High anxiety and depression scores and mental health service use among South Asian advanced cancer patients: A multi-country study.

Journal Article (Journal Article)


Addressing symptoms of anxiety and depression is important in cancer palliative care. However, little information exists on the prevalence of anxiety and depression and mental health service use among advanced cancer patients in South Asia.


To examine among South Asian advanced cancer patients, the 1) prevalence of high anxiety and depression scores, 2) factors associated with high anxiety and depression scores, and 3) mental health service use.


This cross-sectional, multi-site study recruited patients receiving oncology care across six major public hospitals in India, Bangladesh and Sri Lanka. Participants were adults, diagnosed with stage IV metastatic solid cancer and aware they had cancer. Participants' high anxiety and depression scores (using clinically-relevant Hospital Anxiety and Depression Scale threshold of >10), sociodemographic characteristics, patient-perceived cancer stigma and mental health service use were assessed.


In the overall sample (N = 1140), 54% met threshold for high anxiety and/or depression scores: 32% reported high anxiety scores and 47% reported high depression scores. Symptom burden (OR's [95% CI's] = 1.09-1.13 [1.05-1.09, 1.12-1.17]) and perceived stigma (1.11-1.16 [1.06-1.11, 1.16-1.22]) were statistically significantly associated with high anxiety and depression scores. Of the patients with high anxiety and/or depression scores (n = 617), 97% had not received mental health services, and 38% of them indicated they were open to a referral.


High, clinically-relevant anxiety and depression scores are common among South Asian advanced cancer patients. Efforts should be made to alleviate psychological morbidity, including providing greater access to supportive/palliative medicine teams or mental health services.

Full Text

Duke Authors

Cited Authors

  • Teo, I; Ozdemir, S; Malhotra, C; Yang, GM; Ocampo, RR; Bhatnagar, S; Hapuarachchi, T; Joad, AK; Mariam, L; Palat, G; Rahman, R; Finkelstein, EA; APPROACH study group,

Published Date

  • November 2021

Published In

Volume / Issue

  • 62 / 5

Start / End Page

  • 997 - 1007

PubMed ID

  • 33872721

Electronic International Standard Serial Number (EISSN)

  • 1873-6513

International Standard Serial Number (ISSN)

  • 0885-3924

Digital Object Identifier (DOI)

  • 10.1016/j.jpainsymman.2021.04.005


  • eng