BACKGROUND AND AIM. We at Cork University Hospital's psycho-oncology service were interested in examining the relationship between psychological ...
Can Psychological Distress be Predicted by Different Cancer Types? 1
1
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Clianna Lavelle , Muhammad Fahmi Ismail , Kieran Doherty , 1 1 2 3 Michele Hill , Ann Bowler , Mas Mahady Mohamad , Eugene M Cassidy 1) South Lee Mental Health Service, Cork University Hospital, Wilton, Cork, Ireland 2) Graduate Entry Medical School, University of Limerick, Limerick, Ireland 3) Department of Psychiatry, College of Medicine and Health, University College Cork, Ireland
BACKGROUND AND AIM We at Cork University Hospital's psycho-oncology service were interested in examining the relationship between psychological distress and different cancer types using the Distress Thermometer screening tool. Previous work in this area (1) suggests that cancer patients may exhibit varying levels of subjective distress according to different types of cancer, from breast to prostate (2). A number of studies have hypothesised that psychological distress can be predicted according to cancer site and may also be associated with poorer global health outcomes (3,4).
METHODS
RESULTS
Data was collected from consecutive referrals to the psycho-oncology liaison service in CUH from 2006 to 2014. The following data was collected: demographics, cancer diagnosis, referral reason and mental health diagnosis. Subjective distress was routinely measured using the Distress Thermometer (DT). Data was analysed using Pearson's Chi-square test, Cramer's V and logistic regression.
Over 8 years, we received a total of 2002 patient referrals, of whom 1781 were assessed. 59% (n=1058) were female and 41% (n=723) were male. (table 1) The mean age was 56 years old (S.D=13.6).
Table 1 - Results 1.1 Demographic details
n
%
1.4 Reason of Referral
n
%
Male
723
40.6
Low mood
504
28.3
Female
1058
59.4
Anxiety / insomnia
423
23.8
Mean age = 56 (18-88)
Poor coping / distress
352
19.8
Mean age SD=13.6
Past psychiatric history
217
12.2
Others
285
16.0
1.2 Referral Source
n
%
Medical oncology
550
30.9
Radiation oncology
390
21.9
1.5 DT Score
n
%
Haematology
301
16.9
DT Score 5 or less
293
16.5
Breast care CNS
97
5.4
DT Score more than 5
899
50.5
Surgical team
94
5.3
Undisclosed
589
33.1
Oncology liaison nurse
84
4.7
Others
265
14.9
1.6 Mental Health Diagnosis
n
%
No mental health diagnosis
679
38.1
1.3 Cancer Diagnosis
n
%
Adjustment disorder
367
20.6
Breast cancer
421
23.6
Mood disorder
206
11.6
Haematological malignancies
391
22.0
Steroid induced mental disorder
123
6.9
Lung & thoracic
230
12.9
Anxiety disorder
115
6.5
GIT malignancies
211
11.8
Cognitive impairment
93
5.2
Genital malignancies
188
10.6
Organic disorder
83
4.7
Others
340
19.1
Others
115
6.5
REFERENCES 1. Zabora J et al. The Prevalence of Psychological Distress by Cancer Site. Psychooncology 2001; 10 (1):19-28. 2. Admiraal JM et al. Do Cancer and Treatment Types affect Distress? Psychooncology 2013; 22 (8); 1766-73. 3. Linden W et al. Psychological Treatment Outcomes for Cancer Patients: What do Meta-analyses tell us about Stress Reduction? Psychooncology 2012; 21 (4):343-350. 4. Vordermaier A et al. Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments. J Natl Cancer Inst 2009; 100 (21): 1464-1488.
The most common cancer diagnosis was breast (n=421), followed by haematological malignancies (n=391). The most common reason of referral was low mood (28%, n=504) followed by anxiety (24%, n=23.8) and poor coping (20%, n=352). Out of 1781, 67% of patients (n=1192) completed the DT questionnaire, with 51% (n=899) scoring >5. 62% (n=1102) was diagnosed with mental health disorder. The most common diagnosis was adjustment disorder (21%, n=367) followed by mood disorder (12%, n=206) and steroid-induced mental disorder (75, n=123). Breast and reproductive cancers were associated with a higher distress score (p= 0.01). However, when adjusted for age and gender, we found that no significant association exists between types of cancer and a diagnosis of mental health disorder as measured by the Distress Thermometer.
CONCLUSION Our study found no significant link between perceived levels of subjective distress and cancer site when age and gender were controlled for. According to our logistic regression analysis, only 6.5% of the variance in patients' distress levels could be explained by the variables included in this model. However, this study has demonstrated that age and gender can in fact predict higher distress scores, with women and younger patients scoring higher on the DT than their counterparts.
