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Supportive Care in Cancer

, Volume 26, Issue 3, pp 813–821 | Cite as

Mental disorder screening on cancer patients before and after radiotherapy and at the 1-month follow-up

  • Juan Antonio CruzadoEmail author
  • Manuel Hernández-Blázquez
Original Article

Abstract

Background

The aim was to study the accuracy of different screening tests to detect psychopathological disorders in cancer patients treated with radiotherapy before (T1) and after radiotherapy (T2), and at the 1-month follow-up (T3).

Methods

The Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS), and the distress thermometer (DT) (0–10) were administered, together with a depression scale (DEPQ) (1–5), an anxiety scale (ANSQ) (1–5), and a physical symptoms questionnaire, to patients treated with radiotherapy at T1 (232 participants), T2 (130 participants), and T3 (130 participants).

Results

The accuracy of the screening tests was higher at T2, with the HADS-T test (cut-off ≥ 10) yielding the best results: sensitivity = 0.80, specificity = 0.92, with an excellent AUC (0.91). The DT test (cut-off ≥ 4) showed a sensitivity = 0.66, a specificity = 0.91, and an AUC = 0.825, and the DEPQ (cut-off > 1) yielded a sensitivity = 0.74, a specificity = 0.78, and an AUC = 0.776. The ANSQ (cut-off > 1) showed a sensitivity = 0.60, a specificity = 0.97, and an AUC = 0.831. At T1 and T3, the sensitivity tests were unsatisfactory. The increase in sensitivity at T2 may be due to an increase of physical symptoms at such time, which occurred more frequently in those patients who scored higher on screening tests and showed mental disorders.

Conclusions

The diagnostic accuracy of the screening tests was higher at T2. At this time, HADS-T proved to be a good screening instrument; whereas at T1 and T3, screening instruments were only useful to detect cases without mental disorders, but not to identify those who suffer from them.

