Anxiety and depression in patients with early stage endometrial cancer: A longitudinal analysis from before surgery to 6-month post-surgery

Background: The prevalence of anxiety and depression, and psychological treatment received by patients with endometrial cancer has rarely been studied. The primary aim of this article was to determine the point prevalence and cumulative prevalence of anxiety and depression in patients with endometrial cancer and types of psychological treatment received. The secondary aim was to evaluate the sociodemographic and clinical factors associated with anxiety and depression from before surgery to 6-month post-surgery. Methods: Secondary data analysis of an international, multicenter, prospective randomized controlled trial of surgery for stage I endometrial cancer was conducted. Anxiety and depression was established by the Hospital Anxiety and Depression Scale-21 (HADS). Regression models were fitted to examine the association of sociodemographic and clinical characteristics of patients with anxiety and depression. Results: Based on a HADS subscale score of ≥11, the highest prevalence of anxiety occurred before surgery (16%, n = 51/318), and the highest prevalence of depression just after surgery (6%, n = 18/314), respectively. The cumulative incidence of anxiety only, depression only, or both anxiety and depression in women within a 6-month timeframe was 15.5% (n = 52/334), 1.8% (n = 6/334), and 7.2% (n = 24/334), respectively. Very few of these patients received mental health support. Comorbid conditions, prescriptions of antidepressants or anxiolytics already at baseline, and non-European ethnicity were associated with depression. Conclusions: Up to 16% of patients with endometrial cancer experienced anxiety or depression around the time of diagnosis and treatment, which is lower than reported in broader gynecological cancer samples. The majority of distressed patients did not receive psychological or pharmaceutical treatments. Further research should aim to identify reasons why patients did not receive support to alleviate anxiety and depression.