Background
-
What were the socio-demographic, cancer-related as well as psychiatric characteristics of patients with cancer seeking help who presented to the psycho-oncology outpatient clinic?
-
What were both the overall and sex-based risk factors in the development of mood disorders, adjustment disorders, and anxiety disorders in those patients?
Methods
Design
Data analyses
Results
Sociodemographic and Cancer-related characteristics of help-seeking patients
Age (years): Mean ± SD (Range) | ||
Overall Patients | 51.22 ± 14.55 (16–87) | |
Female (t: 3.370, p = 0.001) | 49.62 ± 13.4 (16–85) | |
Male | 53.83 ± 16 (16–87) | |
n | % | |
Sex
| ||
Female (χ2: 32.678/ p < 0.001) | 351 | 62 |
Male | 215 | 38 |
Education level
| ||
Literate / elementery school | 314 | 55.5 |
Secondary school graduates | 188 | 33.2 |
College | 64 | 11.8 |
Marital status
| ||
Married | 430 | 76 |
Single | 59 | 10.4 |
Divorced/Widowed | 77 | 13.6 |
Employment
| ||
Housewife | 212 | 37.5 |
Working fulltime | 152 | 26.9 |
Retired | 176 | 31.1 |
Other | 26 | 4.6 |
Income level
| ||
Low | 120 | 21.1 |
Middle | 430 | 76 |
Upper | 16 | 2.8 |
Type of family
| ||
Core | 512 | 90.5 |
Extended | 40 | 7.1 |
Alone | 14 | 2.5 |
Cancer site
| ||
Breast | 176 | 31.1 |
Lung | 63 | 11.1 |
Gastrointestinal cancers | 70 | 12.4 |
Head and neck cancer | 64 | 11,3 |
Brain tumors | 30 | 5.3 |
Gynecologic cancers | 56 | 9.9 |
Male genitourinary cancers | 29 | 5.1 |
Leymphoma | 36 | 6.4 |
Malignant melanoma /skin cancer | 12 | 2.1 |
Bone and soft tissue cancer | 17 | 3 |
Other | 13 | 2.3 |
Stage
| ||
Local disease | 315 | 55.7 |
Locoregional recurrence | 114 | 20.1 |
Metastatic | 128 | 22.6 |
Unknown | 9 | 1.6 |
Oncological treatment
| ||
Surgery+chemotherapy+ radiotheraphy (+hormone therapy) | 182 | 32.2 |
Surgery+chemotherapy | 112 | 19.8 |
Chemotherapy+ radiotheraphy | 85 | 15 |
Chemotherapy | 76 | 13.4 |
Surgery+radiotheraphy | 51 | 9 |
Radiotheraphy | 19 | 3.4 |
Surgery+chemotherapy+hormone therapy | 16 | 2.8 |
Surgery | 12 | 2.1 |
Surgery +interferon | 3 | 0.5 |
Treatment is not yet started | 4 | 0.7 |
Other | 9 | 1.6 |
Any other medical illnesses
| ||
Yes | 113 | 20 |
No | 453 | 80 |
Family history of cancer
| ||
Yes | 82 | 14.5 |
No | 484 | 85.5 |
Secondary cancer
| ||
Yes | 16 | 2.8 |
No | 550 | 97.2 |
Duration of cancer (month): Mean ± SD (Range) | 22.3 ± 33.1 (1–240) |
Psychiatric characteristics and distribution of diagnoses
Female | Male | Total | ||||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Who is requesting the application
| ||||||
By the oncologists | 293 | 83.5 | 169 | 78.6 | 462 | 81.6 |
By ownself | 41 | 11.7 | 9 | 4.2 | 50 | 8.8 |
By family members | 17 | 4.8 | 37 | 17.2 | 54 | 9.5 |
Referral symptoms
| ||||||
Sleep problems | 92 | 26.2 | 84 | 39.1 | 176 | 31.1 |
