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The sixth vital sign

One in four cancer patients has anxiety disorder.

Significant numbers of cancer patients experiencing anxiety post diagnosis are seeing their condition escalate to a clinical disorder because they are not being picked up early enough and referred for treatment.

In a presentation today to the Clinical Oncological Society of Australia’s Annual Scientific Meeting, psycho-oncologist Jane Fletcher will explain that around 25 per cent of cancer patients meet the criteria for an anxiety disorder, with 3 per cent suffering post traumatic stress disorder.

“There is a lot of under-reporting, unmet need and high levels of morbidity,” Fletcher said.

“The impact on cancer patients and family members can be significant and long-term.”

Disorders range from general anxiety to panic and post traumatic stress, phobic reactions such as needle phobia and conditioned responses such as anticipatory nausea.

“Patients’ conditions can rapidly escalate from general anxiety to more serious issues, such as panic attacks. In some cases they are incapable of leaving the house,” Fletcher said.

“Unfortunately, we don’t have the clinical culture or training to readily identify and intervene early enough. Without encouragement and support from health professionals, patients won’t raise issues and tend to think anxiety is something they just have to put up with.”

Fletcher said there was high level evidence to support a range of non-pharmacological interventions such as relaxation therapies, cognitive behavioural therapy and hypnosis.

“But we need oncologists, GPs and other health professionals to be more adept at noticing when their patients exhibit signs of anxiety or distress and to take appropriate action.”

Professor Bruce Mann, Clinical Oncological Society of Australia president, said the push by COSA and other clinical groups around the world to have ‘distress’ recognised as the sixth vital sign (after temperature, blood pressure, pulse, respiratory rate and pain) would ensure health professionals became more cognisant of the issue and incorporate it as a routine part of patient assessment.

“For those of us working in chronic diseases like cancer, the disease itself is often so debilitating, we sometimes neglect to pay enough attention to what can be very serious issues such as anxiety,” he said.

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