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. 2015 Nov;24(11):1477-84.
doi: 10.1002/pon.3758. Epub 2015 Feb 17.

Posttraumatic stress and depressive symptoms in renal cell carcinoma: association with quality of life and utility of single-item distress screening

Seema Malhotra Thekdi  1 , Kathrin Milbury  2 , Amy Spelman  2 , Qi Wei  2 , Christopher Wood  3 , Surena F Matin  3 , Nizar Tannir  4 , Eric Jonasch  4 , Louis Pisters  3 , Lorenzo Cohen  2
Affiliations

Posttraumatic stress and depressive symptoms in renal cell carcinoma: association with quality of life and utility of single-item distress screening

Seema Malhotra Thekdi et al. Psychooncology. 2015 Nov.

Abstract

Objective: The purpose of this study was to examine the prevalence of posttraumatic stress symptoms (PTSS) in patients with renal cell carcinoma (RCC), the associations and co-occurrence between PTSS, depressive, and other cancer-related symptoms and the ability of a single-item distress question to identify patients with PTSS.

Methods: Patients with stage I-IV RCC completed assessments of depressive symptoms (Center for Epidemiologic Studies Depression Scale), PTSS (Impact of Event Scale), cancer-related symptoms (MD Anderson Symptom Inventory), fatigue (Brief Fatigue Inventory), and sleep disturbance (Pittsburgh Sleep Quality Index). We used the distress item on the MD Anderson Symptom Inventory as a distress screener and general linear model analyses to test study hypotheses.

Results: Of the 287 patients (29% stage IV; 42% female; mean age = 58 years), 46% (n = 131) reported psychiatric symptoms with 15% (n = 44) reporting comorbid clinical levels of depressive symptoms and PTSS, 24% (n = 70) PTSS alone, and 6% (n = 17) depressive symptoms alone. Controlling for age, gender, and stage, patients with comorbid depressive symptoms and PTSS reported more cancer-related symptoms (p < 0.0001), fatigue (p < 0.0001), and sleep disturbance (p = 0.0003) than those with PTSS alone and more cancer-related symptoms (p = 0.002) and fatigue (p = 0.09) than those with depressive symptoms alone. Sensitivity analyses revealed that 26.9% of negative cases on the distress item fell within the clinical range of the Impact of Event Scale and 9.3% of negative cases met caseness on the Center for Epidemiologic Studies Depression Scale.

Conclusions: Posttraumatic stress symptoms occurred both independently and comorbid with depressive symptoms in patients with RCC. PTSS were correlated with overall cancer symptom burden. Single-item distress screening was less sensitive in detecting PTSS than depressive symptoms. Therefore, additional screening strategies are required in the clinical setting.

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Figures

Figure 1
Figure 1
Least square means for the associations between the four psychiatric groups of comorbid symptoms (comorbid), posttraumatic symptoms alone (PTSS), depressive symptoms alone (depressive), or neither; and a) cancer-related symptoms severity (MDASI-Symptom Severity), cancer-related symptoms interference (MDASI-Interference), fatigue (BFI), and sleep disturbances (PSQI). +, denotes excluding “sadness” and “distress” items. *, denotes a significant difference from the comorbid group at P<0.05; **, significant difference from the neither PTSS nor depressive symptom group at P<0.05.
Figure 1
Figure 1
Least square means for the associations between the four psychiatric groups of comorbid symptoms (comorbid), posttraumatic symptoms alone (PTSS), depressive symptoms alone (depressive), or neither; and a) cancer-related symptoms severity (MDASI-Symptom Severity), cancer-related symptoms interference (MDASI-Interference), fatigue (BFI), and sleep disturbances (PSQI). +, denotes excluding “sadness” and “distress” items. *, denotes a significant difference from the comorbid group at P<0.05; **, significant difference from the neither PTSS nor depressive symptom group at P<0.05.
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