Journal Article Annotations
2022, 4th Quarter
Annotations by Barbara Lubrano di Ciccone, MD and R Garrett Key, MD
The Hospital Anxiety and Depression Scale (HADS) was administered to 7509 outpatients to determine the point prevalence of anxiety and depression among patients with different cancer types. Anxiety was present in 35% of patients; depression, in 28%. Every sixth patient was likely to have a psychiatric condition. Being female, elderly, or having lung or brain cancer were associated with anxiety or depression. The lowest rates of depression were found among patients with breast cancer.
Strength and weaknesses:
The authors did not control for cancer stage or treatment phase, including current or past chemotherapy or therapy response. Additionally, in the context of cancer, the use of screening instruments for depression and anxiety are often over-inclusive regarding a potential diagnosis, and the HADS has not been validated for brain cancers. As a single-centre study, the generalisability of results may be limited. Nevertheless, the large sample size of the present study should be emphasised as a strength. Using an unselected mixed cancer patient sample might reflect prevalence as actually encountered in an outpatient clinic, thus providing a realistic picture of the actual burden of outpatient cancer patients.
It is known that there is a high proportion of psychological burden in cancer patients. This article highlights the importance of ongoing screening for depression and anxiety in all cancer patients, particularly in patient with lung and brain cancers. There should be a low threshold for providing mental health services.
End-of-life (EOL) communication is relatively infrequent in the sample of nursing home medical personnel and also family members. Nursing home residents are generally willing to talk about EOL preferences but often assume that their end-of-life preferences are already known by either family or medical staff without explicit discussion. Their choices about EOL care are likely to be influenced by personal experiences around deaths to which they have been close. Provider-initiated conversations about EOL preferences may improve outcomes and decision making in this large vulnerable population.
Strength and weaknesses:
The strengths of this secondary analysis are that it includes a wealth of first-hand narrative statements from nursing home residents, staff, and family members around EOL communication preferences. Weaknesses include a small and local sample size from one institution in Florida and therefore unclear generalizability to other populations.
C-L Psychiatrists are often involved in the care of nursing home patients either in their residence, during acute medical hospitalization, and during transition events that can result in initial nursing home placement. This position offers opportunity to initiate or clarify discussions of EOL preferences to improve outcomes for patients and families as they navigate the later stages of life.