Tendency to cry easily | 74 | 21.1 | 26 | 12.1 | 100 | 17.7 |
Irritability / intolerance | 67 | 19.1 | 56 | 26 | 123 | 21.7 |
Despondency | 48 | 13.7 | 27 | 12.6 | 75 | 13.3 |
Pre-occupation with illness | 63 | 17.9 | 22 | 10.2 | 85 | 15 |
Trouble / restlessness | 35 | 10 | 26 | 12.1 | 61 | 10.8 |
Pessimism | 14 | 4 | 6 | 2.8 | 20 | 3.5 |
Olm / metastasis / fear of recurrence | 14 | 4 | 4 | 1.9 | 18 | 3.2 |
Palpitations, fainting sensation | 14 | 4 | 2 | 0.9 | 16 | 2.8 |
Marital problem | 25 | 7.1 | 2 | 0.9 | 27 | 4.8 |
Pain | 41 | 11.7 | 29 | 13.5 | 70 | 12.4 |
Inability to enter MR or the radiotherapy device | 16 | 4.6 | 9 | 4.2 | 25 | 4.4 |
Concern | 39 | 11.1 | 16 | 7.4 | 55 | 9.7 |
Unhappiness | 12 | 3.4 | 7 | 3.3 | 19 | 3.4 |
Precision / obsession | 4 | 1.1 | 1 | 0.5 | 5 | 0.9 |
Forgetfulness | 7 | 2 | 6 | 2.8 | 13 | 2.3 |
Body image problems | 14 | 4 | 5 | 2.3 | 19 | 3.4 |
Control of a previously started drug | 6 | 1.7 | 4 | 1.9 | 10 | 1.8 |
Getting newly cancer diagnosis | 3 | 0.9 | 3 | 1.4 | 6 | 1.1 |
Treatment rejection | 3 | 0.9 | 5 | 2.3 | 8 | 1.4 |
Request for support | 12 | 3.4 | 2 | 0.9 | 14 | 2.5 |
Other | 6 | 1.7 | 6 | 2.8 | 12 | 2.1 |
No complaints | 11 | 3.1 | 13 | 6 | 24 | 4.2 |
Psychiatric Diagnosis
| ||||||
Anxiety disorders | ||||||
Anxiety disorder | 19 | 5.4 | 8 | 3.7 | 27 | 4.8 |
Common anxiety disorder | 9 | 2.6 | 4 | 1.9 | 13 | 2.3 |
Panic disorder | 2 | 0.6 | 1 | 0.5 | 3 | 0.5 |
The claustrophobia | 4 | 1.1 | – | – | 4 | 0.7 |
Obsessive-compulsive disorder | 1 | 0.3 | – | – | 1 | 0.2 |
Somatoform Disorder | 5 | 1.4 | 2 | 0.9 | 7 | 1.2 |
Mood disorders | ||||||
Depression | 58 | 16.5 | 27 | 12.6 | 85 | 15 |
M depression + obsessive compulsive disorder | 5 | 1.4 | – | – | 5 | 0.9 |
M depression + generalized anxiety disorder | 3 | 0.8 | 4 | 1.9 | 7 | 1.2 |
Complicated grief reaction | 2 | 0.6 | – | – | 2 | 0.4 |
Bipolar disorder | 2 | 0.6 | – | – | 2 | 0.4 |
Adjustment Disorders | ||||||
Anxious adjustment disorder | 112 | 31.9 | 94 | 43.7 | 206 | 36.4 |
Depressive adjustment disorder | 94 | 26.8 | 49 | 22.8 | 143 | 25.2 |
Mixt adjustment disorder | 16 | 4.6 | 3 | 1.4 | 19 | 3.4 |
Delirium | 2 | 0.6 | 6 | 2.8 | 8 | 1.4 |
Insomnia | 1 | 0.3 | 4 | 1.9 | 5 | 0.9 |
Personality disorder | 3 | 0.9 | 5 | 2.3 | 8 | 1.4 |
Delusional disorder | 4 | 1.1 | 3 | 1.4 | 7 | 1.2 |
No complaints | 9 | 2.6 | 5 | 2.3 | 14 | 2.5 |
History of psychiatric disorder
| ||||||
Yes | 28 | 8 | 15 | 7 | 43 | 7.6 |
No | 323 | 92 | 200 | 93 | 523 | 92.4 |
History of psychiatric disorder in family
| ||||||
Yes | 2 | 0.6 | 2 | 0.9 | 4 | 0.7 |
No | 349 | 99.4 | 213 | 99.1 | 562 | 99.3 |
Social Support
| ||||||
Sufficient social support | 168 | 47.9 | 109 | 50.7 | 277 | 48,9 |
Poor social support | 183 | 52.1 | 106 | 49.3 | 289 | 51.1 |
