Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | All Patients (n = 172) |
---|---|
Age | |
Mean | 52 |
Median | 53 |
Standard deviation (SD) | 14.4 |
Range | 19–87 |
Unknown | n = 5 |
Sex—n (%) | |
Male | 73 (42%) |
Female | 99 (58%) |
Marital Status—n (%) | |
Married | 89 (52%) |
Single | 46 (27%) |
Divorced | 22 (13%) |
Unknown | 7 (4%) |
Widowed | 6 (3%) |
Common-law | 2 (1%) |
Cancer Type—n (%) | |
Breast | 32 (19%) |
Gastrointestinal | 24 (14%) |
Hematologic | 22 (13%) |
Head and neck | 21 (12%) |
Gynecologic | 19 (11%) |
Lung | 11 (6%) |
Brain | 8 (5%) |
Lymphoma | 7 (4%) |
Other | 28 (17%) |
Anxiety based on psychiatric assessment (reference gold standard)—n (%) | |
Yes | 39 (23%) |
No | 133 (77%) |
Depression based on psychiatric assessment (reference gold standard)—n (%) | |
Yes | 59 (34%) |
No | 113 (66%) |
PHQ Cut-Off | True Positives | True Negatives | False Positives | False Negatives | Sensitivity | Specificity | PPV | NPV | Likelihood Ratios | |
---|---|---|---|---|---|---|---|---|---|---|
No. of Correctly Predicted Events | No. of Correctly Predicted Non-Events | No. of Non-Events Predicted as Events | No. of Events Predicted as Non-Events | |||||||
LR Positive | LR Negative | |||||||||
≥0 | 59 | 0 | 113 | 0 | 1.00 | 0.00 | 0.34 | ― | 1.00 | ― |
≥1 | 59 | 3 | 110 | 0 | 1.00 | 0.03 | 0.35 | 1.00 | 1.03 | 0.00 |
≥2 | 59 | 5 | 108 | 0 | 1.00 | 0.04 | 0.35 | 1.00 | 1.05 | 0.00 |
≥3 | 59 | 10 | 103 | 0 | 1.00 | 0.09 | 0.36 | 1.00 | 1.10 | 0.00 |
≥4 | 59 | 12 | 101 | 0 | 1.00 | 0.11 | 0.37 | 1.00 | 1.12 | 0.00 |
≥5 | 59 | 22 | 91 | 0 | 1.00 | 0.19 | 0.39 | 1.00 | 1.24 | 0.00 |
≥6 | 58 | 29 | 84 | 1 | 0.98 | 0.26 | 0.41 | 0.97 | 1.32 | 0.07 |
≥7 | 53 | 35 | 78 | 6 | 0.90 | 0.31 | 0.40 | 0.85 | 1.30 | 0.33 |
≥8 | 50 | 44 | 69 | 9 | 0.85 | 0.39 | 0.42 | 0.83 | 1.39 | 0.39 |
≥9 | 48 | 49 | 64 | 11 | 0.81 | 0.43 | 0.43 | 0.82 | 1.44 | 0.43 |
≥10 | 43 | 59 | 54 | 16 | 0.73 | 0.52 | 0.44 | 0.79 | 1.53 | 0.52 |
≥11 | 39 | 69 | 44 | 20 | 0.66 | 0.61 | 0.47 | 0.78 | 1.70 | 0.56 |
≥12 | 36 | 72 | 41 | 23 | 0.61 | 0.64 | 0.47 | 0.76 | 1.68 | 0.61 |
≥13 | 35 | 78 | 35 | 24 | 0.59 | 0.69 | 0.50 | 0.76 | 1.92 | 0.59 |
≥14 | 31 | 86 | 27 | 28 | 0.53 | 0.76 | 0.53 | 0.75 | 2.20 | 0.62 |
≥15 | 28 | 92 | 21 | 31 | 0.47 | 0.81 | 0.57 | 0.75 | 2.55 | 0.65 |
≥16 | 26 | 94 | 19 | 33 | 0.44 | 0.83 | 0.58 | 0.74 | 2.62 | 0.67 |
≥17 | 24 | 100 | 13 | 35 | 0.41 | 0.88 | 0.65 | 0.74 | 3.54 | 0.67 |
≥18 | 19 | 104 | 9 | 40 | 0.32 | 0.92 | 0.68 | 0.72 | 4.04 | 0.74 |
≥19 | 16 | 106 | 7 | 43 | 0.27 | 0.94 | 0.70 | 0.71 | 4.38 | 0.78 |
