A STUDY TO EVALUATE THE PREVALENCE OF DEPRESSION AND ANXIETY AND ITS IMPACT ON QUALITY OF LIFE IN CERVICAL CANCER PATIENTS IN A TERTIARY CARE HOSPITAL

Abstract

BACKGROUND AND OBJECTIVE Among women worldwide, cervical cancer is the fourth most common cancer to be diagnosed. In women, it ranks as the fourth most common cause of cancer related mortality. India accounts for 25% of the world’s mortality rate as well. Women who have cervical cancer are more likely to be depressed and anxious. Patients may experience severe adverse effects from the diagnosis and treatment of cervical cancer, which can significantly lower their quality of life. A cancer diagnosis is often accompanied by significant psychological distress. Multiple studies state the burden of psychiatric morbidities is notable in gynaecology clinic setting. Patients who have depression and anxiety concurrently tend to experience more severe symptoms, require longer period for recovery, use more healthcare resources, and generally face worse prognosis compared to individuals with only one of these disorders. Therefore, evaluation of cancer patients should include persons take on the disease, medical, personal and family history of psychiatric co morbidities along with suicidal tendencies. The present mental and physical condition, treatment side effects and their impact on health are crucial factors to consider. Therefore, the main objective of this research is to evaluate the prevalence of anxiety and depression among the subjects with cervical cancer and to investigate relationship between these conditions and quality of life. METHODOLOGY This cross-sectional observational research study was carried out at R.L.Jalappa Hospital, a teaching hospital of Sri Devaraj Urs Medical College, a constituent college of Sri Devaraj Urs Academy of Higher Education and Research. All in-patients diagnosed with cervical cancer meeting study criteria were interviewed and a pretested, semi structured proforma applied for clinical socio demographic xviii | P a g e profile, relevant scales that is HAM-A, HDRS and EORTC QLQ-C30were applied after obtaining informed consent for same. RESULTS Of the 76 patients studied following findings were revealed- 53.8 years was the average age of subjects in this study. Majority of the research subjects were found to be illiterate (71%), daily wage workers (54%), belonging to BPL category (96%) living in a nuclear setup (68%), bearing 1-3 children (62%), married between15-25 years (74%) and diagnosed within timeframe of 4-26 weeks (79%). A large proportion of study subjects (39%) were diagnosed with cervical cancer, stage 3b. Majority of patients were noted to suffer from moderate-severe anxiety (48.7%) as well as moderate depression (39.5%), along with moderate quality of life (67.1%). The HDRS scores correlated with carcinoma stage showed statistical significance (P=0.0001). Stage 3b, 3c, 4a had severe depression compared to 2b. Patients without formal education had better quality of life when compared to literate (P=0.003). Association of QoL and occupation of the patients also showed statistically significant results (P=0.0079) revealing employed participants to have better QoL compared to unemployed. Correlation of degree of anxiety and depression resulted in P=< 0.01which was significant, likewise was correlation of QoL and level of anxiety (P=0.0048). The association of life quality and depression levels also showed significance (P=0.0002) CONCLUSION This research highlights anxiety and depression prevalence women with carcinoma cervix with moderate quality of life. Cervical cancer is easily treatable if diagnosed early but the burden worsens with coexisting psychiatric morbidities which also impacts the compliance of treatment, mortality and prognosis of the cancer. This study throws light on the need for comprehensive approach to treatment of cervical cancer patients by addressing their mental health and necessary intervention to improve overall outcome in individuals afflicted with cancer of cervix.