Supportive Care in Cancer

, Volume 17, Issue 5, pp 573–579 | Cite as

Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting

  • Marvin Delgado-Guay
  • Henrique A. Parsons
  • Zhijun Li
  • J. Lynn Palmer
  • Eduardo Bruera
Original Article



Mood disorders are among the most distressing psychiatric conditions experienced by patients with advanced cancer; however, studies have not shown a direct association of physical symptoms with depression and anxiety.


The purpose of this study is to determine the relationship between the frequency and intensity of patients’ physical symptoms and their expressions of depression and anxiety.

Patients and methods

We retrospectively reviewed the records of 216 patients who had participated in three previous clinical trials conducted by our group. We assessed patients’ demographic data using descriptive statistics. We analyzed physical symptom frequency and intensity using the Edmonton Symptom Assessment System (ESAS) and anxiety and depression using the respective subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D).


Sixty-two percent were male; the median age was 59 years (range 20–91 years). Seventy nine (37%) of the patients had depressive mood (HADS-D ≥ 8), and 94 (44%) had anxiety (HADS-A ≥ 8). Patients with depressive mood expressed higher frequency of drowsiness (68/78, 64%; p = 0.0002), nausea (52/79, 66%; p = 0.0003), pain (74/79, 94%; p = 0.0101), dyspnea (68/79, 86%; p = 0.0196), worse appetite (72/79, 91%; p = 0.0051), and worse well-being (78/79, 99%; p = 0.0014) and expressed higher intensity of symptoms (ESAS ≥ 1) [median (Q1–Q3)] including drowsiness [4 (3–7), p = 0.0174], fatigue [7 (5–8), p < 0.0001], and worse well-being [6 (5–7), p < 0.0001]. Patients with anxiety expressed higher frequency of nausea (59/94, 57%; p = 0.0006), pain (88/94, 89%; p = 0.0031), and dyspnea (84/94, 96%, p = 0.0002) and expressed a higher intensity of pain [6 (3–8), p = 0.0082], fatigue [6 (5–8), p = 0.0011], worse appetite [6 (4–8), p = 0.005], and worse well-being [5 (3–7), p = 0.0007]. Spearman’s correlation showed a significant association between HADS-A and HADS-D and other symptoms in the ESAS. Spearman’s correlations of HADS with ESAS-Anxiety and ESAS-Depression were 0.56 and 0.39, respectively (p < 0.001).


Expression of physical symptoms may vary in frequency and intensity among advanced cancer patients with anxiety and depression. Patients expressing high frequency and intensity of physical symptoms should be screened for mood disorders in order to provide treatment for these conditions. More research is needed.


Depression Anxiety Advanced cancer Mood disorders Symptom distress Palliative care 



This research study was presented as invited lecture at the Supportive Care in Cancer MASCC/ISOO 2008 International Symposium in Houston, Texas on June 26–28, 2008.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Marvin Delgado-Guay
    • 1
  • Henrique A. Parsons
    • 2
  • Zhijun Li
    • 2
  • J. Lynn Palmer
    • 2
  • Eduardo Bruera
    • 2
  1. 1.The University of Texas Medical School at HoustonLyndon B. Johnson General HospitalHoustonUSA
  2. 2.Department of Palliative Care and Rehabilitation MedicineThe University of Texas, M. D. Anderson Cancer CenterHoustonUSA

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