How cancer care may be affected by depression, anxiety

A study by the Cancer Aging Research Group, which includes Upstate’s Ajeet Gajra, MD, examined the relationship between age, anxiety and depression in older adults with cancer.

Some facts:

More than half of all cancer diagnoses and almost three quarters of cancer deaths occur in patients older than 65.

Depression and anxiety are associated with poorer treatment outcomes, reduced ability to make treatment decisions, decreased adherence to lengthy treatment and longer hospital stays and suicide.

The study:

Researchers looked at data collected on 500 men and women age 65 and older who were about to start chemotherapy. The patients were recruited from outpatient oncology practices between November 2006 and November 2009. To assess their anxiety and depression levels, patients answered a 14-item validated tool survey called the Hospital Anxiety and Depression Scale.

The results: anxiety was apparent in 21 percent, and depression was apparent in 13 percent. Researchers compared those results with patient ages, genders, stages of cancer, education levels, social support and other medical problems.

Findings

–about depression:

People with an advanced stage of cancer were likely to have a higher level of depression.

Researchers found that depression was more likely in older patients who had multiple medical problems, poor social support and advanced cancer. They determined that screening or assessing such patients for depression is important. And, they suggest interventions that reduce loneliness and isolation could help.

–about anxiety:

As age increased, anxiety levels decreased. Some possible reasons why: Older adults 1. are more likely to take life on a day-by-day basis, 2. have learned to adapt to their strengths and weaknesses, 3. may have developed better emotional regulation and the ability to cope with life’s challenges, 4. are at a stage of life where they are focused on making peace with their lives, and 5. may benefit from a shortened time perspective, allowing them to concentrate on what matters at the moment.

–about anxiety and depression:

People who lack social support were likely to have higher levels of anxiety and depression.

People with multiple medical problems were likely to have higher levels of anxiety and depression.

At Upstate:

A dedicated social worker and a psychiatrist who specializes in oncology are available at the Upstate Cancer Center. Both of these people can help mediate problems associated with depression and anxiety.

In addition, the Cancer Center helps reduce the stress for patients by offering:

  • services for cancer care located within the same building;
  • multidisciplinary care that allows patients to meet with each member of their care team in a single afternoon; and
  • customized care, which means caregivers consider the social effects of various treatment regimens as they make recommendations.

Gajra impresses upon medical students and colleagues the importance of screening patients for depression and anxiety and treating them appropriately, since both can impact cancer treatment.

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