The HADS contains 14 items and consists of two subscales: anxiety and depression. Each item is rated on a four-point scale, giving maximum scores of 21 for anxiety and depression. Scores of 11 or more on either subscale are considered to be a significant 'case' of psychological morbidity, while scores of 8–10 represents 'borderline' and 0–7 'normal' [6 (link)]. Emotional functioning and global quality of life was measured using the EORTC QLQ-C30 subscales. Emotional functioning contains 4 items and each item is rated on a four-point scale and global quality of life contains 2 items and each item is rated on a seven-point scale. A linear transformation was performed to standardize the row scores. Scores of each subscales range from 0 to 100 and the higher values indicate a higher (better) level of functioning and global quality of life [7 ]. Demographic data were collected using a short questionnaire at the patients' first clinic visit and included recording of age, educational level, and marital status. Disease stage was extracted from case records.