Clinically Significant Distress Seen in 12.6% of Cancer Patients

ANAHEIM, CALIF. – Serious psychological distress was identified in 12.6% of 4,168 cancer patients in a population-based sample, researchers reported at the annual meeting of the American Psychosocial Oncology Society.

The comparatively high rates of distress were seen in patients who were surveyed under the Centers for Disease Control and Prevention’s 2009 Behavioral Risk Factor Surveillance System (BRFSS), which used the Kessler-6 questionnaire to identify signs of anxiety, depression, hopelessness, and feelings of worthlessness.

Women, smokers, and patients with low rates of emotional support, perceived health status, and life satisfaction accounted for 28% of variance in nonsomatic distress among cancer patients in a multivariate regression model, said Eric Hanson, a graduate student in the department of psychology at Loma Linda (Calif.) University.

Significant univariate predictors of distress included all of those variables, plus lower education and income; lack of insurance; ethnicity (black or Hispanic vs. white); age (younger vs. older); and cancer type.

Female reproductive cancer, breast cancer, and a broad category of "other" cancers, including head and neck cancer, had the strongest associations with distress in the univariate analysis, reported Mr. Hanson.

Rates of emotional distress among cancer patients have been highly variable in the literature, largely because of a dearth of instruments that are specifically designed to look at psychological variables in cancer patients, explained Mr. Hanson during his podium presentation at the meeting.

"We are cobbling together what we can of psychosocial outcomes from surveys largely intended for other purposes," he said.

Some recent population-based studies have estimated that fewer than 6% of cancer patients experience clinically relevant distress. Rates of depression in cancer patients have ranged from 0% to 58% in various studies, whereas anxiety rates have been reported in 19%-61% of patients.

"We really need to pin this down," said Narineh Hartoonian, another graduate student involved in the study that was led by Jason E. Owen, Ph.D. "Depression rates ranging from 0% to 58% – that’s crazy."

Identification of distress and specific cancer populations who are at risk has taken on urgency as new findings point to links between depression and survival among cancer patients, Mr. Hartoonian noted in an interview.

Among those studies are the following:

• A meta-analysis of 31 prospective studies reported a 25% higher mortality rate among cancer patients with depressive symptoms, and a 39% higher mortality rate among those whose symptoms reached the threshold for a diagnosis of major depression ( Cancer 2009; 115:5349-61 ).
• A recent secondary analysis of a randomized trial in 101 women with metastatic breast cancer demonstrated a doubling of survival time (53.6 months vs. 25.1 months) among women whose depression symptoms decreased during the first year of treatment, compared with women whose symptoms increased ( J. Clin. Oncol. 2011; 29:413-20 ).

The researchers from Loma Linda University reported no relevant financial conflicts of interest.