Prevalence of Psychological Distress

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For most people a diagnosis of cancer is a distressing life event. For many, the initial reaction is that they have been given a death sentence. In fact the majority of patients diagnosed with cancer will adjust psychologically, cope with subsequent treatment, and adapt their lives appropriately. Nevertheless, a substantial minority of patients will experience clinical levels of psychological distress that merit some level of professional intervention.

Estimates of the prevalence of psychological/psychiatric disorder in a population with cancer vary widely, due to differences in the subgroups studied and use of different criteria for defining disorders. Derogatis et al. [1] found that 47% of adult inpatients with cancer had formal psychiatric disorders. Zabora et al. [2] screened a large (n = 4496), heterogeneous population of cancer patients with the Brief Symptom Inventory [3] (a psychometrically sound self-report measure) and found that 35.1% were suffering clinical levels of psychological distress. Greer et al. [4] studied 1260 patients with various cancers, within 12 weeks of diagnosis, and found 23% to have clinically significant anxiety or depression. Hence it can be assumed that between a quarter and a third of cancer patients will experience clinically relevant levels of psychological distress at some point in their cancer experience. The great majority of that distress will be directly related to disease or treatment.

Risk factors for developing psychological disorder, in the face of cancer, include: previous history of psychological problems; inadequate social support; serious negative life events in addition to cancer; maladaptive coping style [5] as well as younger age at diagnosis; preexisting marital problems; low expectations regarding the effectiveness of treatment; a prior adverse experience of cancer in the family; lack of involvement in satisfying activities; and inability to accept the physical changes associated with the disease or its treatment [6]. Adjustment disorders, depression, and anxiety are the most common psychological disorders within a cancer population. Other problems encountered include: post-traumatic stress disorder; phobic avoidance of treatment; relational problems; sexual dysfunction; and delirium. Patients are more likely to be psychologically vulnerable at certain key points in their cancer journey, for example at diagnosis, at discharge from treatment, and if recurrence of disease occurs. Unfortunately studies indicate that the majority of psychological distress in cancer patients goes undetected and therefore untreated [7,8].

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