identifying anxious and depressive states in cancer patients, and they may thus be applicable in clinical practice.

A contribution to the validation of the Italian version of the Body Image Scale (BIS).

BACKGROUND: The Body Image Scale (BIS) is a 10-item mono-factorial scale, designed to capture distress and symptoms related to body image in cancer patients. This paper describes the conversion and psychometric evaluation of an Italian BIS version. METHODS: After the back-translation procedure, the Italian version of the BIS, together with the Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey Questionnaire, have been administered to a sample of Italian adult females, surgically treated for a breast cancer at least one year before. RESULTS: Data on 109 participants were analyzed. The response rate was 92.5%. Response prevalence was adequate for 9 out of 10 items. Principal component analysis showed a one-factor structure. Internal consistency (Cronbach's alpha =0.924) was good. The BIS correlated with the theoretically pertinent subscales of the other administered tools and was able to discriminate participants (discriminant validity) according to the undertaken surgical treatment (p = 0.031). CONCLUSIONS: This study supports the valid and reliable use also of the Italian version of the BIS.

Facilitating the integration of emotional states in patients' personal disease experience with cancer: a new brief intervention for managing psychological distress.

PURPOSE: This paper describes an intervention performed at an Italian oncological institute to manage psychological distress related to the oncological experience. Its objectives are to encourage and normalize awareness of the importance of emotional aspects of the cancer experience, to provide psycho-education to patients on the importance of psycho-social care in promoting well-being, and to introduce our psychology service and promote its usage. METHODS: The intervention consists of three consecutive steps: the psychological distress screening; the clinical interview, which is conducted according to Rogers' client-centered model; and the collection of data regarding the appreciation and usefulness of the initiative, performed through a feedback questionnaire and the codification of the interview contents. RESULTS: Between September 2011 and February 2012, the intervention was administered to 484 consecutive new inpatients. Among them, the prevalence of psychological distress and its components of anxiety and depression are comparable to those found in the literature. The low percentage of participants who refuse the screening (15.4 %) as well as of those who do not wish to have the results returned to them (3.1 %), together with the high scores regarding the usefulness and effectiveness given to the intervention (all >80/100), documents the positive reception of this activity. Lastly, the analysis of the contents of the exit interview shows that a wide range of themes, far more varied and heterogeneous than just anxiety and/or depression symptoms, was discussed. CONCLUSIONS: Even though this was a clinical and not a research activity, it still offers important descriptive data.