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REVIEW ARTICLE

Psychometric and clinical utility of the Hospital Anxiety and Depression Scale in cancer patients: A narrative review on the Albanian population

Eralba Zenelaj1 ,  Jasemin Todri1* ,  Orges Lena1
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1 Physiotherapy Department, Innovation in Manual and Physical Therapies (ITEM), Faculty of Physiotherapy, Podiatry and Occupational Therapy, San Antonio Catholic University of Murcia (UCAM), Murcia, Spain
EJMO, 026060067 https://doi.org/10.36922/EJMO026060067
Received: 5 February 2026 | Revised: 26 March 2026 | Accepted: 21 April 2026 | Published online: 19 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Anxiety and depression are highly prevalent among patients with cancer and negatively affect quality of life, treatment adherence, and clinical outcomes. The Hospital Anxiety and Depression Scale (HADS) is widely used in oncology due to its brevity and limited overlap with somatic symptoms. However, its psychometric performance varies across cultural and clinical settings, requiring context-specific evaluation. This study summarizes and compares evidence regarding the psychometric properties, factor structure, and clinical utility of the HADS in adult patients with cancer, and identifies gaps in cross-cultural validation, particularly the absence of an Albanian version. A narrative review of studies was conducted using major electronic databases. Validation studies, cross-cultural adaptations, systematic reviews, and meta-analyses assessing the HADS in patients with cancer were included. Evidence on reliability, validity, factor structure, and diagnostic performance was synthesized descriptively. Across diverse patient populations with cancer, the HADS demonstrated acceptable to excellent internal consistency, with Cronbach’s α values generally exceeding 0.70 for both subscales. Most studies supported the original two-factor structure, although alternative models were reported in some cultural contexts. Meta-analytic findings indicated moderate to good diagnostic accuracy for detecting clinically significant anxiety and depression. Numerous language adaptations confirmed its international applicability; however, variability in optimal cut-off scores and factor structures was observed. No validated Albanian version for cancer patients was found. The HADS is a reliable and practical screening tool in oncology. The absence of a validated Albanian version highlights the need for culturally adapted psychometric studies to support effective psychosocial screening in Albanian-speaking cancer populations.

Graphical abstract
Keywords
Hospital Anxiety and Depression Scale
Cancer
Oncology
Psychometric validation
Cross-cultural adaptation
Psychological distress
Albanian population
Funding
None.
Conflict of interest
The authors declare no conflict of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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