Psychiatric Treatment Recommendation
| ||||||
Medication | 207 | 59 | 152 | 70.7 | 359 | 63.4 |
Medication + psychotherapy | 85 | 24.2 | 30 | 14 | 115 | 20.3 |
Psychotherapy | 49 | 14 | 26 | 12.1 | 75 | 13.2 |
Follow-up without medication | 10 | 2.8 | 5 | 2.3 | 15 | 2.7 |
Directing to the Alcohol Substance unit | – | – | 2 | 0.9 | 2 | 0.4 |
Risk factors for mood disorders, adjustment disorders, and anxiety disorders
B | p | OR | 95% CI for OR | |||
---|---|---|---|---|---|---|
Lower | Upper | |||||
Mood disorders | Marital status (Married/not married) | −0.849 | 0.014 | 2.08 | 0.218 | 0.841 |
Education level (≤8 years / > 8 years) | 0.679 | 0.045 | 1.97 | 1.014 | 3.839 | |
Income level (Low/Middle or upper) | −1.485 | 0.003 | 4.41 | 0.089 | 0.609 | |
Social Support (Poor/Sufficient) | −1.043 | 0.002 | 2.84 | 0.183 | 0.679 | |
Recurence (No/Yes) | −3.679 | < 0.001 | 40 | 0.010 | 0.066 | |
Metastasis (No/Yes) | −1.344 | 0.007 | 3.83 | 0.098 | 0.693 | |
Secondary cancer (No/Yes) | −2.310 | 0.001 | 10.1 | 0.026 | 0.376 | |
Other medical illnesses (No/Yes) | −1.511 | < 0.001 | 4.52 | 0.117 | 0.417 | |
History of psychiatric disorder (No/Yes) | −1.788 | < 0.001 | 5.99 | 0.075 | 0.373 | |
Constant | 7.291 | < 0.001 | 146.7 | |||
Nagelkerke R2 | 0.571 | |||||
Adjustment Disorders | Marital status (Not married/Married) | −0.464 | 0.050 | 1.59 | 0.394 | 1.003 |
Income level (Low/Middle-upper) | −1.256 | < 0.001 | 3.86 | 0.141 | 0.476 | |
Social Support (Poor/Sufficient) | −0.452 | 0.030 | 1.57 | 0.424 | 0.957 | |
Duration of illnesses (0–12 / ≥13 months) | 0.706 | 0.001 | 2.03 | 1.300 | 3.156 | |
Metastasis (No/Yes) | −0.870 | 0.002 | 2.39 | 0.243 | 0.721 | |
Recurence (No/Yes) | 1.256 | < 0.001 | 3.51 | 0.142 | 0.573 | |
Cancer history in family members (No/Yes) | −0.766 | 0.015 | 2.15 | 0.250 | 0.863 | |
Other medical illnesses (No/Yes) | −0.696 | 0.005 | 2.01 | 0.307 | 0.807 | |
History of psychiatric disorder (No/Yes) | −1.431 | < 0.001 | 4.18 | 0.126 | 0.455 | |
Constant | 9.631 | < 0.001 | 152.3 | |||
Nagelkerke R2 | 0.276 | |||||
Anxiety Disorders | Income level (Low/Middle-upper) | 0.954 | 0.001 | 2.6 | 1.462 | 4.609 |
Social Support (Poor/Sufficient) | 0.621 | 0.003 | 1.86 | 1.234 | 2.808 | |
Duration of illnesses (0–12 / ≥13 months) | 0.504 | 0.02 | 1.65 | 1.081 | 2.533 | |
Recurence (No/Yes) | 1.884 | < 0.001 | 6.58 | 3.065 | 14.14 | |
Secondary cancer (No/Yes) | 1.632 | 0.01 | 5.11 | 1.470 | 17.79 | |
Other medical illnesses (No/Yes) | 0.631 | 0.011 | 1.88 | 1.155 | 3.06 | |
History of psychiatric disorder (No/Yes) | 1.202 | < 0.001 | 3.32 | 1.743 | 6.345 | |
Constant | −11.35 | < 0.001 | 128.3 | |||
Nagelkerke R2 | 0.295 |
Risk factors according to sex for mood disorders, adjustment disorders, and anxiety disorders
Female | Male | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
