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Background:We hypothesised that patients with advanced disease or a cancer type that has a poor prognosis may be more likely to report anxiety and depressive symptoms after diagnosis; younger age and female gender may moderate these effects.Methods:Patients (n=3850) were consecutively assessed with PSSCAN, a standardised, validated tool, at two large cancer centres between 2004 and 2009.Results:Female patients reported more anxiety and depressive symptoms (P=0.003 to P<0.001) compared with men and a healthy comparison group. Older age was associated with fewer anxiety (P=0.033 to P<0.001) and fewer depressive symptoms (P<0.001), but this was not true for lung cancer. Presence of metastases was associated with more anxiety symptoms in patients with gastrointestinal (P=0.044; R2Δ=0.001), lung (P=0.011; R2Δ=0.016), and prostate (P=0.032; R2Δ=0.008) cancer, but this was not true for breast cancer. Furthermore, early disease stage was associated with fewer depressive symptoms among older prostate cancer patients (P=0.021; R2Δ=0.008). Men with early lung cancer reported fewer anxiety (P=0.020; R2Δ=0.013) and depressive (P=0.017; R2Δ=0.016) symptoms than men with advanced disease or women.Conclusion:As hypothesised, disease stage was directly associated with emotional distress, except for patients with breast cancer. Furthermore, age and gender moderated some of these effects.

BackgroundWe are reporting on the development of a psychosocial screening tool for cancer patients. The tool was to be brief, at a relatively low reading level, capture psychological variables relevant to distress and health-related quality-of-life in cancer patients, possess good reliability and validity, and be free of copyright protection.MethodItem derivation is described, data on reliability and validity as well as norms are reported for three samples of cancer patients (n = 1057; n = 570, n = 101).ResultsThe resulting 21-item psychological screen for cancer (PSCAN) assesses perceived social support, desired social support, health-related quality-of-life, anxiety and depression. It has good psychometrics including high internal consistency (alpha averaging .83, and acceptable test-retest stability over 2 months (averaging r = .64). Validity has been established for content, construct and concurrent validity.ConclusionPSCAN is considered ready for use as a screening tool and also for following changes in patient distress throughout the cancer care trajectory. It is freely available to all interested non-profit users.

To avoid both over- and undertreatment of distressed individuals, repeated measurements are needed to identify actual adjustment trajectories. Initial assessment of emotional reaction to a diagnosis is not a reliable predictor of long-term adjustment. Patients should be made aware that completion of initial medical treatment even when accompanied by a positive prognosis does not in and of itself forecast how well patients adjust during survivorship.

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