JMIR Publications

ABSTRACT

Background:

Physicians and nurses in cancer care easily fail to detect symptoms of psychological distress due to barriers such as lack of time, training on screening methods and knowledge about how to diagnose anxiety and depression. National guidelines in several countries recommend routine screening for emotional distress in patients with cancer, but in many clinics, this is not implemented. By inventing screening methods that are time-efficient, such as digitalized and automatized screenings with short instruments, we can alleviate the burden on patients and staff.

Objective:

The objective of this study was to compare online versions of the ultrashort Visual Analogue Scale (eVAS) anxiety and depression and the short Hospital Anxiety and Depression Scale (HADS) with online versions of the longer Montgomery Åsberg Depression Rating Scale – Self-report (MADRS-S) and the State Trait Anxiety Inventory – State (STAI-S) with regard to their ability to identify symptoms of anxiety and depression in patients with cancer.

Methods:

Data was obtained from a consecutive sample of patients with newly diagnosed (<6 months) breast, prostate or colorectal cancer or with recurrence of colorectal cancer (N=558). The patients were recruited at four hospitals in Sweden between April 2013 and September 2015, as part of an intervention study administered via Internet. All questionnaires were completed online at the baseline assessment in the intervention study.

Results:

The ultrashort and short Internet-delivered eVAS anxiety and depression and HADS was found to have an excellent ability to discriminate between persons with and without clinical levels of symptoms of anxiety and depression compared to recommended cutoffs of the longer instruments MADRS-S and STAI-S (AUC: 0.88-0.94). Cutoffs of 6 on HADS Anxiety and 7 hundredths (hs) on VAS Anxiety identified patients with anxiety symptoms with high accuracy. For HADS Depression, at a cutoff of 5 and VAS Depression at a cutoff of 7 hs, the accuracy was likewise very high.

Conclusions:

The use of the short and ultrashort tools eVAS and HADS is a suitable initial method of online screening in busy clinical settings. However, there is still a proportion of patients who lack access to the Internet or the ability to use it. There is a need to find solutions for this group in order to find all the patients with psychological distress. Clinical Trial: ClinicalTrials.gov Identifier: NCT01630681 https://clinicaltrials.gov/ct2/show/NCT01630681?term=NCT01630681&rank=1