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Anxiety Screening in Cancer Patients

Anxiety Screening in Cancer Patients  

Anxiety Screening in Cancer Patients  

Cancer patients are highly susceptible to anxiety, depression, severe distress, and other psychological and emotional stresses (Sarkar et al., 2015). This is because cancer is life threatening, and therefore cancer patients experience anxiety because of the possibility of losing their lives and the reduction of the quality of their lives as they receive cancer care, and the fear of cancer recurrence (Sarkar et al., 2015).

With depression and anxiety among cancer patients and survivors afflicting about 24 % of the 300 million people globally, its occurrence is of grave concern among the patients, families of the patients and the medical practitioners that provide care to these patients (Vartolemei, et al., 2018). According to the Anxiety and Depression Association of America (2018), in the United States, about 40 million people making up 18 % of the country’s population, are afflicted by one form of an anxiety disorder or another annually. In the same respect, anxiety and depression among cancer patients was under-diagnosed, leading to reduced intervention and support and subsequently having a negative impact on the coping mechanism and treatment outcomes, according to Milligan et al. (2018). Additionally, with the numbers of new cancer cases and deaths due to cancer being expected to rise and estimated to reach 21.6 million and 12 million respectively by 2010, the occurrence of anxiety and depressive disorders were expected to rise concomitantly (Grassi, Spiegel & Riba, 2017).

Unfortunately, anxiety interferes with the treatment of the cancer and therefore addressing anxiety in cancer patients is vital if the treatment regimes are to be effective. This is of concern to the management of cancer because the ineffectiveness of treatment of cancer may cause an increase in mortality rates among cancer patients while reflecting negatively to the healthcare services. Therefore, the ability to diagnose and treat anxiety in cancer patients is vital because it influences the effectiveness of cancer treatment. This discussion dwells on the screening of anxiety in cancer patients as an important step in addressing anxiety in patients and improving the effectiveness of cancer treatment. 

Background/literature review

The proportion of the population that suffers from anxiety disorders and the prevalence of these disorders among cancer patients has been studied extensively with different findings being published. For instance, the levels and prevalence of anxiety and depression among cancer patients differs across the time of treatment, gender and types of cancer, and age. In this regard, Watts, et al. (2015) noted that 14 % to 56 % of all cancer patients were afflicted by anxiety and depressive disorders. Similarly, Smith (2015) noted that the prevalence of anxiety highest during the diagnosis period, in patients with the visible forms of cancer, in females for some cancers, and in the older people compared to adolescents and children.   

To understand how anxiety afflicted cancer patients, Butow, et al., (2015) claimed that diagnosis of cancer often influences the physical, social and psychological functioning of the patient and therefore is often accompanied by anxiety and depression. Consequently, after diagnosis, cancer patients experienced challenges in the performance of work, interaction with their families and others, taking care of themselves, and leading normal lives, in addition to the suicidal ideation that afflicts them (Haun, et al., 2014). These conditions lower the quality of life of the cancer patients (Haun, et al., 2014).  

The presence of anxiety in a patient is diagnosed using various instruments as illustrated by literature. Questionnaires such as the hospital and depression scale (HADS) and personal health questionnaire (PHQ) are common anxiety diagnostic tools (Andersen, et al., 2014; Bitow, et al., 2015; Nikbakhsh et al., 2014). Specifically, the hospital and depression scale (HADS) is a presumptive tool that comprises of 14 items that are evaluated at 4 levels (Bitow, et al., 2015). The results from this scale can inform on the severity of the anxiety, with the absence of anxiety or depression, mild anxiety and symptomatic anxiety being scored as 0-7, 8-10 and 11-21 respectively (Bitow, et al., 2015; Nikbakhsh et al., 2014). The personal health questionnaire (PHQ-9) comprises of nine items, whose cut-off score is less or equal to 10 to signify he presence of an anxiety disorder (Andersen, et al., 2014). Other screening tools include the General Anxiety Disorder Scale (GAD-7) that contains seven items that are rated on a 4-point Likert scale and the Fear of Progression questionnaire (FoP-Q-SF) (Sakar, et al., 2015).

