Objective: The primary objective of this study was to determine the frequency of screening instrument-detected depression and anxiety in outpatients on initial presentation to a consultation psychiatric oncology clinic. The secondary objectives were to identify characteristics associated with depression and anxiety among these patients, and to determine the optimal cut-off score for the ESAS-Anxiety (ESAS-A) and ESAS-Depression (ESAS-D) items, using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale (GAD-7) as a gold standard in cancer patients.
Methods: A retrospective chart review was conducted for 1221 consecutive cancer patients seen in the Psychiatric Oncology Center as an initial consult between June 1, 2014 and January 31, 2017.
Results: When the cutoff was 10 for the PHQ-9 and the GAD-7, 60% of patients self-reported depression and 51% self-reported anxiety. When the cutoff was 15 (severe symptom) for the PHQ-9 and GAD-7, approximately 30% and 27% of the patients had severe depression or anxiety, respectively. Age and gender were found to be associated with anxiety. An ESAS cutoff value of ≥3 for depression and ≥5 for anxiety resulted in sensitivity of 0.84 and 0.85 when using PHQ 9 ≥ 10 for depression and GAD 7 ≥ 10 for anxiety, respectively.
Conclusions: Self-reported depression and anxiety are frequent symptoms among patients at a psychiatric oncology center for an initial visit. ESAS-A and ESAS-D have good sensitivity for anxiety and depression screening of cancer patients.
Keywords: ESAS; Edmonton symptom assessment system; GAD-7; PHQ-9; anxiety; cancer; depression; distress screening; oncology; psycho-oncology.
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