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Study of Anxiety Disorder and Depression in Long-Term Survivors of Testicular Cancer

From the Department of Clinical Cancer Research, The Norwegian Radium Hospital; Departments of Oncology and Psychiatry, Ullevaal University Hospital, University of Oslo, Oslo; Research Centre for Health Promotion, University of Bergen; Department of Oncology, Haukeland University Hospital, Bergen; Department of Oncology, University Hospital of Northern Norway, University of Tromsø, Tromsø; and Department of Oncology, Saint Olav's Hospital, National University for Science and Technology, Trondheim, Norway

Address reprint requests to Alv A. Dahl, MD, PhD, The Norwegian Radium Hospital, N-0310 Oslo, Norway; e-mail: alvd{at}ulrik.uio.no

PURPOSE: To increase our knowledge of the prevalence of anxiety disorder and depression in long-term testicular cancer survivors (TCSs), and to identify variables associated with such caseness.

PATIENTS AND METHODS: Participants were 1,408 TCSs treated between 1980 and 1994 in Norway. Participants provided information about their medical, social, and familial situation on a questionnaire. They also completed the Hospital Anxiety and Depression Scale (HADS). Anxiety disorder and depression were defined by a score 8 on the HADS subscales. The prevalence rates were compared with age-adjusted norm data.

RESULTS: HADS-defined anxiety disorder was more prevalent in TCSs (19.2%; 95% CI, 17.2% to 21.3%) than in the norm sample (13.5%; 95% CI, 13.1% to 13.9%; P < .001), whereas the prevalence of HADS-defined depression did not differ from the norm (TCSs, 9.7%; 95% CI, 8.1% to 11.2% v norm, 10.1%, 95% CI, 9.5 to 10.5; P = .56). The relative risk for anxiety disorder was 1.49 (95% CI, 1.31 to 1.69) and for depression the relative risk was 0.96 (95% CI, 0.81 to1.14) in TCSs compared with norm. In multivariate analyses, HADS-defined anxiety disorder in TCSs was associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, relapse anxiety, and having been treated for mental problems.

CONCLUSION: Long-term TCSs have an increased risk of HADS-defined anxiety disorder that warrants clinical attention. Checking easily available demographic and TC-related data and use of a simple screening test such as HADS assists the identification of TCSs with anxiety disorder.

Supported by grants from The Norwegian Cancer Association, and Health & Rehabilitation Inc.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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