Issues in the Psychiatric Screening of Cancer Patients

Abstract

The experience of cancer represents a unique challenge to both the physical and psychological health of the individual. High levels of distress are common in cancer patients irrespective of the type of pathology. However, the physiological aspects of the disease process may be a source of confound in the psychiatric screening process, thereby reducing the accuracy of case identification. The current review examines the salient factors which should be considered by clinicians when screening for clinically significant psychological distress. The review will evaluate the strengths and limitations of contemporary screening instruments within this context and suggest approaches to maximize screening accuracy in this clinical group. Finally, the review will consider issues in the efficiency of the referral pathway to liaison psychiatry services for those patients positively screened. Implications for current psychiatric practice and the direction of future research are also discussed.

Impact of mood disturbance, sleep disturbance, fatigue and pain among patients receiving cancer therapy

“…The relationship between pain and sleep has often been assumed to be reciprocal -pain can lead to disturbed sleep, and vice versa (Smith & Haythornthwaite 2004). A previous review also indicated that the psychological burden of the diagnosis and treatment of cancer can reach clinically significant levels (Martin & Cheng 2006). In a study of patients with advanced cancer receiving palliative care, Delgado-Guay et al (2011) revealed that patients with sleep disturbance were more likely to report pain (P = 0.0132), depression (P = 0.019), anxiety (P = 0.01) and a poorer sense of well-being (P = 0.035) compared with patients who did not experience sleep disturbance.…”

“…The literature indicates that mood disturbance often increase during the treatment period (Glajchen 1999;Palesh et al 2010) and should not be neglected. A previous review also indicated that the psychological burden of the diagnosis and treatment of cancer can reach clinically significant levels (Martin & Cheng 2006). Nevertheless, it seems possible that mood disturbance was not merely additive in its influence on the patients' functional status and QoL.…”

Evaluation of the factor structure and psychometric properties of the brief symptom inventory—18 with homebound older adults

“…The HADS depression subscale has exhibited promising psychometric properties with older cancer patients (Martin and Cheng, 2006), but may have less face validity with homebound elders because it does not contain items assessing suicide ideation or loneliness which are especially salient to homebound older adult populations (Mitty and Flores, 2008; Barg et al ., 2006). The HADS anxiety scale appears valuable to measure severity of anxiety symptoms but exhibits poor sensitivity and specificity for screening in older medical patients (Davies et al ., 1993, Johnson et al ., 1995).…”