Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer

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Abstract
BACKGROUND High levels of distress are a concern regarding patients with head and neck cancer. Early detection of and intervention for such distress are needed to predict patients' adaptation to treatment or rehabilitation, but few studies have investigated the detection of their distress in a patient population of significant size. METHODS The authors examined 107 consecutive patients with head and neck cancer to assess their psychologic distress (adjustment disorders or major depression) or other psychiatric problems by structured psychiatric interview before the initial cancer treatment. They also evaluated predictive factors for psychologic distress and assessed the ability of a self‐rating questionnaire (Hospital Anxiety and Depression Scale, HADS) to screen for distress. RESULTS Of 107 subjects, 18 (16.8%) had an adjustment disorder or major depression. Thirty‐six (33.6%), 7 (6.5%), and 35 (32.7%) met criteria for alcohol dependence, alcohol abuse, and nicotine dependence, respectively. Logistic regression analysis revealed that having advanced stage cancer (odds ratio, 5.77; 95% confidence interval [CI], 1.41–39.7; P = 0.03) and living alone (odds ratio, 4.83; 95% CI, 1.04–22.2; P = 0.04) were significantly associated with having psychologic distress. The optimal cutoff point for the HADS screening for psychologic distress was 15. This cutoff point gave 72.2% sensitivity and 81.4% specificity. CONCLUSIONS Head and neck cancer patients who have advanced disease or live alone should be assessed so that psychologic distress can be detected and intervention made. HADS is a useful clinical instrument to screen for their distress. Cancer 2000;88:2817–23. © 2000 American Cancer Society.