More Evidence That Patients With Cancer Need Careful Monitoring for Distress

Anja Mehnert, PhD

A new study has found that nearly one third of cancer patients suffer from anxiety or other mental health challenges, with breast cancer patients, head and neck cancer patients and melanoma patients suffering the most.

The study, published in the October 6 issue of the Journal of Clinical Oncology, was the largest to date assessing mental and emotional health of patients with cancer.

"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," lead study author Anja Mehnert, PhD, a professor of psychosocial oncology at the University of Leipzig in Germany, said in a statement."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."

Researchers interviewed more than 2100 patients with cancer at inpatient and outpatient care centers in Germany and found that nearly one third of them experienced a clinically meaningful level of mental or emotional distress that meets the strict diagnostic criteria for mental disorders including anxiety and depressive and adjustment disorders.

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%).

"We have always assumed that the diagnosis of cancer is hard on our patients, but these findings indicate how common these feelings may be,” Don S. Dizon, MD, an ASCO expert, said in a statement. “They also stress the importance that providers keep in mind that mental health issues are common across cancer types."

For the study, researchers asked standardized questions in a face-to-face interview with 2141 patients with cancer (ages 18-75) in hospitals, outpatient cancer care centers, and rehabilitation centers across Germany. Interview answers were then immediately entered into a computer based-diagnostic program.

The test assessed various psychological symptoms over the previous 4-week period. Patients' diagnoses were classified according to the Diagnostic and Statistical Manual of Mental Disorders, the standard classification used by mental health professionals.

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). This prevalence is higher than in the general population, in which 18-20% are estimated to have a clinically meaningful mental disorder.

In the 4-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.

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.