Evaluation of the psychological burden during the early disease trajectory in patients with intracranial tumors by the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4)
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Depressive symptoms of patients with intracranial tumors need to be assessed adequately. The Patient Health Questionnaire for Depression and Anxiety (PHQ-4) is an ultra-short screening tool consisting of four items, a cutoff of six indicates depressive symptoms. The aim was to assess patients’ psychological burden by the PHQ-4 compared with the results of well-established screening instruments.
Patients were screened three times after primary diagnosis postoperatively (t1), after 3 (t2) and 6 (t3) months using the PHQ-4, the Hornheide Screening Instrument (HSI), the NCCN Distress Thermometer (DT), and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire with its brain module (EORTC QLQ-C30 + BN20). Demographic, tumor-related data, and Karnofsky Performance Scale (KPS) were analyzed. A cutoff value for PHQ-4 indicating a need for support or increased distress was determined by applying receiver operating characteristic (ROC).
The proportion of patients reaching a total score ≥ 6 was n = 32 out of 139 (23%) at t1; at t2, n = 12 out of 117 (10%) scored ≥ 6. At t3, n = 8 out of 96 (8%) scored ≥ 6. At t1, PHQ-4 scores did not differ significantly between gender, age groups, and tumor laterality. A cutoff value of 2.5 was identified to moderately discriminate between patients in or not in distress (sensitivity 76.8%) and between patients wishing further, specific support or not (sensitivity 82.5%).
The PHQ4 can be applied in this patient cohort to detect those with relevant psychological comorbidities. The cutoff value should be re-evaluated in a larger cohort as we observed that a cutoff of 6, as recommended previously, may be too high in order to detect affected patients adequately.
KeywordsCancer Oncology Brain tumor Distress Intracranial tumor Psychosocial burden Quality of life Screening
We thank all patients who participated in the study. We acknowledge all further members of our study group—Markus Haug, Susanne Janz, Güler Savas and Stefan Kindel—for the tremendous support. This work contains parts of the dissertation of Isabell Neppel, Sari Soebianto and Helena Tsakmaklis. This study was funded by the Friedhelm Frees Stiftung, Mainz, Germany.
The study was supported by the Friedhelm Frees Stiftung, Mainz, Germany. The authors have no financial relationship with the organization that sponsored the research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. The first author has full control of all primary data and agrees the journal to review the data if requested.
- 7.Hartung TJ, Friedrich M, Johansen C, Wittchen HU, Faller H, Koch U, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Mehnert A (2017) The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer. 123(21):4236–4243CrossRefGoogle Scholar
- 9.Renovanz M, Hickmann AK, Coburger J, Kohlmann K, Janko M, Reuter AK, Keric N, Nadji-Ohl M, König J, Singer S, Giese A, Hechtner M (2018) Assessing psychological and supportive care needs in glioma patients - feasibility study on the use of the supportive care needs survey short form (SCNS-SF34-G) and the supportive care needs survey screening tool (SCNS-ST9) in clinical practice. Eur J Cancer Care (Engl) 27(1). https://doi.org/10.1111/ecc.12598
- 16.Renovanz M, Tsakmaklis H, Soebianto S, Neppel I, Nadji-Ohl M, Beutel M, Werner A, Ringel F, Hickmann AK (2018) Screening for distress in patients with intracranial tumors during the first 6 months after diagnosis using self-reporting instruments and an expert rating scale (the basic documentation for psycho-oncology short form - PO-Bado SF). Oncotarget. 9(57):31133–31145CrossRefGoogle Scholar
- 18.Rumpold G, Augustin M, Zschocke I, Strittmatter G, Sollner W (2001) The validity of the Hornheide questionnaire for psychosocial support in skin tumor patients: a survey in an Austrian and German outpatient population with melanoma. Psychother Psychosom Med Psychol 51(1):25–33 Die Validitat des Hornheider Fragebogens zur psychosozialen Unterstutzung bei Tumorpatienten. Eine Untersuchung an zwei reprasentativen ambulanten Stichproben von MelanompatientenCrossRefGoogle Scholar
- 19.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, JCJM H, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
- 20.Taphoorn MJ, Claassens L, Aaronson NK, Coens C, Mauer M, Osoba D, Stupp R, Mirimanoff RO, van den Bent M, Bottomley A, EORTC Quality of Life Group, and Brain Cancer, NCIC and Radiotherapy Groups (2010) An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer 46(6):1033–1040CrossRefGoogle Scholar
- 23.Strittmatter G (2006) Screening-Instrumente zur Ermittlung der Betreuungsbedürftigkeit von Tumorpatienten. In: Herschbach P, Heußner P, Sellschopp A (eds) Psycho-Onkologie Perspektiven heute. Papst Science Publishers, Lengerich, pp 122–142Google Scholar
- 25.Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlenbaum Associates, New JerseyGoogle Scholar
- 27.Hickmann AK, Hechtner M, Nadji-Ohl M, Janko M, Reuter AK, Kohlmann K, Haug M, Grüninger S, Deininger M, Ganslandt O, König J, Wirtz CR, Coburger J, Renovanz M (2017) Evaluating patients for psychosocial distress and supportive care needs based on health-related quality of life in primary brain tumors: a prospective multicenter analysis of patients with gliomas in an outpatient setting. J Neurooncol 131(1):135–151. https://doi.org/10.1007/s11060-016-2280-0