Brocken, P., Prins, J.B., Dekhuijzen, P.N., & van der Heijden, H.F. (2012). The faster the better? A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psycho-Oncology, 21(1), 1-10.

Purpose

STUDY PURPOSE: To synthesize the evidence regarding the effect of rapid diagnostic approaches on anxiety in patients with cancer

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, PsycINFO, and Cochrane Collaboration
 
KEYWORDS: Neoplasm, anxiety, distress, stress, quality of life (QOL), and psychological
 
INCLUSION CRITERIA: Patients scheduled to undergo at least one invasive diagnostic procedure; suspicion of cancer; pre- and post-use of at least one validated measure for anxiety, QOL, or depression; follow-up within six weeks
 
EXCLUSION CRITERIA: Small pilot studies, abstracts, studies involving cancer screening, studies involving surgery, and editorials and letters

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,846
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: No quality rating identified

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED: 23
  • TOTAL PATIENTS INCLUDED IN REVIEW: 3,663
  • SAMPLE RANGE ACROSS STUDIES: 27-583 patients
  • KEY SAMPLE CHARACTERISTICS: Most (16) studies involved patients with breast cancer.

Phase of Care and Clinical Applications

PHASE OF CARE: Diagnostic

Results

Patients receiving a benign diagnosis showed significant decreases in anxiety. Women eventually diagnosed with breast cancer had either increased or sustained anxiety levels; however, increases were not statistically significant in all but one study. Findings were mixed in this regard across studies involving prostate and ovarian cancer and melanoma. Among suspected breast cancer cases, 46%-73% had anxiety scores (Hospital Anxiety and Depression Scale [HADS] instrument) that were ≥ 8, indicating at least borderline clinically relevant anxiety. In studies using the State-Trait Anxiety Inventory (STAI) tool, suspected patients with breast cancer had mean STAI scores between 40.1 and 60, with a score of 44 being considered high anxiety. Three studies examined the effect of rapid diagnostic evaluation in breast cancer. One study found significantly larger reduction in anxiety after 24 hours in a one-stop evaluation versus two-stop evaluation; however, this difference disappeared after three weeks. In all studies, anxiety declined significantly among those who had benign result when results were obtained more quickly. In all studies, there were small numbers of patients who were diagnosed with benign disease.

Conclusions

Rapid diagnostic pathways reduce anxiety in patients with benign disease.

Limitations

No evaluation of the quality of studies was included.

Nursing Implications

Findings that anxiety declines in patients with benign disease are not surprising. Findings confirm that the more quickly one receives a benign diagnosis, the more quickly related anxiety is reduced. The emotional impact during the diagnostic phase related to cancer can be substantial. Use of one-stop rapid diagnosis can result in a shorter period of uncertainty and related anxiety.

Legacy ID

3562