One in Three People with Cancer Has Anxiety or Other Mental Health Challenges

•Results of a large study performed across cancer centers in Germany are being published online October 6, 2014 in the Journal of Clinical Oncology and show that 32% of people with cancer experienced some form of clinically relevant mental health challenge, such as anxiety, depressive and adjustment disorders. This prevalence is higher than in the general population, primarily due to a higher rate of anxiety and adjustment disorders.•Quote for attribution to Don Dizon, MD, American Society of Clinical Oncology Expert•Links to additional information on Cancer.Net, ASCO’s cancer information website

Researchers in Germany report that nearly a third of more than 2,100 patients with cancer interviewed at inpatient and outpatient care centers experienced a clinically meaningful level of mental or emotional distress that meets the strict diagnostic criteria for mental disorders including anxiety, depressive and adjustment disorders during the prior four weeks. The prevalence of these issues varied by cancer type. The highest prevalence was found among patients with breast cancer (42%) and head and neck cancer (41%), followed by malignant melanoma (39%). The lowest prevalence was seen among patients with prostate cancer (22%), stomach cancers (21%), and pancreatic cancer (20%). The study — the largest to date assessing the mental and emotional health of patients with cancer using a fully standardized, diagnostic face-to-face interview — is published in the October 6 issue of the Journal of Clinical Oncology.

"These findings reinforce that, as doctors, we need to be very aware of signs and symptoms of mental and emotional distress. We must encourage patients to seek evaluation, support, and treatment if necessary as there are long-term risks often associated with more severe, untreated mental health disorders. This research also sheds light on which patients we should watch more closely," said lead study author Anja Mehnert, PhD, a professor of psychosocial oncology at the University of Leipzig in Germany. "We also want to reassure patients who are struggling that they are not alone or unique, and that these mental and emotional challenges can be temporary, especially with effective psychological support or state-of-the-art mental health treatment."

Psychological support options may include individual, couples, family, and group psychotherapy, and relaxation therapy and imagery, among others, according to the authors.

The authors note that prior studies have reported elevated levels of distress among people with cancer, but they vary in quality due to small sample sizes, different diagnostic criteria and assessment standards, and an over-representation of women with breast cancer.

This multicenter study, funded by the German Cancer Aid, was coordinated by the University Medical Center Hamburg-Eppendorf; participating study centers included the University Medical Centers of Freiburg, Heidelberg, Leipzig, and Würzburg. Researchers asked standardized questions in a face-to-face interview with 2,141 patients with cancer (ages 18-75) in hospitals, outpatient cancer care centers, and rehabilitation centers in Germany. Interview answers were then immediately entered into a computer based-diagnostic program. The test assessed various psychological symptoms over the previous four-week period. Patients' diagnoses were classified according to the Diagnostic and Statistical Manual of Mental Disorders, the standard classification used by mental health professionals. Assessed patients had a range of cancer types, with the most common types being breast cancer (44%), prostate cancer (15%), and colorectal cancer (14%), and the average time since cancer diagnosis was 13.5 months. Fifty-one percent of the study participants were women.

The investigators found that 32% of patients experienced at least one clinically meaningful mental health issue (defined in the study as a mental health disorder) — a prevalence higher than in the general population, in which 18-20% are estimated to have a clinically meaningful mental disorder.

In the four-week period prior to the interview, 11.5% of patients experienced an anxiety disorder, 11% met the criteria for an adjustment disorder (a predominantly mixed anxiety-depressive syndrome that persisted for at least 4 weeks in response to a significant life change like cancer), and 6.5% had signs of a mood disorder (such as major depression).

The 11.5% rate of anxiety disorders -- such phobia, panic or generalized anxiety disorder -- was slightly higher than in the general population (9%), while the prevalence of other mental health diagnoses was similar to rates in the general population. It is likely that the prevalence of adjustment disorders (11%), which is rarely assessed in general population surveys, significantly contributed to the overall higher prevalence rate of mental disorders in this population of patients with cancer.

Dr. Mehnert noted that it was surprising that patients with a more treatable cancer, such as breast cancer, experienced more distress than people with cancers that are more challenging to treat, such as stomach and pancreatic cancers, and that more research is needed to interpret these findings. She stated that the findings can likely be generalized to patients in the United States because the prevalence of mental health diagnoses is similar between the two countries.

She and her colleagues will be publishing other studies in the future where patients' mental health is assessed over a period longer than four weeks. The findings of this study may be useful for planning future support programs for cancer patients, and can provide additional information to guide programs for people with specific cancer types.

Expert Perspective

Don S. Dizon, MD, ASCO expert

"We have always assumed that the diagnosis of cancer is hard on our patients, but these findings indicate how common these feelings may be. They also stress the importance that providers keep in mind that mental health issues are common across cancer types. Patients should be offered support as appropriate. It’s also important that our patients be aware of just how common distress is, and that help in managing a challenging situation is available for them and their families."

Helpful Links from Cancer.Net, ASCO’s cancer information website:• Anxiety• Depression• Managing Stress• Finding Support and Information

The Journal of Clinical Oncology is the tri-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world’s leading professional society representing physicians who treat people with cancer.

ATTRIBUTION TO THE JOURNAL OF CLINICAL ONCOLOGY IS REQUESTED IN ALL NEWS COVERAGE.

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