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Anxiety, depression symptoms require careful monitoring in MEN2
Adults with multiple neuroendocrine neoplasia type 2 frequently exhibit high levels of coping strategies, but they should be actively monitored for symptoms of anxiety and depression, according to findings published in Thyroid.
Delmar M. Lourenço Jr., MD, PhD, of the endocrine genetics unit at the University of São Paulo School of Medicine, and colleagues evaluated 43 adults with clinical and genetic diagnosis of multiple neuroendocrine neoplasia type 2 (MEN2) to assess anxiety, depression, quality of life and coping skills. Follow-up was a mean of 10.6 years. Overall, 25 participants had uncured medullary thyroid carcinoma, and 16 were biochemically cured.
Researchers conducted psychological assessments using semi-directed interviews, the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Scale of Mental Adjustment to Cancer.
During the interview, 72% of participants reported fear of dying upon a genetic diagnosis. Seventy percent of participants had at least one RET mutation-positive child; of these, 76% reported feelings of fear of losing their children, and 35% reported a feeling of guilt of transmitting the mutation to their child.
Results from the Hospital Anxiety and Depression Scale revealed that 42% of participants had high scores for anxiety symptoms, 28% had clinically relevant anxiety symptoms and 14% exhibited symptoms of anxiety disorders. Twenty-six percent of participants had high scores for depression symptoms, 12% had clinically relevant depression symptoms and 14% had symptoms of depression disorders. Forty-six percent of participants exhibited distress (anxiety and/or depression).
Results from the Scale of Mental Adjustment to Cancer revealed that coping behaviors, including fighting spirit, cognitive avoidance and fatalism, were higher compared with weakness-discouragement and anxious preoccupation. Higher scores were found for fighting spirit (86%) and fatalism (65%) compared with cognitive avoidance (42%), anxious preoccupation (16%) and weakness-discouragement (9%).
Results from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Scale of Mental Adjustment to Cancer revealed that most participants were in a satisfactory global state of health. There was a strong correlation between anxiety and depression symptoms (P < .001), and both sets of symptoms had correlations with weakness-discouragement, anxious preoccupation, cognitive avoidance, fatigue, pain, insomnia and constipation. Anxiety and depression symptoms were inversely correlated with scales of global health status and functional subscales (role, cognitive, social and emotional functioning; P < .05). Psychotherapeutic follow-up after the initial evaluation was required in 25% of participants.
Participants who were cured of medullary thyroid carcinoma had higher scores of physical functioning (P = .021) and cognitive avoidance (P = .024) compared with participants who were not cured.
“The psychological assessment protocol developed for and directed to the care of MEN2 patients has proven effective to identify individuals requiring psychological assistance and individual psychotherapeutic treatment,” the researchers wrote. “Symptoms of anxiety and depression should be actively investigated and monitored in MEN2 patients given their high prevalence and long duration. Coping behaviors were frequent in the MEN2 patients studied here, especially fatalism and fighting spirit. The presence of MEN2-related stress-inducing factors may result in the occurrence of adverse psychologic effects and may require targeted psychological support. Specialized multidisciplinary teams involving genetic counselors, physicians, surgeons and psychologists with expertise in MEN2 may improve the quality of medical care of the patients and their family members.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.