Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic

- OBJECTIVE: Patients with chron-ic disease whose treatments are limited may ex-perience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure.PATIENTS AND METHODS: 118 patients with ad-vanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a do-nor were enrolled. To evaluate the stress, depres-sion, and anxiety levels during the COVID-19 pro-cess, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were ad-ministered to 118 patients through a face-to-face interview. Sociodemographic and clinical charac-teristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was con-structed to predict the scores of the DASS-21 total.RESULTS: There were significant differences be-tween DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not sig-nificant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most im-portant predictors for the DASS total. CONCLUSIONS: Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. There-fore, the crucial factors were clinically consid-ered for managing depression, stress, and anxi-ety in HCC patients.