Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire

Background: The emotional functioning (EF) dimension of the European Organi zation for Research and Treatment of Cancer Quality of Life Questionnaire ( EORTC QLQ C33) and the Hospital Anxiety and Depression Scale (HADS) evaluat e anxiety and depression. We wanted to compare cancer patients' responses t o EF with those to HADS, as well as the impact of anxiety and depression on the quality of life (QL) dimensions of the EORTC QLQ C33. Method: A total of 568 cancer patients completed both the EORTC QLQ C33 and HADS at the sam e occasion. The association between the patients' EF scorings and their HAD S scores was analyzed by multiple linear regression. Gender and age were in cluded as covariates. Results: Statistically significant negative relations were found between EF and HADS-A (anxiety), HADS-D (depression) and HADS-T (total score), respectively, with the highest correlation coefficient for HADS-A. Older patients and males reported less emotional distress assessed by the EF scale than younger ones and females with comparable HADS-T or HAD S-D scores. Both HADS-A and HADS-D were significantly related to other QL d imensions, and depression was a stronger predictor for reduced QL than anxi ety. Conclusion: The EF dimension of EORTC QLQ C33 predominantly assesses a nxiety, whereas depression is rated to a lesser degree. Combined with signi ficant age and gender relations, this implies a risk of underdiagnosed depr ession, if the EORTC QLQ C33 is used as the only instrument to screen for p sychological distress in cancer patients. As depression has a stronger impa ct on global QL of cancer patients than anxiety, the use of an additional i nstrument is recommended for assessment of depression. (C) 2000 Elsevier Sc ience Inc. All rights reserved.