Leicester General Hospital, Leicester Partnership Trust, Leicester, UK.
Lancet Oncol. 2011 Feb;12(2):160-74. doi: 10.1016/S1470-2045(11)70002-X. Epub 2011 Jan 19.
Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. We aimed to quantitatively summarise the prevalence of depression, anxiety, and adjustments disorders in these settings.
We searched Medline, PsycINFO, Embase, and Web of Knowledge for studies that examined well-defined depression, anxiety, and adjustment disorder in adults with cancer in oncological, haematological, and palliative-care settings. We restricted studies to those using psychiatric interviews. Studies were reviewed in accordance with PRISMA guidelines and a proportion meta-analysis was done.
We identified 24 studies with 4007 individuals across seven countries in palliative-care settings. Meta-analytical pooled prevalence of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria was 16·5% (95% CI 13·1-20·3), 14·3% (11·1-17·9) for DSM-defined major depression, and 9·6% (3·6-18·1) for DSM-defined minor depression. Prevalence of adjustment disorder alone was 15·4% (10·1-21·6) and of anxiety disorders 9·8% (6·8-13·2). Prevalence of all types of depression combined was of 24·6% (17·5-32·4), depression or adjustment disorder 24·7% (20·8-28·8), and all types of mood disorder 29·0% (10·1-52·9). We identified 70 studies with 10,071 individuals across 14 countries in oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4-19·5); for DSM-defined major depression it was 14·9% (12·2-17·7) and for DSM-defined minor depression 19·2% (9·1-31·9). Prevalence of adjustment disorder was 19·4% (14·5-24·8), anxiety 10·3% (5·1-17·0), and dysthymia 2·7% (1·7-4·0). Combination diagnoses were common; all types of depression occurred in 20·7% (12·9-29·8) of patients, depression or adjustment disorder in 31·6% (25·0-38·7), and any mood disorder in 38·2% (28·4-48·6). There were few consistent correlates of depression: there was no effect of age, sex, or clinical setting and inadequate data to examine cancer type and illness duration.
Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30-40% of patients in hospital settings without a significant difference between palliative-care and non-palliative-care settings. Clinicians should remain vigilant for mood complications, not just depression.
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癌症患者中情绪障碍的患病率存在很大的不确定性，包括在肿瘤学、血液学和姑息治疗环境中的患者。我们旨在定量总结这些环境中抑郁、焦虑和适应障碍的患病率。
我们在 Medline、PsycINFO、Embase 和 Web of Knowledge 中搜索了关于癌症成人在肿瘤学、血液学和姑息治疗环境中使用明确界定的抑郁、焦虑和适应障碍的研究。我们将研究限制为使用精神病学访谈的研究。根据 PRISMA 指南对研究进行了审查，并进行了比例荟萃分析。
我们在七个国家的姑息治疗环境中确定了 24 项研究，涉及 4007 人。使用精神疾病诊断和统计手册（DSM）或国际疾病分类（ICD）标准定义的抑郁症的荟萃分析汇总患病率为 16.5%（95%CI 13.1-20.3），DSM 定义的重度抑郁症为 14.3%（11.1-17.9），DSM 定义的轻度抑郁症为 9.6%（3.6-18.1）。单独适应障碍的患病率为 15.4%（10.1-21.6），焦虑症为 9.8%（6.8-13.2）。所有类型抑郁症的综合患病率为 24.6%（17.5-32.4），抑郁症或适应障碍为 24.7%（20.8-28.8），所有类型的情绪障碍为 29.0%（10.1-52.9）。我们在 14 个国家的肿瘤学和血液学环境中确定了 70 项研究，涉及 10071 人。DSM 或 ICD 标准定义的抑郁症患病率为 16.3%（13.4-19.5）；DSM 定义的重度抑郁症为 14.9%（12.2-17.7），DSM 定义的轻度抑郁症为 19.2%（9.1-31.9）。适应障碍的患病率为 19.4%（14.5-24.8），焦虑症为 10.3%（5.1-17.0），心境恶劣为 2.7%（1.7-4.0）。联合诊断很常见；所有类型的抑郁症在 20.7%（12.9-29.8）的患者中发生，抑郁症或适应障碍在 31.6%（25.0-38.7）的患者中发生，任何情绪障碍在 38.2%（28.4-48.6）的患者中发生。抑郁症的一致相关性很少：年龄、性别或临床环境没有影响，癌症类型和疾病持续时间的数据不足，无法进行检查。
与之前的想法相比，使用精神病学访谈定义的癌症患者中的抑郁和焦虑症并不常见，尽管在医院环境中，约有 30-40%的患者存在某种类型的情绪障碍，姑息治疗和非姑息治疗环境之间没有显著差异。临床医生应保持警惕，不仅要注意抑郁症，还要注意情绪并发症。
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