Research reportAnxiety and depression among haematological cancer patients attending treatment centres: Prevalence and predictors
Introduction
Haematological cancers, which include myelomas, leukaemias and lymphomas, are estimated to account for 9% of all cancers in the economically developed world (Smith et al., 2011). While haematological cancers can occur at any age, the likelihood of a diagnosis increases markedly for individuals who are 50 years and over (Smith et al., 2011). Haematological cancer patients may require intensive periods of treatment, including those received as an inpatient such as autologous bone marrow transplants (Montgomery et al., 2002). Debilitating side effects of cancer treatment experienced by those with haematological malignancy include fatigue, neutropenia, infection, and nausea and vomiting (Ganz et al., 2003, Impact of Neutropenia in Chemotherapy-European Study Group, 2008, Montgomery et al., 2002, Mols et al., 2012). Some haematological cancers have a relapsing remitting course, which can have a significant impact on a person׳s family life, capacity to maintain employment and ability to plan for the future (Bellizzi et al., 2007).
In a recent study conducted by Linden and colleagues, anxiety and depression was examined among a mixed sample of cancer patients from two treatment centres. Of the 167 patients who had haematological cancer, rates of sub-clinical and clinical anxiety were 50% and 23%, respectively, and rates of sub-clinical and clinical depression were 38% and 17%, respectively (Linden et al., 2012). Past studies conducted with people with haematological cancers have reported rates of anxiety of between 20% (Santos et al., 2006) and 37% (Romito et al., 2008), and rates of depression of between 14% and 51% (Montgomery et al., 2003). However, these estimates of distress are limited due to the small sample sizes of these studies (Montgomery et al., 2003, Pulgar et al., 2012, Trask et al., 2002), or their lack of generalisability given that many studies have only recruited patients from one treatment centre (Santos et al., 2006, Romito et al., 2008, Akaho et al., 2003).
One large, population-based Australian study examined the prevalence of anxiety and depression in a sample of 1323 people with mixed cancer diagnoses recruited through two state cancer registries at six months post diagnosis (Boyes et al., 2011). Among the subgroup of haematological cancer patients (n=181), the reported rate of anxiety was 27%, depression 17%, and co-morbid anxiety and depression 11% (Boyes et al., 2011). While these data provide valuable information about the psychological wellbeing of patients at six months post diagnosis, it is unclear how relevant these findings are to patients who are receiving care in an outpatient setting.
Given that outpatient appointments provide an opportunity for detection and referral, accurate information about the prevalence of anxiety and depression among haematological cancer patients in this setting is vital to inform the development and delivery of appropriate services. Further, to facilitate identification of those at risk of poor psychological outcomes, up-to-date information about factors associated with increased odds of anxiety and depression among this population are needed.
This study aimed to: (1) estimate the prevalence of anxiety and/or depression among haematological cancer patients who were currently attending treatment centres; and (2) explore the demographic, disease, and treatment characteristics associated with anxiety and/or depression.
Section snippets
Design
The study involved a cross-sectional survey of haematological cancer patients attending three haematology outpatient clinics located in three different Australian states.
Clinic eligibility and selection
To ensure that a large and representative sample was obtained, clinics were eligible if they provided care to at least 300 adult haematological cancer patients per annum.
Patient eligibility and selection
Eligible patients were attending an outpatient appointment at a participating clinic during the recruitment period (October 2012 to March 2013), had a
Results
Of the 428 eligible haematological cancer patients identified, 386 (90%) consented to participate in the study. Three-hundred and four participants (71%) returned a completed questionnaire and were included in the analysis. Non-consenters were significantly more likely to be younger than consenters (p<0.0001).
Participant demographic, disease and treatment characteristics are presented in Table 1, Table 2. Over half of the participants were aged between 55 and 74 years (n=170, 56%) with a higher
Prevalence of anxiety, depression and co-morbid anxiety and depression
There are few international studies with samples large enough to provide robust estimates of the prevalence of anxiety and depression among haematological outpatients. Hence, the current study provides important data to inform psychosocial care for this population. The prevalence of anxiety (27%) and depression (17%) found is consistent with other studies recruiting similar patients from treatment centres (Romito et al., 2008, Santos et al., 2006, Montgomery et al., 2003). It is difficult to
Conclusions
Approximately 20% of haematological cancer patients attending outpatient clinics may be experiencing clinically significant levels of anxiety and/or depression. This risk appears to be higher for patients who have to relocate to receive treatment or who are former smokers. Clinical staff should be aware of these factors and monitor patients with these characteristics carefully. Early referral to mental health professionals, and provision of practical support may help to address anxiety and
Role of funding source
This research was supported by a Strategic Research Partnership Grant from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C), and infrastructure funding from the Hunter Medical Research Institute (HMRI). Dr Tara Clinton-McHarg was supported by a Leukaemia Foundation of Queensland Post-Doctoral Fellowship. Dr Flora Tzelepis was supported by a Leukaemia Foundation and Cure Cancer Australia Foundation Post-Doctoral Research Fellowship. These funding sources had no role the
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
The authors would like to thank Ms Alessandra Bisquera for assistance with data analyses and Dr Heidi Turon for research support.
References (28)
- et al.
Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis
J. Affect. Disord.
(2011) - et al.
Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age
J. Affect. Disord.
(2012) - et al.
Predicting psychological distress in patients with leukaemia and lymphoma
J. Psychosom. Res.
(2003) - et al.
Psychosocial adaptation and quality of life among Brazilian patients with different hematological malignancies
J. Psychosom. Res.
(2006) - et al.
Identifying psychological distress at key stages of the cancer illness trajectory: a systematic review of validated self-report measures
J. Pain Symptom Manage.
(2011) - et al.
Psychological factors and survival after bone marrow transplantation in patients with leukemia
Psychiatry Clin. Neurosci.
(2003) National Survey of Mental Health and Wellbeing: Summary of Results
(2008)Cancer in Australia: An Overview
(2012)- et al.
Positive and negative life changes experienced by survivors of non-Hodgkin׳s lymphoma
Ann. Behav. Med.
(2007) - et al.
Prevalence and predictors of the short-term trajectory of anxiety and depression in the first year after a cancer diagnosis: a population-based longitudinal study
J. Clin. Oncol.
(2013)