title: Psychological distress in cancer from survivorship to end of life care: prevalence, associated factors and clinical implications.
abstract: OBJECTIVE
  Understanding how psychological distress changes over the cancer trajectory is essential to target interventions and care, but is little researched because of difficulties in conducting longitudinal studies. We aimed to determine the prevalence of psychological distress, its associated factors and clinical implications at three different stages in the cancer trajectory.
  
  
  METHODS
  Cancer patients from cancer outpatients (n=200), the general community (n=364) and specialist palliative care (n=150) were included. Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12). Associated factors and clinical prognostic value were investigated using logistic regression and Cox regression.
  
  
  RESULTS
  Overall prevalence of psychological distress was 24.5% (95% CI: 18.5-30.5%) in cancer outpatients during or soon after treatment, 16.5% (95%CI: 12.7-20.3%) in the general community and rose to 59.3% (95%CI: 51.4-67.2%) in specialist palliative care. Cancer type was the best predictor for psychological distress in both specialist palliative care (PR(prostate cancer versus other cancers)=5.61; 95%CI: 1.21-26.04; p=0.008) and general community samples (PR(lung cancer versus other cancers)=3.64; 95%CI: 1.08-12.35; p=0.003). Higher scores on GHQ-12 items predicted shorter survival in palliative care patients and showed weak protective or no association with survival in cancer outpatients.
  
  
  CONCLUSIONS
  Patients undergoing oncological treatment and then again as they approaching death have increased levels of psychological distress. Assessing psychological distress through survivorship and especially at these times may identify unmet psychological needs and allow targeted psychological support.
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, King's Healthcare Partners, Weston Education Centre, 3rd Floor, Cutcombe Road, Denmark Hill, London SE5 9RJ, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Michael I
authors.initials: MI
authors.lastname: Bennett
authors.forename: Daniel
authors.initials: D
authors.lastname: Stark
authors.forename: Scott
authors.initials: S
authors.lastname: Murray
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010166:Palliative Care; D015995:Prevalence; D013315:Stress, Psychological / Q000401:mortality*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*