Recognition of anxiety and depression in gynaecological cancer using the HAD Score


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Hannah Kither2, Jacki Routledge1, Meriel Burns1, Ric Swindell1, Susan Davidson1

1Christie Hospital NHS Foundation Trust, Manchester, UK, 2Manchester Royal Infirmary, UK

Abstract

Background
Levels of psychological distress are significantly higher in cancer patients than in the general population. This study aimed to see if clinicians who were treating patients with radical radiotherapy for gynaecological cancers recognised psychological distress and identify factors that might influence this.

Method
Hospital Anxiety and Depression scale (HADs) scores for patients treated from 1988 -2006 were examined with the clinical notes to see if patients with high HADs scores were being recognised clinically. A retrospective group of 91 patients completed one questionnaire at least three years following treatment. The prospective group of 110 patients completed questionnaires pre- and post treatment and annually for 3 years.

Results
The HADs scores were significantly higher for the prospective patient group (anxiety p=0.018, depression p=0.038). In 28% of the total number of cases examined (56 of 201) the HADs score was indicative of significant anxiety or depression and only 12 (21%) of these patients with high scores were recognised clinically as defined by documentation of anxiety or depression in the clinical notes.

Conclusion
Anxiety and depression is poorly recognised and documented in patients undergoing radical radiotherapy and as such maybe under-treated. The peak incidence for depression was immediately post treatment in the prospective group of women. This highlights that the first outpatient follow up appointment at 6 weeks could be a potential opportunity for early recognition of anxiety and depression.

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