The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of X13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of X6 (specificity 0.21). With scores of X16 and X22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals.

We examined psychological parameters in family caregivers of palliative cancer patients before and after the death of the patients. Caregivers' data about depression and anxiety (Hospital Anxiety and Depression Scale), quality-of-life (Short Form-8 Health Survey), and social support (Oslo Social Support Scale) were collected at the beginning of home care (t1) and 2 months after the patient had died (t2). Regression models were employed to examine factors related to depression and anxiety in the bereaved caregivers. We interviewed 72 relatives, who were the primary caregiver of a patient. One-third (31.9%) of caregivers had high anxiety levels and 29.2% had high depression levels (t1, cut-off = 10). At t2, anxiety and depression had decreased significantly. There were no changes in quality-of-life over time. At both points of assessments, quality-of-life was lower than in the general population. Relevant factors for higher anxiety and depression in the bereaved caregivers were high levels of distress at t1, insufficient social support and low physical function. Bereaved caregivers were particularly depressed when they had been the spouse of the patient. Healthcare professionals should consider social isolation of caring relatives both during homecare and afterwards. Thus, it seems to be important to routinely offer support to spouses.

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Objective: Our study analysed fear of cancer recurrence (FoR) in long-term cancer survivors in relation to medical variables, depression, anxiety, and quality of life. Methods:We present data obtained from 1,002 cancer survivors (53% male, mean age=68 years, 26% prostate cancer, 22% breast cancer) across all cancer types 5 (N=660) and 10 (N=342) years after diagnosis, who were recruited via a large Clinical Cancer Registry in Germany in a cross-sectional study. FoR, depression, and anxiety were measured using validated self-report questionnaires (12-item short version of

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Even though our findings need to be supported in future investigations using larger sample sizes, they imply that male cancer patients with underage children are in particular need of psychosocial support.

Patients with bladder cancer experience various QoL concerns at the beginning of inpatient rehabilitation. These problems can partly be explained by the type of treatment the patients receive. Type of urinary diversion is relevant for QoL in subgroups of patients.