Predicting anxiety in hospitalized cancer patients.

Abstract Context Anxiety in cancer patients is highly prevalent, yet remains underestimated and inadequately assessed. Little is known about predictors for anxiety in hospitalized cancer patients. Insight in predictors should improve recognition and enable a targeted approach. Objectives To determine the prevalence of anxiety and predictors for anxiety in hospitalized cancer patients, at different stages of disease. Methods A cross-sectional analysis of cancer patients admitted to the Utrecht University Medical Centre in 2015-2018 was conducted. The Utrecht Symptom Diary, an adapted Dutch version of the Edmonton Symptom Assessment System, was used to assess symptom burden on a numeric rating scale (0=no symptom, 10=worst possible). Scores ≥4 were considered clinically relevant. All patients completed the USD as part of routine care. The first questionnaire after admission was selected. Using multivariable linear regression, the predictive value of potential predictors on anxiety was analyzed. Results In total, 2144 patients were included of which 22% reported clinically relevant anxiety. The prevalence of anxiety was highest (36%) in patients receiving symptom directed palliation only. In the total group, female gender, younger age, depressed mood, sleeping problems, dyspnea and cancer of the head or neck were predictive of anxiety. Throughout all stages of disease, depressed mood was consistently the strongest predictor. Conclusion We found a high prevalence of anxiety in hospitalized cancer patients. It is recommended to explore anxiety in hospitalized cancer patients, in particular when they experience depressed mood. Structural use of a symptom diary during hospitalization facilitates the recognition of anxiety and concurrent symptoms. Key Message This cross-sectional cohort study, in a poorly studied population, determined the prevalence and predictors for anxiety in hospitalized cancer patients at different stages of disease. Results show a high prevalence of anxiety and multiple predictors, which emphasizes the need for structural assessment and intensification of monitoring when predictors are present.