title: Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis.
abstract: BACKGROUND
  Undergoing diagnostic evaluation for cancer has been associated with a high prevalence of anxiety and depression and affected health-related quality of life (HRQoL). The aims of this study were to assess HRQoL, anxiety, and depression pre- and post-diagnosis in patients undergoing diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors.
  
  
  METHODS
  A prospective, multicenter survey study of patients suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus patients with non-cancer diagnoses were calculated. The impact of baseline psychological, socio-demographic, and medical factors on HRQoL, anxiety and depression at follow-up was explored by bootstrapped multivariate linear regression analyses and logistic regression analyses.
  
  
  RESULTS
  A total of 838 patients participated in this study; 679 (81 %) completed the follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of the follow-up. Patients presented initially with a high burden of symptoms and affected role and emotional functioning and global health/QL, irrespective of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis. There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self-rated health.
  
  
  CONCLUSIONS
  Patients undergoing diagnostic evaluations for cancer based on non-specific symptoms experience a high prevalence of anxiety and affected quality of life prior to knowledge of the diagnosis. The predictive value of the baseline scores is important when assessing the psychological impact of undergoing diagnostic evaluations for cancer.
authors.affiliation: Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Nordsjælland, Dyrehavevej 29, DK - 3400, Hillerød, Denmark. elar0073@regionh.dk.
authors.forename: Ellen
authors.initials: E
authors.lastname: Moseholm
authors.affiliation: Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, and Department of Public Health, Section for Nursing, Aarhus University, Bispebjerg Bakke 23, 20D, Copenhagen, NV, DK- 2400, Denmark.
authors.forename: Susan
authors.initials: S
authors.lastname: Rydahl-Hansen
authors.affiliation: Department of Nursing, Metropolitan University College, Tagensvej 86, Copenhagen, N, DK - 2200, Denmark.
authors.forename: Dorthe
authors.initials: D
authors.lastname: Overgaard
authors.affiliation: Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Nordsjælland, Dyrehavevej 29, DK - 3400, Hillerød, Denmark.
authors.forename: Hanne S
authors.initials: HS
authors.lastname: Wengel
authors.affiliation: Department of Endocrinology, Copenhagen University Hospital, Herlev, Herlev Ringvej 75, Building 64, Herlev, DK-2730, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Frederiksen
authors.affiliation: Department of Gastroenterology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 60, Copenhagen, NV, DK- 2400, Denmark.
authors.forename: Malene
authors.initials: M
authors.lastname: Brandt
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, Department 144, Hvidovre, DK- 2650, Denmark.
authors.forename: Bjarne Ø
authors.initials: BØ
authors.lastname: Lindhardt
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D003718:Denmark; D003863:Depression / Q000523:psychology*; D003955:Diagnostic Tests, Routine / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Anxiety; Cancer; Depression; Health-related quality of life; Oncology; Pre-diagnosis