≥20 | 14 | 109 | 4 | 45 | 0.24 | 0.96 | 0.78 | 0.71 | 6.70 | 0.79 |
≥21 | 11 | 111 | 2 | 48 | 0.19 | 0.98 | 0.85 | 0.70 | 10.53 | 0.83 |
≥22 | 11 | 111 | 2 | 48 | 0.19 | 0.98 | 0.85 | 0.70 | 10.53 | 0.83 |
≥23 | 8 | 111 | 2 | 51 | 0.14 | 0.98 | 0.80 | 0.69 | 7.66 | 0.88 |
≥24 | 6 | 111 | 2 | 53 | 0.10 | 0.98 | 0.75 | 0.68 | 5.75 | 0.91 |
≥25 | 4 | 112 | 1 | 55 | 0.07 | 0.99 | 0.80 | 0.67 | 7.66 | 0.94 |
≥26 | 1 | 112 | 1 | 58 | 0.02 | 0.99 | 0.50 | 0.66 | 1.92 | 0.99 |
≥27 | 1 | 112 | 1 | 58 | 0.02 | 0.99 | 0.50 | 0.66 | 1.92 | 0.99 |
Diagnosis of Depression | Not Diagnosed with Depression | ||||||||||
DART Measure | Mean | Median | SD | Min | Max | Mean | Median | SD | Min | Max | p Value |
ESAS Depression (ESAS-D) | 6.19 | 7.00 | 2.78 | 0 | 10 | 4.22 | 4.00 | 2.78 | 0 | 10 | <0.0001 |
PHQ-9 | 14.53 | 14.00 | 6.12 | 5 | 27 | 9.67 | 9.00 | 5.45 | 0 | 27 | <0.0001 |
Diagnosis of Anxiety | Not Diagnosed with Anxiety | ||||||||||
ESAS Anxiety (ESAS-A) | 5.77 | 6.00 | 2.90 | 0 | 10 | 5.36 | 6.00 | 2.77 | 0 | 10 | 0.39 |
GAD-7 | 10.08 | 9.00 | 6.25 | 0 | 21 | 8.53 | 8.00 | 5.83 | 0 | 21 | 0.18 |
SD = Standard deviation |
Parameter | Prescribed Medication | Estimate | Standard Error | Chi-Square | Pr > Chi-Square |
---|---|---|---|---|---|
PHQ-9 Summed Score | Antidepressant | 0.0671 | 0.0324 | 4.28 | 0.0386 |
Anxiolytic | 0.0891 | 0.0443 | 4.06 | 0.044 | |
Both | 0.1817 | 0.0454 | 16.02 | <0.0001 | |
GAD-7 Summed Score | Antidepressant | −0.00095 | 0.0327 | 0 | 0.9769 |
Anxiolytic | 0.0817 | 0.0443 | 3.4 | 0.0652 | |
Both | 0.0938 | 0.0435 | 4.64 | 0.0312 |
Parameter | DF | Estimate | Standard Error | Wald 95% Confidence Limits Min. | Wald 95% Confidence Limits Max. | Wald Chi-Square | Pr > Chi-Square | |
---|---|---|---|---|---|---|---|---|
PHQ Summed Score | 1 | 0.0408 | 0.0053 | 0.0303 | 0.0512 | 58.46 | <0.0001 | |
Age | 1 | −0.0015 | 0.0027 | −0.0067 | 0.0037 | 0.33 | 0.5682 | |
Sex | F vs. M | 1 | 0.1054 | 0.0738 | −0.0393 | 0.25 | 2.04 | 0.1533 |
Advanced Stage | No vs. Yes | 1 | 0.7111 | 0.0915 | 0.5318 | 0.8904 | 60.43 | <0.0001 |
GAD Summed Score | 1 | 0.0373 | 0.0056 | 0.0264 | 0.0483 | 44.47 | <0.0001 | |
Age | 1 | −0.0007 | 0.0027 | −0.006 | 0.0046 | 0.07 | 0.7942 | |
Sex | F vs. M | 1 | 0.0881 | 0.0738 | −0.0566 | 0.2327 | 1.42 | 0.2328 |
Advanced Stage | No vs. Yes | 1 | 0.7011 | 0.0915 | 0.5217 | 0.8805 | 58.68 | <0.0001 |
PHQ-9 SUMMED SCORE | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cutoff | ≥11 | ≥12 | ≥13 | ≥14 | ≥15 | ≥16 | ≥17 | ≥18 | |||||||||
+ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | ||
≥1 | 49% | 7% | 49% | 8% | 52% | 8% | 56% | 8% | 59% | 8% | 60% | 9% | 67% | 9% | 70% | 9% | |
ESAS Depression | ≥2 | 50% | 10% | 50% | 11% | 53% | 11% | 57% | 11% | 60% | 12% | 61% | 12% | 68% | 12% | 71% | 13% |
≥3 | 53% | 11% | 52% | 12% | 56% | 11% | 59% | 12% | 63% | 12% | 63% | 13% | 70% | 13% | 73% | 14% | |
≥4 | 53% | 13% | 53% | 15% | 56% | 14% | 60% | 15% | 63% | 15% | 64% | 16% | 71% | 16% | 73% | 17% | |
≥5 | 58% | 12% | 58% | 13% | 61% | 12% | 64% | 13% | 68% | 13% | 68% | 14% | 74% | 14% | 77% | 15% | |
≥6 | 58% | 12% | 58% | 13% | 61% | 12% | 64% | 13% | 68% | 13% | 68% | 14% | 74% | 14% | 77% | 15% |
Depression | Anxiety | |||||
---|---|---|---|---|---|---|
Performance Index | ESAS-D | PHQ-9 | Two-Step | ESAS-A | GAD-7 | Two-Step |
Cutoff | ≥2 | ≥15 | ≥2 → ≥15 | ≥2 | ≥15 | ≥2 → ≥15 |
Sensitivity | 0.92 | 0.47 | - | 0.92 | 0.26 | - |
Specificity | 0.21 | 0.81 | - | 0.13 | 0.80 | - |
Likelihood ratio positive | 1.16 | 2.55 | - | 1.06 | 1.31 | - |
Likelihood ratio negative | 0.40 | 0.65 | - | 0.60 | 0.92 | - |
Post-test probability positive | 37% | 57% | 60% | 24% | 28% | 29% |
Post-test probability negative | 17% | 25% | 12% | 15% | 22% | 14% |
Outcome = Diagnosis of depression | Area Under the Curve (AUC) | −2 Log likelihood | Deviance | p value |
ESAS Depression Score | 0.70 | 202.69 | 8.87 | Top of Form |
ESAS Depression Score + PHQ Summed Score | 0.73 | 193.82 | 0.003 | |
Outcome = Diagnosis of anxiety | AUC | −2 Log likelihood | Deviance | p value |
ESAS Anxiety Score | 0.55 | 183.50 | 1.51 | Top of Form |
ESAS Anxiety Score + GAD Summed Score | 0.57 | 181.98 | 0.22 |
GAD-7 Cutoff | True Positives | True Negatives | False Positives | False Negatives | Sensitivity | Specificity | PPV | NPV | Likelihood Ratios | |
---|---|---|---|---|---|---|---|---|---|---|
No. of Correctly Predicted Events | No. of Correctly Predicted Non-Events | No. of Non-Events Predicted as Events | No. of Events Predicted as Non-Events | LR Positive | LR Negative | |||||
≥0 | 39 | 0 | 133 | 0 | 1.00 | 0.00 | 0.23 | ― | 1.00 | ― |
≥1 | 37 | 7 | 126 | 2 | 0.95 | 0.05 | 0.23 | 0.78 | 1.00 | 0.97 |
≥2 | 36 | 14 | 119 | 3 | 0.92 | 0.11 | 0.23 | 0.82 | 1.03 | 0.73 |
≥3 | 35 | 24 | 109 | 4 | 0.90 | 0.18 | 0.24 | 0.86 | 1.10 | 0.57 |
≥4 | 33 | 30 | 103 | 6 | 0.85 | 0.23 | 0.24 | 0.83 | 1.09 | 0.68 |
≥5 | 30 | 39 | 94 | 9 | 0.77 | 0.29 | 0.24 | 0.81 | 1.09 | 0.79 |
≥6 | 29 | 51 | 82 | 10 | 0.74 | 0.38 | 0.26 | 0.84 | 1.21 | 0.67 |
