|Year : 2018 | Volume
| Issue : 6 | Page : 1312-1315
Assessment of spectrum of mental disorders in cancer patients
PU Prakash Saxena1, Vaman Kulkarni2, Rekha Thapar2, Keshva Pai3, Ayushi Gupta4, Himani Kotian5
1 Department of Radiotherapy and Oncology, Kasturba Medical College, Mangalore, Karnataka, India
2 Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India
3 Department of Psychiatry, Kasturba Medical College, Mangalore, Karnataka, India
4 Kasturba Medical College, Mangalore, Karnataka, India
5 Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Mangalore, Karnataka, India
|Date of Web Publication||28-Nov-2018|
P U Prakash Saxena
Department of Radiotherapy and Oncology, Kasturba Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Cancer is one of the leading causes of disability worldwide. The psychological factors that significantly affect the functioning of the cancer patients are anxiety, depressive disorders, and somatization.
Aims: To find out the spectrum of psychological disorders in cancer patients, also to find the association between sociodemographic variables and stage of tumor, treatment modality with the various psychological problems among cancer patients.
Settings and Design: This cross-sectional study was carried out among cancer patients undergoing treatment in our institution.
Subjects and Methods: Patient Health Questionnaire (PHQ)-somatization, anxiety, depression screeners is a prevalidated standard questionnaire which is a combination of PHQ-9, generalized anxiety disorder 7, and PHQ-15 plus panic measures from original PHQ. This questionnaire was given to patients and assessed later.
Statistical Analysis: The association between variables of interest is tested using Chi-square test. P < 0.05 is be considered statistically significant. The data were analyzed using SPSS version 16 (SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
Results: Patients suffered from depression and also from other psychiatric morbidities. There was significant association among residential addresses and various scale (P < 0.05), PHQ-9 was maximum among radiotherapy patients (P = 0.04). PHQ-15 had association with stage of cancer (P = 0.007).
Conclusion: Psychological problems are highest among patients from rural areas and among female patients compared to male. Highest anxiety and somatization was found among patients in Stage II cancer and depression in Stage IV cancer. Among treatment modalities, highest anxiety was found among patients under chemotherapy treatment, somatization among patients under both chemotherapy and radiotherapy, and depression among patients under radiotherapy treatment.
Keywords: Anxiety, Patient Health Questionnaire-somatization; anxiety; depression screeners, somatization
|How to cite this article:|
Prakash Saxena P U, Kulkarni V, Thapar R, Pai K, Gupta A, Kotian H. Assessment of spectrum of mental disorders in cancer patients. J Can Res Ther 2018;14:1312-5
| > Introduction|| |
Cancer is one of the leading causes of mortality. Contemporary psychooncology focuses on the study of the psychological determinants of the functioning of cancer patients to find the answers about ways of coping with the disease, helping the healing process, facilitating the establishment of a good therapeutic relationship, delaying the progression of the disease, and facilitating the process of adapting to difficult situations. Among the psychological factors that significantly affect the functioning of the patients are anxiety and depressive disorders. Depression has an adverse effect on the course of the illness, treatment and recovery process, the interaction of the patient during the treatment process, the selection of coping strategies, the type of relationships with people, and social support.
Anxiety disorders are quite common in oncological patients, especially during the diagnosis and the first stages of treatment. Trzebiatowska classifies the causes of anxiety reactions in patients with cancer into three groups: (1) Those associated with the cancer (the perception of cancer as an incurable disease, fear of suffering associated with the disease and its treatment, fear of pain, metastases, and premature death); (2) those associated with the treatment process (fear of chemotherapy, radiation therapy and surgery, fear of treatment side effects such as vomiting, weakness, hair loss, mutilation and disfigurement, potency, and sexual functioning disorders); and (3) those associated with social functioning and relationships with others (fear of worsening relations with the family, fear of loss of professional and social status, fear of isolation, and fear of lack of acceptance and social rejection).
