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
APA StyleGascon, B., Elman, J., Macedo, A., Leung, Y., Rodin, G., & Li, M. (2024). Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data. Current Oncology, 31(11), 6488-6501. https://doi.org/10.3390/curroncol31110481