≥7 | 27 | 56 | 77 | 12 | 0.69 | 0.42 | 0.26 | 0.82 | 1.20 | 0.73 |
≥8 | 22 | 63 | 70 | 17 | 0.56 | 0.47 | 0.24 | 0.79 | 1.07 | 0.92 |
≥9 | 20 | 76 | 57 | 19 | 0.51 | 0.57 | 0.26 | 0.80 | 1.20 | 0.85 |
≥10 | 19 | 81 | 52 | 20 | 0.49 | 0.61 | 0.27 | 0.80 | 1.25 | 0.84 |
≥11 | 18 | 86 | 47 | 21 | 0.46 | 0.65 | 0.28 | 0.80 | 1.31 | 0.83 |
≥12 | 17 | 92 | 41 | 22 | 0.44 | 0.69 | 0.29 | 0.81 | 1.41 | 0.82 |
≥13 | 14 | 100 | 33 | 25 | 0.36 | 0.75 | 0.30 | 0.80 | 1.45 | 0.85 |
≥14 | 11 | 103 | 30 | 28 | 0.28 | 0.77 | 0.27 | 0.79 | 1.25 | 0.93 |
≥15 | 10 | 107 | 26 | 29 | 0.26 | 0.80 | 0.28 | 0.79 | 1.31 | 0.92 |
≥16 | 9 | 112 | 21 | 30 | 0.23 | 0.84 | 0.30 | 0.79 | 1.46 | 0.91 |
≥17 | 8 | 119 | 14 | 31 | 0.21 | 0.89 | 0.36 | 0.79 | 1.95 | 0.89 |
≥18 | 7 | 121 | 12 | 32 | 0.18 | 0.91 | 0.37 | 0.79 | 1.99 | 0.90 |
≥19 | 4 | 123 | 10 | 35 | 0.10 | 0.92 | 0.29 | 0.78 | 1.36 | 0.97 |
≥20 | 4 | 125 | 8 | 35 | 0.10 | 0.94 | 0.33 | 0.78 | 1.71 | 0.95 |
≥21 | 3 | 130 | 3 | 36 | 0.08 | 0.98 | 0.50 | 0.78 | 3.41 | 0.94 |
GAD-7 Summed Score | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cutoff | ≥11 | ≥12 | ≥13 | ≥14 | ≥15 | ≥16 | ≥17 | ≥18 | |||||||||
+ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | +ve | −ve | ||
≥1 | 29% | 8% | 31% | 8% | 31% | 8% | 28% | 9% | 29% | 9% | 32% | 9% | 38% | 8% | 39% | 8% | |
ESAS Anxiety | ≥2 | 29% | 13% | 31% | 13% | 31% | 13% | 28% | 14% | 29% | 14% | 32% | 14% | 38% | 14% | 39% | 14% |
≥3 | 26% | 28% | 28% | 27% | 28% | 28% | 25% | 30% | 26% | 30% | 28% | 30% | 35% | 29% | 35% | 29% | |
≥4 | 28% | 19% | 30% | 19% | 31% | 19% | 28% | 21% | 29% | 21% | 31% | 21% | 37% | 20% | 38% | 20% | |
≥5 | 29% | 18% | 31% | 17% | 32% | 18% | 29% | 19% | 30% | 19% | 32% | 19% | 38% | 19% | 39% | 19% | |
≥6 | 29% | 18% | 31% | 17% | 32% | 18% | 29% | 19% | 30% | 19% | 32% | 19% | 38% | 19% | 39% | 19% |
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Gascon, B.; Elman, J.; Macedo, A.; Leung, Y.; Rodin, G.; Li, M. Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data. Curr. Oncol. 2024, 31, 6488-6501. https://doi.org/10.3390/curroncol31110481
Gascon B, Elman J, Macedo A, Leung Y, Rodin G, Li M. Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data. Current Oncology. 2024; 31(11):6488-6501. https://doi.org/10.3390/curroncol31110481
Chicago/Turabian StyleGascon, Bryan, Joel Elman, Alyssa Macedo, Yvonne Leung, Gary Rodin, and Madeline Li. 2024. "Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data" Current Oncology 31, no. 11: 6488-6501. https://doi.org/10.3390/curroncol31110481