ATLANTA – Anxiety, depression, and pain are often overlooked in older cancer survivors, according to results of a study presented at the annual meeting of the American Society of Clinical Oncology.
In this study of 150 men who had been diagnosed with cancer an average of 3 years prior, pain, anxiety, and depression were common, occurring in 64%, 26%, and 21% of men, respectively, according to prospective analysis of responses to a questionnaire.
Despite the high frequency of these issues, in many cases, oncologists did not discuss pain and well-being with their patients. According to blinded chart reviews, oncologists did not inquire about pain in 22% of the men. Inquiries about mental health were more infrequent: 95% of men were not asked about anxiety, and 88% of men were not asked about depression.
Because of this failure to inquire about pain and mental health, a significant proportion of men with each condition was overlooked, including 18% of men with pain, 85% with anxiety, and 75% with depression.
In an interview during his poster presentation, Dr. Harvey Jay Cohen said this information is very relevant for primary care physicians. “People need to be aware that cancer survivors, older ones at least, not infrequently are anxious and showing signs of depression,” said Dr. Cohen, professor and interim chair in the department of medicine and director of the Center for the Study of Aging and Human Development at Duke University Medical Center in Durham, N.C. “That's something people at least need to inquire about.”
In the study, Dr. Cohen and his colleagues evaluated 153 male patients who visited a single oncology clinic at a Veterans Affairs Medical Center. The men filled out questionnaires reporting pain using the pain thermometer and mental health using the Hospital Anxiety and Depression Scale.
The patients averaged 68 years old, and 40% were African American. Most of the men (64%) were married, though 22% lived alone. They had, on average, about five comorbidities. The most common cancers involved were prostate (47%), head and neck (19%), and lung (12%).
A total of 147 men were evaluable for the pain component of the study, 128 for anxiety, and 136 for depression, based on the presence of responses to each segment of the evaluation and available chart information.
The investigators looked for any notes about mood, anxiety, depression, other psychological or psychiatric conditions, notes about treatment, and suggestions for psychiatric referrals in the chart. They analyzed a 3-month period of charts to rule out that they had not overlooked the appointment where the issues were discussed.
“We looked for anything that in the chart would've indicated that [the oncologist] had noticed anything–they said something, treated the patients–we took absolutely anything,” Dr. Cohen said.