Patients with metastatic disease have higher rates of anxiety, depression
SAN DIEGO — Compared with patients who have localized cancer and non-oncologic disease, patients with metastatic disease have higher rates of anxiety and depression, according to a presenter.
“Over the past 2 decades, agencies like the FDA and American Cancer Society have strongly urged clinicians to use patient-reported outcomes measurement information system (PROMIS) metrics to help gauge clinical outcomes,” Patrick H. England, BA, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Two specific PROMIS measures – anxiety and depression – have both been validated and shown to perform similarly to legacy measures across many orthopedic and oncologic populations,” he added.
England and colleagues retrospectively reviewed data for 276 patients who underwent resection of a primary malignancy, palliative surgery for metastatic cancer or total joint arthroplasty by an orthopedic oncology service at a single institution from 2015 to 2020. Researchers defined clinically relevant anxiety and depression as PROMIS scores of more than 60 and clinically relevant changes in anxiety and depression as a difference in perioperative PROMIS scores of at least 4 points.
Overall, anxiety and depression were most prevalent in patients undergoing palliative surgery for metastatic disease. Patients undergoing palliative surgery for metastatic disease had preoperative and postoperative anxiety scores of 53.8% and 42%, respectively, as well as preoperative and postoperative depression scores of 28.8% and 27.3%, respectively. In comparison, patients undergoing resection of a primary sarcoma had preoperative and postoperative anxiety scores of 29.9% and 15.5%, respectively, and preoperative and postoperative depression scores of 16.9% and 11.3%, respectively. Patients undergoing TJA had preoperative and postoperative anxiety scores of 36.8% and 11.9%%, respectively, and preoperative and postoperative depression scores of 16.8% and 2.4%, respectively.
Researchers also noted the greatest proportion of patients who experienced clinically relevant improvements in anxiety and depression were in the TJA cohort.
“While we cannot establish causation, it is important to know the correlation that worse pain and physical function are both independently associated with greater anxiety and depression, even when controlling for the disease,” England said. “So, it is important to know the relationship between both physical and mental health when trying to optimize treatment for musculoskeletal cancer patients,” he concluded.
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England PH, et al. Paper 162. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31 - Sept. 3, 2021; San Diego.
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