Design and participants: Cross-sectional survey of 863 adults diagnosed with a new histologically confirmed cancer (local or metastatic) between 1 April and 30 November 1997 and still alive in 2002, living in NSW, able to read and understand English adequately, physically and mentally capable of participating, and aware of their cancer diagnosis, who were randomly selected from the New South Wales Central Cancer Registry.
Main outcome measures: Prevalence of anxiety and depression assessed by the Hospital Anxiety and Depression Scale; and factors (patient, disease, and treatment characteristics; coping style; social support) predicting clinical or borderline levels of anxiety and depression.
Results: Levels of anxiety and depression were low; only 9% of participants reported clinically important levels of anxiety and 4% reported depression. The strongest predictive factors of borderline or clinical anxiety were previous treatment for psychological illness, maladaptive coping styles (helplessness–hopelessness, anxious preoccupation) and poor social support. Borderline or clinical depression was most strongly predicted by previous treatment for psychological illness, being an invalid pensioner, maladaptive coping style (helplessness–hopelessness) and poor positive social interaction.
Conclusions: By 5 years after diagnosis, most survivors had adjusted well to their cancer experience, with levels of anxiety and depression similar to those of the general population. Nevertheless, a small and important group of long-term survivors continue to experience adverse psychological effects and need assistance. Monitoring of psychological wellbeing and referring patients when appropriate need to be integrated into routine care for cancer survivors.
- 1. Australian Institute of Health and Welfare and Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2006. Canberra: AIHW, 2004. (AIHW Catalogue No. CAN 32. Cancer Series No. 37.) http://www.aihw.gov.au/publications/can/ca06/ca06.pdf (accessed Feb 2009).
- 2. National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Sydney: National Breast Cancer Centre, 2003.
- 3. Australian Bureau of Statistics. National health survey: summary of results, 2004–05. Canberra: ABS, 2006. (ABS Cat. No. 4364.0.) http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/3B1917236618A042CA2571 1F00185526/$File/43640_2004-05.pdf (accessed Feb 2009).
- 4. Murray M, McMillan CL. Gender differences in perceptions of cancer. J Cancer Educ 1993; 8: 53-62.
- 5. Helgeson VS, Tomich PL. Surviving cancer: a comparison of 5-year disease-free breast cancer survivors with healthy women. Psycho-oncology 2005; 14: 307-317.
- 6. Wettergren L, Björkholm M, Axdorph U, Languis-Eklöf A. Determinants of health-related quality of life in long-term survivors of Hodgkin’s lymphoma. Qual Life Res 2004; 13: 1369-1379.
- 7. Ganz PA, Rowland JH, Desmond K, et al. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 1998; 16: 501-514.
- 8. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-370.
- 9. Bjelland I, Dahl A, Tangen Haug T, et al. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52: 69-77.
- 10. Hermann C. International experiences with the Hospital Anxiety and Depression Scale — a review of validation data and clinical results. J Psychosom Res 1997; 42: 17-41.
- 11. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991; 32: 705-714.
- 12. Watson M, Law M, dos Santos M, et al. The mini-MAC: further development of the mental adjustment to cancer scale. J Psychosoc Oncol 1994; 12: 33-46.
- 13. Hosmer DW, Lemeshow S. Applied logistic regression. New York: John Wiley & Sons, 1989.
- 14. Crawford JR, Henry JD, Crombie C, et al. Brief report. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 2001; 40: 429-434.
- 15. Australian Bureau of Statistics. Mental health and wellbeing: profile of adults, Australia. Canberra: ABS, 1998. http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/CA25687100069892CA25688900233CAF/$File/43260_1997.pdf (accessed Feb 2009).
- 16. Smith DP, Supramaniam R, King M, et al. Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol 2007; 25: 2560-2566.
- 17. Girgis A, Boyes A, Sanson-Fisher RW, et al. Perceived needs of women diagnosed with breast cancer: rural versus urban location. Aust N Z J Public Health 2000; 24: 166-173.
- 18. Ayanian J, Jacobsen P. Enhancing research on cancer survivors. J Clin Oncol 2006; 24: 5149-5153.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.