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Anxiety Disorders in Cancer Patients: Their Nature, Associations, and Relation to Quality of Life

From the Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, and Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom.

Address reprint requests to D. Stark, MD, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Beckett St, Leeds LS9 7TF, United Kingdom; email: csjds{at}cancermed.leeds.ac.uk

PURPOSE: We aimed to estimate the prevalence and types of anxiety disorders diagnosed according to standardized criteria in cancer patients, to compare screening tools in detecting them, and to examine their demographic, oncologic, and psychosocial associations.

METHODS: In this cross-sectional observational study of 178 subjects with lymphoma, renal cell carcinoma, malignant melanoma, or plasma cell dyscrasia, we related responses to questionnaires (administered by computer touch-screen) measuring psychological symptoms, quality of life (QOL), and social support to standardized psychiatric interviews and cancer management.

RESULTS: Forty-eight percent of subjects reported sufficient anxiety for anxiety disorder to be considered. At subsequent diagnostic interview, 18% fulfilled International Classification of Disorders, 10th Revision criteria for anxiety disorder, including 6% of patients who reported low levels of anxiety by questionnaire. When subjects reported anxiety by questionnaire, if disruptive somatic anxiety was present, this increased the probability of diagnosable anxiety disorder from .31 to .7. The most accurate screening questionnaires were the trait scale of the State-Trait Anxiety Inventory and the Hospital Anxiety and Depression scale. Female sex and negative aspects of social support were associated with anxiety disorder in multivariate analyses. Anxiety disorder was independently associated with a deficit in QOL, particularly insomnia.

CONCLUSION: Anxiety symptoms are common in cancer patients. Screening by questionnaire seems to assess anxiety symptoms adequately but discriminates abnormal anxiety inadequately. To improve this, we may need to use criteria such as disruption from anxiety, as illustrated by the impact of anxiety disorders on QOL. There seem to be few oncologic variables that could target screening for anxiety disorders.

The software was designed by A.S., who can be contacted for further information at the Cancer Research UK Clinical Centre at Leeds, Leeds, United Kingdom.

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