Keywords

Screening mental disorders Emotional distress Psychopathology Cancer Radiotherapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Fritzsche K, Liptai C, Henke M (2004) Psychosocial distress and need for psychotherapeutic treatment in cancer patients undergoing radiotherapy. Radiother Oncol 72:183–189.  https://doi.org/10.1016/j.radonc.2004.03.015 CrossRefPubMedGoogle Scholar
  2. 2.
    Hernández Blázquez M, Cruzado JA (2016) A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy. J Psychosom Res 87:14–21.  https://doi.org/10.1016/j.jpsychores.2016.05.010 CrossRefPubMedGoogle Scholar
  3. 3.
    Mehnert A, Brähler E, Faller H, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Hund B, Reuter K, Richard M, Sehner S, Sommerfeldt S, Szalai C, Wittchen HU, Koch U (2014) Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol 32:3540–3546.  https://doi.org/10.1200/JCO.2014.56.0086 CrossRefPubMedGoogle Scholar
  4. 4.
    Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12:160–174.  https://doi.org/10.1016/S1470-2045(11)70002-X CrossRefPubMedGoogle Scholar
  5. 5.
    Singer S, Szalai C, Briest S, Brown A, Dietz AJ, Einenkel J et al (2013) Co-morbid mental health conditions in cancer patients at working age—prevalence, risk profiles, and care uptake. Psychooncology 22:2291–2297.  https://doi.org/10.1002/pon.3282 CrossRefPubMedGoogle Scholar
  6. 6.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370.  https://doi.org/10.1111/j.1600-0447.1983.tb09716.x CrossRefPubMedGoogle Scholar
  7. 7.
    Mitchell AJ, Meader N, Symonds P (2010) Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affective Dis 126:335–348CrossRefGoogle Scholar
  8. 8.
    Vodermaier A, Millman RD (2011) Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 12:1899–1908.  https://doi.org/10.1007/s00520-011-1251-4 CrossRefGoogle Scholar
  9. 9.
    Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Cancer. Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82:1904–1908CrossRefPubMedGoogle Scholar
  10. 10.
    NCCN (2008) Distress Management. The complete library of NCCN clinical practice guidelines in oncology. National Comprehensive Cancer Network, JenkintownGoogle Scholar
  11. 11.
    Mitchell AJ (2015) Screening and assessment for distress. In: Holland J, Breitbart WP, Butow PN, Jacobsen PB, Loscalzo M, McCorkle R (eds) Psycho-oncology (3™ ed.). Oxford University Press, New YorkGoogle Scholar
  12. 12.
    Recklitis CJ, Blackmon JE (2016) Chang G3 Screening young adult cancer survivors for distress with the distress thermometer: comparisons with a structured clinical diagnostic interview. Cancer 122:296–303.  https://doi.org/10.1002/cncr.29736 CrossRefPubMedGoogle Scholar
  13. 13.
    Chochinov HM, Wilson KG, Enns M, Lander S (1997) “Are you depressed?” Screening for depression in the terminally ill. Am J Psychiatry 154:674–676CrossRefPubMedGoogle Scholar
  14. 14.
    Kawase E, Karasawa K, Shimotsu S, Imasato S, Ito K, Matsuki H, Sakano Y, Horikawa N (2006) Evaluation of a one-question interview for depression in a radiation oncology department in Japan. Gen Hosp Psychiatry 28:321–322CrossRefPubMedGoogle Scholar
  15. 15.
    Mitchell AJ (2008) Are one or two simple questions sufficient to detect depression in cancer and palliative care? A Bayesian meta-analysis. Br J Cancer 98:1934–1943.  https://doi.org/10.1038/sj.bjc.6604396
  16. 16.
    Davey HM, Barratt AL, Butow PN, Deeks JJ (2007) A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety. J Clin Epidemiol 60:356–360CrossRefPubMedGoogle Scholar
  17. 17.
    Yucel B, Akkaş EA, Okur Y, Eren AA, Eren MF, Karapinar H, Babacan NA, Kiliçkap S (2014) The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. Support Care Cancer 22:2479–2487.  https://doi.org/10.1007/s00520-014-2235-y CrossRefPubMedGoogle Scholar
  18. 18.
    Lewis S, Salins N, Kadam A, Rao R (2013) Distress screening using distress thermometer in head and neck cancer patients undergoing radiotherapy and evaluation of causal factors predicting occurrence of distress. Indian J Palliat Care 19:88–92.  https://doi.org/10.4103/0973-1075.116703 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Neilson K, Pollard A, Boonzaier A, Corry J, Castle D, Smith D et al (2013) A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer. Psychooncology 22:1843–1848.  https://doi.org/10.1002/pon.3228 CrossRefPubMedGoogle Scholar
  20. 20.
    Chen AM, Jennelle RL, Grady V, Tovar A, Bowen K, Simonin P, McCrudden D, Stella JR, Vijayakumar S (2009) Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 73:187–193.  https://doi.org/10.1016/j.ijrobp.2008.04.010 CrossRefPubMedGoogle Scholar
  21. 21.
    Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The MINI International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 59(Suppl. 20):22–33PubMedGoogle Scholar
  22. 22.
    Ferrando L, Bobes J, Gibert J, Soto M, Soto O (2000) MINI. International Neuropsychiatric Interview. Spanish version 5.0.0. DSM-IV. Spanish translation by Franco-Alfonso L. December 2000. http://www.academia.cat/
  23. 23.
    Folstein CB, Folstein SE, McHugh, PR (2002) MMSE. Examen Cognoscitivo Mini-Mental. Translation and adaptation to Spanish: Lobo A, Saz P, Marcos G and Grupo ZARADEMP, TEA Ediciones, MadridGoogle Scholar
  24. 24.
    Karnofsky D, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205Google Scholar
  25. 25.
    Caro I, Ibáñez E (1992) La escala hospitalaria de ansiedad y depresión: su utilidad práctica en Psicología de la Salud [Hospital Anxiety and Depression Scale (HADS): review in Spanish samples.] Bol Psicol 36:43–69Google Scholar
  26. 26.
    Mitchell AJ (2011) Sensitivity × PPV is a recognized test called the clinical utility index (CUI+). Eur J Epidemiol 26:251–252CrossRefPubMedGoogle Scholar
  27. 27.
    Grassi L, Sabato S, Rossi E, Marmai L, Biancosino B (2009) Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD-10 data and performance of the distress thermometer from the Southern European Psycho-Oncology Study (SEPOS). J Affect Disord 114:193–199.  https://doi.org/10.1016/j.jad.2008.07.016 CrossRefPubMedGoogle Scholar
  28. 28.
    Grassi L, Travado L, Moncayo FL, Sabato S, Rossi E, SEPOS Group (2004) Psychosocial morbidity and its correlates in cancer patients of the Mediterranean area: findings from the Southern European Psycho-Oncology Study. J Affect Disord 83:243–248CrossRefPubMedGoogle Scholar
  29. 29.
    Schellekens MP, van den Hurk DG, Prins JB, Molema J, van der Drift MA, Speckens AE (2016) The suitability of the Hospital Anxiety and Depression Scale, distress thermometer and other instruments to screen for psychiatric disorders in both lung cancer patients and their partners. J Affect Disord 203:176–183.  https://doi.org/10.1016/j.jad.2016.05.044 CrossRefPubMedGoogle Scholar
  30. 30.
    Beck KR, Tan SM, Lum SS, Lim LE, Krishna LK (2016) Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: screening cancer patients for distress, anxiety and depression. Asia Pac J Clin Oncol 12:e241–e249.  https://doi.org/10.1111/ajco.12180 CrossRefPubMedGoogle Scholar
  31. 31.
    Ryan DA, Gallagher P, Wright S, Cassidy EM (2012) Sensitivity and specificity of the distress thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a ‘help’ question for psychological distress and psychiatric morbidity in patients with advanced cancer. Psychooncology 21:1275–1284.  https://doi.org/10.1002/pon.2042 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Facultad de PsicologíaUniversidad Complutense de Madrid, Campus de SomosaguasMadridSpain
  2. 2.Psycho-oncology Unit, Psychiatry ServiceBasurto University Hospital, OSI Bilbao-BasurtoBilbaoSpain

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