Various intervention approaches have been reported in literature. Notably, the International Psycho-Oncology Society (IPOS) Standard on Quality Cancer Care recommends that distress be considered as the ‘6th vital sign’ for cancer care and that the routine screening and treatment of anxiety and depression among cancer patients should be mandatory (Grassi, Spiegel & Riba, 2017). As such, the time and frequency of screening was vital in arresting the challenges of screening for anxiety in cancer patients (Grassi, Spiegel & Riba, 2017).    


From the literature, anxiety was prevalent among cancer patients with adults being afflicted more that the youth while the long-time cancer survivors experienced higher rates of anxiety compared to those in treatment. Various types of questionnaire-based diagnostic tools were used to diagnose the presence of anxiety disorders in cancer patients. However, there was not a tool that was specifically designed for cancer patients, as the tools found in literature were applicable for all people.

In conformance with the International Psycho-Oncology Society (IPOS) Standard on Quality Cancer Care recommendations that distress be considered as the ‘6th vital sign’ for cancer care and that the routine screening and treatment of anxiety and depression among cancer patients should be mandatory, a protocol to address anxiety screening should include the best practices in the recommendation (Grassi, Spiegel & Riba, 2017). As such, the screening of anxiety among cancer patients is best initiated as part of the early nursing assessment practice when patients are first diagnosed with cancer with continuous screening being recommended in regular intervals during the treatment and care of cancer patients even among cancer survivors (Andersen et al., 2014). The hospital and depression scale (HADS), which is a questionnaire tool was best for the screening process due to its comprehensiveness and detail from its 14 items and 4-level scale, which makes it highly valid and reliable (Stern, 2014). Therefore, a protocol that best screens for anxiety disorders among cancer patients should begin with the screening for the predisposition to anxiety and depressive disorders when the patients are first diagnosed with cancer, at the commencement of the treatment regime and after the cancer patient has been discharged from hospital.   


Anxiety co-occurs with cancer in cancer patients due the debilitating effects of the disease and possible demise of the patient. Anxiety not only diminishes the quality of life of a cancer patient, it also depresses the effectiveness of cancer treatment. The early treatment of anxiety in cancer patients can only be effected it anxiety is diagnosed early as part of the early nursing care practice and screening tools should be as comprehensive, valid and reliable as possible. Therefore, to facilitate the diagnosis of anxiety among cancer patients, anxiety screening should be done early as part of nursing practice and regularly, to facilitate the effective control of its occurrence and improve the outcomes of cancer treatment. Screening practices that conform to the recommendations by the International Psycho-Oncology Society (IPOS) Standard on Quality Cancer Care would improve the screening effectiveness.  


Andersen, B. L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., … & Rowland, J. H. (2014). Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. Journal of Clinical Oncology32(15), 1605-1620.

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Milligan, F., Martinez, F., Aal, S. H. M. A., Ahmed, S. A., Joby, B., Matalam, J. S., … & Melepeedikayil, S. S. (2018). Assessing anxiety and depression in cancer patients. British Journal of Nursing27(10), S18-S23.

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Sarkar, S., Sautier, L., Schilling, G., Bokemeyer, C., Koch, U., & Mehnert, A. (2015). Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients. Journal of Cancer Survivorship9(4), 567-575.

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Vartolemei, L., Ferro, M., Mirone, V., Shariat,S.F.,  & Vartolomei, M.D. ( 2018). Systematic Review: Depression and anxiety prevalence in bladder cancer patients. Bladder Cancer.4(3), 319-326.doi:10.3233/BLC-180181.

Watts, S., Prescott, P., Mason, J., McLeod, N., & Lewith, G. (2015). Depression and anxiety in ovarian cancer: A systemic review and meta-analysis of prevalence rates. British Medical Journal. 5(11), e007618. doi:10.1136/bmjopen-2015-007618.

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