Participants
The cross-sectional study recruited patients with lung cancer who were hospitalized in the Oncology Department of Guang’anmen Hospital, a Grade 3A TCM hospital in Beijing, between January 1 and December 31, 2019. The diagnosis and Tumor Node Metastasis (TNM) staging of lung cancer referred to “Chinese guidelines for diagnosis and treatment of primary lung cancer 2018 (English version)” [12].
Inclusion criteria were:(i) diagnosed with primary bronchial lung cancer by pathology and/or cytology. (ii) aware of having lung cancer. (iii) hospitalized in the oncology department of Guang'anmen Hospital for the first time in 2019. (iv) aged ≥18 years. (v)can communicate with clinicians and cooperate with investigation. (vi) can understand the questions included in the questionnaire.
Exclusion criteria were: (i)uncertain cancer diagnosis. (ii)schizophrenia or other psychiatric disorders. (iii) acute or unstable complications. (iv) poor compliance and unwilling to complete data filling. (v)cognitive impairment.
Procedures
The proposal was approved by the Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (reference number:2016-048-KY-02). Potential participants were approached and invited to this study on the first day when they were admitted to the hospital ward. This was a convenience sample. The study was conducted in the oncology ward of Guang'anmen Hospital. After the inclusion criteria of patients were determined, the method and purpose of the research were explained to them. After the patients provided written informed consent, their information was collected. The study was conducted in compliance with the Declaration of Helsinki.
Measurements
All evaluation data would be collected on the first day of patients' hospitalization. (1) General information including name, age, gender, and medical insurance. (2)Clinical information including: Disease course(days), treatment method(surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy), BMI, NRS score, KPS score, pathological classification, TNM staging, tobacco smoking, and other chronic comorbid conditions information. (3)Clinical symptoms including: poor appetite, cough, constipation, diarrhea and insomnia. (4)Observation indexes were PHQ-9(9-Item Patient Health Questionnaire) [13]and GAD-7(7-Item Generalized Anxiety Disorder )[14] scales score, which had been validated to Chinese for evaluating the depression and anxiety respectively[15]. General information and partial clinical information were gathered from the medical records available. Another partial clinical information, clinical symptoms and observation indexes of two scales score were obtained from the patients directly.
Depression
The PHQ-9 was a 9-item scoring scale designed and validated for diagnosis and grading depression based on DSM-IV criteria, including the following aspects : (1) anhedonia; (2) depressed mood; (3) trouble sleeping; (4) feeling tired; (5) change in appetite; (6) guilt, self-blame, or worthlessness; (7) trouble concentrating; (8) feeling slowed down or restless; (9) thoughts of being better off dead or hurting oneself [16]. Symptoms are rated using a 4-point scale (0 - never; 1 – several days; 2 - more than half the time; 3 - nearly every day) regarding the past two weeks experienced. The overall scores ranged from 0 to 27. Total score 0-4 points indicated the lack of any depression disorder, 5-9 indicated mild depression,10-14 indicated moderate depression,15-19 indicated moderate and severe depression, and 20-27 indicated severe depression.
Anxiety
GAD-7 [17] was a questionnaire designed to assess anxiety symptoms. Patients were invited to answer 7 questions assessing past two-weeks period. Questions: (1) Feeling nervous, anxious or on edge;(2) Not being able to stop or control worrying; (3) Worrying too much about different things; (4) Trouble relaxing;(5) Being so restless that was hard to sit still;(6) Becoming easily annoyed or irritable; (7) Feeling afraid as if something awful might happen. Four alternatives are offered: (A)Not at all;(B) Several days;(C) More than half the days;(D) Nearly every day. Scores could range from 0 to 21. Total score 0-4 points indicated no anxiety, 5-9 indicated mild anxiety,10-13 indicated moderate anxiety,14-18 indicated moderate and severe anxiety, and 19-21 indicated severe anxiety.
Chronic comorbid conditions and Physical symptom burden
To analyze the chronic comorbid conditions and physical symptoms associated with depression and anxiety, four common chronic medical conditions were added: Hypertension, Diabetes Mellitus, Coronary Heart Disease, Hyperlipidemia. And five common physical symptoms were added: insomnia, cough, constipation, diarrhea and poor appetite, which assessed by Guidelines for clinical research of Traditional Chinese Drug Research [18].
Statistical analyses
The SPSS 24.0 software was used for statistical analysis of all data, using a two-sided difference test. P ≤ 0.05 is considered statistically significant. Descriptive statistics for both continuous (frequencies, mean, standard deviation) and categorical variables (frequencies, percentages) were calculated. Comparisons between depression/anxiety and non-depression/non-anxiety groups were performed in a one-way analysis of variance. To identify significant factors associated with depression and anxiety inpatients with lung cancer, a multivariate logistic regression model was used after univariate analysis.