title: Anxiety and depression in oncology patients; a longitudinal study of a screening, assessment and psychosocial support intervention.
abstract: BACKGROUND
  Anxiety and depression in cancer patients are associated with poor health-related quality of life (HRQOL). Clinical interventions to detect and support patients with these symptoms need to be developed and evaluated. We investigated the feasibility of screening with the Hospital Anxiety and Depression Scale (HADS) in a clinical oncology setting. In patients with anxiety or depression symptoms (HADS >7) we explored the use of clinical assessment and psychosocial support and described the development of anxiety, depression and HRQOL during a six-month period.
  
  
  METHODS
  Four hundred and ninety-five consecutive patients were screened for anxiety and depression at the time of their first visit at an oncology department (baseline). Half of the patients with HADS >7 on any of the two HADS subscales were referred to clinical assessment and psychosocial support (intervention group, IG) and half received standard care (SCG) using a historical control group design. HADS and EORTC QLQ-C30 were completed at baseline and after one, three and six months.
  
  
  RESULTS
  One hundred and seventy-six (36%) of 495 patients had anxiety or depression symptoms at screening, HRQOL at baseline was clearly impaired for them. Thirty-six (43%) of 84 IG patients attended clinical assessment, resulting in subsequent psychosocial support for 20 (24%) of them. In the SCG, only five (5%) patients attended clinical assessment after self referral, two received subsequent psychosocial support. Anxiety and depression decreased and HRQOL increased statistically significantly over time although anxiety was frequent and HRQOL impaired during the entire six month period. There were no differences between the SCG and IG regarding anxiety, depression or HRQOL at any time point.
  
  
  CONCLUSIONS
  Systematic screening with HADS is feasible for oncology patients in clinical settings; it identifies patients with persistent symptoms and increases referral to clinical assessment and utilisation of psychosocial support.
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden. annika.thalen-lindstrom@onkologi.uu.se
authors.forename: Annika
authors.initials: A
authors.lastname: Thalén-Lindström
authors.forename: Gunnel
authors.initials: G
authors.lastname: Larsson
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Birgitta
authors.initials: B
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000628:therapy*; D016022:Case-Control Studies; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D012944:Social Support; D013548:Sweden; D055815:Young Adult