The concept of mental adaptation to disease is based on the cognitive theory and transactional model by Lazarus and Folkman, which assumes that the stress experienced as a result of cancer is not only a result of the physical consequences of the disease but also the result of the cognitive assessment of a stressful situation. No regional study has been done regarding psychological problems in cancer patients. Moreover, no prior study has been done to assess the variety of disorders in cancer patients. Since cancer is common in our setting and psychological problems are generally neglected in our society; the present is undertaken to assess how psychological problems varies with stage of tumor and treatment modalities and also to assess these problems at an early stage in these patients so as to improve our health services and to ensure a better quality of life for these patients.
| > Subjects and Methods|| |
This is a cross-sectional study. The study was conducted among patients in our institute. The study was approved by the Institutional Ethics Committee. One hundred cancer patients were taken. Each patient was explained the purpose of the study, procedures, and consent was taken from patients then questionnaire was given, and this was assessed later.
Diagnosed cancer patients more than 18 years of age who were willing to participate in this study.
- Patients with preexisting psychological/psychiatric problems
- Patients with very advanced metastatic cancer
- Patients with poor performance score
- Patients not willing to sign the consent form.
Patient Health Questionnaire (PHQ)-somatization, anxiety, depression screeners - it is a prevalidated standard questionnaire which is combination of PHQ-9, generalized anxiety disorder 7 (GAD-7), and PHQ-15 plus panic measures from original PHQ. Over time, the severity scores have been particularly the popular use of the measures and are now used much more commonly than the provisional diagnoses. The cut points of 5, 10, and 15 represent mild, moderate, and severe levels of depressive, anxiety, and somatic symptoms, on the PHQ-9, GAD-7, and PHQ-15, respectively.
| > Results|| |
Among the profile of study population, 54 were males (54%) and 46 were females (46%). Of the total study population, 96 were married (96%) and 4 were unmarried (4%). Out of these 96, 87 had kids while 9 were married but without kids, 67 lived in rural areas (67%) while 33 lived in urban areas (33%). Participants were aged between 20 and 78 years. The mean age of the participants was calculated to be 52.83 years.
[Figure 1] represents the percentage of patients among the various sites of cancer. Out of total participants, having different cancers, 8 are in Stage I (8%), 29 are in Stage II cancer (29%), 29 are in Stage III (29%), and 34 are in Stage IV cancer (34%). Various different treatment modalities were used such as chemotherapy (21%), radiotherapy (28%), surgery (2%), or combination of the above. For PHQ-15 (anxiety), it was found that 51% of the study population was normal, 34% had mild anxiety, 10% had moderate, and 5% population had severe anxiety. For GAD-7 (somatization), it was found that 64% of the study population was normal, 28% had mild somatic disorder, 7% was moderate, and 1% population had severe somatic disorder. For PHQ-9 (depression), it was found that 29% of the study population was normal, 32% had mild depression, 31% was moderate, and 8% population had severe depression. For associations, we have considered positive as all mild, moderate, and severe for all the three categories.
Among association between marital status and various disorder, it was found that 67.85% (59) married people who had kids suffered from depressive disorder after having cancer while rest 32.2% were normal. Similarly, depression was found among 88.9% of married people but without kids, and all 4 (100%) of unmarried people showed signs of depression according to PHQ-9 scale. P value was found to be 0.177 which showed that association was not statistically significant. For somatic disorder (GAD), it was found that 36.8% (32) married people who had kids had somatic problems while rest 63.2% were normal. Similarly, somatic problems were found among 44.4% of married people but without kids, and all 4 (100%) of unmarried people showed no somatic problems. P value was found to be 0.279 which showed that association was not statistically significant. For PHQ-15, it was found that 48.3% (42) married people who had kids suffered from anxiety problems after having cancer while rest 51.7% were normal. 88.9% of married people but without kids showed anxiety problems and 1 (25%) out of the 4 unmarried people showed signs of anxiety according to PHQ-15 scale. P value was found to be 0.356 which showed that association was not statistically significant [Table 1].
