Cancer patient receiving

chemotherapy

Credit: Rhoda Baer

In a large German study, investigators found that nearly a third of cancer patients experienced some form of clinically relevant mental health

challenge.

Of the more than 2100 cancer patients interviewed, 32% had experienced a clinically meaningful level of mental or emotional distress in the previous 4 weeks.

This prevalence is higher than that observed in the general population, and the difference is primarily due to a higher rate of anxiety and adjustment disorders.

The incidence of mental health issues varied by cancer type. The highest was among patients with breast cancer (42%) and head and neck cancer (41%), followed by malignant melanoma (39%).

The lowest prevalence was seen among patients with prostate cancer (22%), stomach cancers (21%), and pancreatic cancer (20%).

These results appear in the Journal of Clinical Oncology.

“These findings reinforce that, as doctors, we need to be very aware of signs and symptoms of mental and emotional distress,” said lead study author Anja Mehnert, PhD, of the University of Leipzig in Germany.

“We must encourage patients to seek evaluation, support, and treatment if necessary, as there are long-term risks often associated with more severe, untreated mental health disorders. This research also sheds light on which patients we should watch more closely.”

Dr Mehnert and her colleagues conducted this study in 2141 cancer patients who were 18 to 75 years of age. The team conducted face-to-face interviews in hospitals, outpatient cancer care centers, and rehabilitation centers in Germany.

Interview answers were immediately entered into a computer based-diagnostic program. The test assessed various psychological symptoms over the previous 4-week period. Patients’ diagnoses were classified according to the Diagnostic and Statistical Manual of Mental Disorders, the standard classification used by mental health professionals.

The patients had a range of cancer types, with the most common being breast cancer (44%), prostate cancer (15%), and colorectal cancer (14%). The average time since cancer diagnosis was 13.5 months, and 51% of the participants were women.

The researchers found that 32% of patients experienced at least one clinically meaningful mental health issue (defined in the study as a mental health disorder). This is a higher prevalence than in the general population, in which 18% to 20% of people are estimated to have a clinically meaningful mental disorder.

In the 4-week period prior to the interview, 11.5% of patients experienced an anxiety disorder. Eleven percent met the criteria for an adjustment disorder, a predominantly mixed anxiety-depressive syndrome that persisted for at least 4 weeks in response to a significant life change. And 6.5% of patients had signs of a mood disorder such as major depression.

The 11.5% rate of anxiety disorders—such as phobia, panic, or generalized anxiety disorder—was slightly higher than in the general population (9%), while the prevalence of other mental health diagnoses was similar to rates in the general population.

It is likely that the prevalence of adjustment disorders (11%), which is rarely assessed in general population surveys, significantly contributed to the overall higher prevalence rate of mental disorders in this population of patients with cancer.

Dr Mehnert said it was surprising that patients with a more treatable malignancy, such as breast cancer, experienced more distress than people with cancers that are more challenging to treat, such as stomach and pancreatic cancers. So more research is needed to interpret these findings.

The investigators believe the study’s results may be useful for planning future support programs for cancer patients, and they can provide additional information to guide programs for people with specific cancer types.

The team also believes the findings can likely be generalized to patients in the US because the prevalence of mental health diagnoses is similar between the 2 countries.

Mental health challenges fairly common in cancer patients