Background: Assessment of psychological burden of disease forms one criterion for accreditation of a cancer specialist center. Patient Health Questionnaire-4 (PHQ-4), a validated self-report ultra-short questionnaire was used to assess anxiety and depression level in patients with GEP NETs, attending the clinics at an ENETS Centre of Excellence.
Methods: PHQ-4 was completed during routine outpatient visits over a three month period by 48 patients, who were randomly selected from the GEP NET database. Composite score of PHQ-4 was calculated. Depression and anxiety was suggested by a score of 68, and strongly suggested by a score above 9. Association between the cumulative score and demographic and disease related factors were also assessed.
Results: The majority (45.8%) of patients were above 70 years and mean age was 64.4 years. (SD-4.6). Most were males (52.2%) and majority were married (72.9%). Eighty five percent of the study population had gastrointestinal NETs, and 18.8% had pancreatic NETs. Small bowel NETs (58.3%) were the commonest. In more than half (56.3%) the disease duration was less than 2 years whereas in 27.1% disease duration was more than 5 years. Metastatic disease was present in 87.5% and 52% had symptoms of carcinoid syndrome.
The mean depression score was 2.14 (SD-3.1). About 83.3% had scores < 6 and only 2.1% had scores ≥ 9. There were no significant associations between the scores and demographic factors [sex (P-0.769), age (P-0.716), and marital status (P-0.162)] and the presence of co-morbidities (P-0.424). Furthermore, depression and anxiety was also not associated with the factors related to the disease itself such as presence of metastasis (P-0.242), presence of carcinoid syndrome (P-0.155), duration of the disease (P-0.33), hormonal activity of the tumour (P-0.89). In addition scores did not differ between pancreatic and non-pancreatic lesions (P-0.62).
Conclusion: Anxiety and depression affects a minority of patients with NETS attending a dedicated NETS centre. There were no statistical significant associations between demographic and disease related factors. These scores concur with a larger recent publication but that anxiety score were higher in recurrent disease.
05 Dec 2016
UK and Ireland Neuroendocrine Tumour Society