Dr Trish Livingstona, Dr Vicky Whiteb, Professor Michael Jeffordc, Dr Amanda Hordernd, Professor Mari Bottie, Dr Carrie Lethborgf, Dr John Oldroydg
a School of Nursing, Deakin University/Eastern Health
b Centre for Behavioural Research in Cancer, The Cancer Council Victoria
c Division of Haematology and Medical Oncology, Peter MacCallum Cancer Institute
d Cancer Information & Support Service, The Cancer Council Victoria
e School of Nursing, Deakin University/Epworth HealthCare
f Oncology and Social Work, St Vincent’s Hospital
g Medicine, Nursing and Health Sciences, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
Clinical levels of depression and anxiety are diagnosed in approximately one-third of patients with cancer. This pilot study linked survivors of colorectal cancer with an existing telephone information and support service for depression and anxiety. Trained cancer nurses from Cancer Council Victoria’s Cancer Information Support Service telephoned the participants twice – first within seven to ten days of final treatment to establish a baseline, and again five weeks after their final treatment. Nurses used the 14-item Hospital Anxiety and Depression Scale (HADS) to determine the participants’ levels of depression, social support and need for professional mental health services.
The study recruited 39 participants who received one phone call; 35 of these participants received a second call and 34 participants took part in a follow-up interview. Participants ranged in age from 33 to 75, with 59.1 per cent male. Three-quarters were living with partners or family members.
At baseline, the average overall HADS score was 9.75, indicating participants experienced borderline clinical levels of distress. The average HADS score decreased to 8.25 at follow-up, which was not a statistically significant reduction. A sub-scale analysis indicated levels of depression had declined significantly after follow-up, while levels of anxiety had not. There was large variation in scores on the HADS, with the average at baseline 9.75, below the considered cut-off for clinical levels of distress (10-11). Scores at the interview were lower, but not significantly.
About 37 per cent of participants scored over 11 at baseline. This was reduced to 26.5 percent at follow-up. These clinical levels of depression and anxiety are consistent with levels previously found in patients with cancer.
The Distress and Impact Thermometer was used to determine any need for immediate psychological support. A total of four participants were referred to hospital for treatment after displaying high distress levels: one participant was referred following the initial phone call while three participants were referred for treatment after the follow-up phone call. The increase in participants referred after a five-week period suggests the importance of continued support during the survivorship phase of cancer.
Follow-up interviews indicated participants, carers and health professionals were satisfied with the screening and referral services and almost 80 per cent of participants reported feeling better knowing “that someone cared about them”. Approximately 75 per cent of participants reported the initial and follow-up phone calls as either “quite helpful” or “very helpful”. The follow-up call was considered particularly helpful and reassuring.
The significant number of cancer survivors who experienced clinical levels of depression and anxiety indicated that screening was valuable. Thirty per cent of participants took action as a result of the calls, from increasing or decreasing physical activity, to joining a support group or contacting their oncologist about physical symptoms.
Implications for policy, practice and further research
Low numbers of eligible participants reduced the ability to generalise about the findings. However, this pilot program is expected to guide the development of a screening program for people who have overcome cancer and have elevated levels of distress and depression.
Male cancer survivors, survivors without partners and those living alone are less likely to have social support in place, and so programs that offer such support should target those groups.
The planned program resulting from the study will help cancer survivors determine any need for clinical mental health support. Other research may compare the findings with those among people who have overcome other forms of cancer, while another study is proposed to screen for anxiety and depression among people recently diagnosed with cancer.