95% CI for OR | 95% CI for OR | ||||||||||
B | p | OR | Lower | Upper | B | p | OR | Lower | Upper | ||
Mood disorders | Income level (Low/Middle- upper) | −1.064 | 0.042 | 2.90 | 0.123 | 0.964 | −2.592 | 0.035 | 13.3 | 0.07 | 0.836 |
Social Support (Poor/Sufficient) | −0.935 | 0.013 | 2.54 | 0.188 | 0.819 | −1.771 | 0.022 | 5.88 | 0.04 | 0.771 | |
Metastasis (No/Yes) | – | – | – | – | – | −2.842 | 0.050 | 17.2 | 0.03 | 0.997 | |
Recurence (No/Yes) | −3.441 | < 0.001 | 31.25 | 0.011 | 0.092 | −5.495 | < 0.001 | 250 | 0.01 | 0.065 | |
Secondary cancer (No/Yes) | −1.940 | 0.030 | 6.94 | 0.025 | 0.827 | −3.445 | 0.011 | 31.25 | 0.02 | 0.451 | |
Other medical illnesses (No/Yes) | −0.984 | 0.009 | 2.67 | 0.178 | 0.785 | −2.698 | < 0.001 | 14.92 | 0.018 | 0.257 | |
History of psychiatric disorder (No/Yes) | −1.560 | 0.001 | 4.76 | 0.083 | 0.530 | −2.135 | 0.017 | 8.47 | 0.021 | 0.679 | |
Constant | 5.703 | < 0.001 | 299.8 | 9.888 | < 0.001 | 1970 | |||||
Nagelkerke R2 | 0.475 | 0.714 | |||||||||
Adjustment Disorders | Education level (≤8 years/ > 8 years) | – | – | – | – | – | −1.017 | 0.016 | 2.76 | 0.158 | 0.830 |
Income level (Low/Middle- upper) | 0.902 | 0.009 | 2.46 | 1.245 | 4.841 | 2.517 | < 0.001 | 12.39 | 3.146 | 4.78 | |
Social Support (Poor/Sufficient) | 0.537 | 0.034 | 1.71 | 1.042 | 2.806 | – | – | – | – | – | |
Metastasis (No/Yes) | – | – | – | – | – | – | – | – | – | – | |
Recurence (No/Yes) | 1.220 | 0.003 | 3.38 | 1.494 | 7.682 | 2.153 | 0.007 | 8.61 | 1.812 | 4.94 | |
Other medical illnesses (No/Yes) | 0.783 | 0.006 | 2.19 | 1.247 | 3.842 | – | – | – | – | – | |
Cancer history in family members (No/Yes) | – | – | – | – | – | −1.668 | 0.032 | 5.29 | 0.041 | 0.870 | |
History of psychiatric disorder (No/Yes) | 1.212 | 0.003 | 3.36 | 1.518 | 7.440 | 1.459 | 0.017 | 4.303 | 1.302 | 4.219 | |
Constant | −2.808 | 0.005 | 16.6 | −2.669 | 0.007 | 8.92 | |||||
Nagelkerke R2 | 0.199 | 0.376 | |||||||||
Anxiety Disorders | Income level (Low/Middle- upper) | −0.767 | 0.027 | 2.15 | 0.235 | 0.918 | −0.767 | 0.027 | 2.15 | 0.235 | 0.918 |
Social Support (Poor/Sufficient) | −0.645 | 0.014 | 1.9 | 0.314 | 0.876 | – | – | – | – | – | |
Metastasis (No/Yes) | −0.893 | 0.021 | 2.43 | 0.192 | 0.876 | – | – | – | – | – | |
Recurence (No/Yes) | −2.052 | < 0.001 | 7.81 | 0.048 | 0.343 | −1.691 | 0.028 | 5.43 | 0.41 | 0.832 | |
Secondary cancer (No/Yes) | −1.502 | 0.048 | 4.06 | 0.049 | 1.229 | −2.585 | 0.031 | 13.33 | 0.07 | 0.789 | |
Other medical illnesses (No/Yes) | −0.643 | 0.034 | 1.09 | 0.290 | 0.951 | – | – | – | – | – | |
History of psychiatric disorder (No/Yes) | −1.502 | 0.001 | 4.48 | 0.095 | 0.520 | – | – | – | – | – | |
Constant | 5.591 | < 0.001 | 167.84 | 3.737 | 0.01 | 41.97 | |||||
Nagelkerke R2 | 0.280 | 0.316 |