|Table 1: Association of marital status with the scales (values are frequency and percentages)|
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For finding the association between various treatment modalities and various scales, above [Table 2] is made. For PHQ-15, maximum positive was found in those who were under chemotherapy treatment (57.1%). Totally, 49 are found positive that is showed anxiety. In these, however, no one was seen who underwent surgery, chemotherapy and surgery, or radiotherapy and surgery. P value is 0.277 which showed it is not statistically significant. For GAD-7, maximum positive was found those who were under both chemotherapy and radiotherapy treatment (43.5%). Totally, 36 are positive for somatic disorders. In these, however, no one was seen who underwent surgery, chemotherapy and surgery, or radiotherapy and surgery. P value is 0.367 which showed it is not statistically significant. For PHQ-9 that is for depression, maximum was found in those who were radiotherapy treatment (82.1%). Totally, 71 are positive for depressive disorders. 57.1% are found positive who were under chemotherapy alone, 78.3% were positive who were under both radiotherapy and chemotherapy treatment. P value is 0.04 which shows the association is statistically significant [Table 2].
|Table 2: Association of various treatment modalities with Patient Health Questionnaire-15, generalized anxiety disorder-7, Patient Health Questionnaire-9|
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For PHQ-15, maximum patients showing anxiety was found in Stage II cancer (62.1%). In these, only 1 (12.5%) was positive who was in Stage I, 9 (31%) in Stage III, and 21 (61.8%) people showed anxiety who were in Stage IV of the disease. P value is 0.007 which showed it is statistically significant result. For GAD-7, maximum patients showing somatic disorder were found in Stage II cancer (41.4%). In these, only 1 (12.5%) was positive who was in Stage I, 10 (34.5%) in Stage III, and 13 (38.2%) people showed anxiety who were in Stage IV of the disease. P value is 0.497 which showed it is not statistically significant. For PHQ-9, maximum patients showing depression was found in Stage IV cancer (79.4%). In these, only 3 (37.5%) was positive who was in Stage I, 20 (69%) in Stage II, and 21 (72.4%) people showed anxiety who were in Stage III of the disease. P value is 0.132 which showed it is not statistically significant [Table 3].
| > Discussion|| |
The study was undertaken with the hypothesis that there is a prevalence of a spectrum of psychological disorders among cancer patients, and these various disorders are associated with different stages of cancer, different treatment modalities used, and other sociodemographic variables such as age, gender, residence of the patients, and marital status. In our study, it was found out that cancer patients suffered from not only depression which is commonly thought but also from other psychiatric morbidities such as anxiety and somatic problems. Although the maximum percentage of people showed depression (71%) which was in accordance to the study which was conducted in the Medical university of Warsaw, Poland, on anxiety and depression in digestive system cancer patients where they found that low severity of depression was found among 79.7% of the patients and anxiety among 37.5% of the patients.
When association was tried to find between gender of the cancer patients and various psychiatric morbidities, it was found that anxiety, somatic problems, and depression were more among females which is in accordance with the national statistics. It was also seen that people living in rural areas suffer more from these disorders which is possibly due to late diagnosis of their disease, social stigma attached to these disorders, lack of proper health care facilities and also low monetary status. This was in contrast to a study which was conducted to find out different psychiatric problems in urban or rural areas where they found out more people suffering from depressive disorder are from urban areas. More studies need to be conducted to find out variability in various setups. On trying to find an association between the marital status of these people it was found that depression and anxiety were more common in people who are married but do not have kids. It is may be because having no kids is itself a factor which causes depression or anxiety. Also having kids give a sense of social support to the patient who helps him cope up better with the situation and disease. Unmarried on the other hand had higher levels of anxiety. It was similar to the study which showed that being married is favorable for survival of cancer patients. On finding an association between the various treatment modalities being used on the patient, it was found that highest anxiety was found among patients under chemotherapy treatment, somatization was found maximum among patients under both chemotherapy and radiotherapy, and depression was maximum among patients under radiotherapy treatment. It is probably due to the effects of drugs and radiations and the combined effect of both. When the association was tried to find between various stages of cancer, highest anxiety and somatization were found among patients in Stage II cancer and depression was maximum among patients in Stage IV cancer which was like the other studies, which were conducted which showed more depression among Stage IV cancer patients., Least was found among Stage I probably because of more hope of getting cured as they were diagnosed early.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]