Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Psychooncology. 2012 Dec;21(12):1338-45. doi: 10.1002/pon.2032. Epub 2011 Aug 12.
We sought to analyze the prevalence and incremental burden of depression among elderly with prostate cancer.
We adopted a retrospective cohort design using the Surveillance, Epidemiology and End Results-Medicare linked database between 1995 and 2003. Patients with prostate cancer diagnosed between 1995 and 1998 were identified and followed retrospectively for 1 year pre-diagnosis and up to 8 years post diagnosis. In this cohort of patients with prostate cancer, depression during treatment phase (1 year after diagnosis of prostate cancer) or in the follow-up phase was identified using the International Classification of Diseases-Ninth Revision depression-related codes. Poisson, general linear (log-link) and Cox regression models were used to determine the association between depression status during treatment and follow-up phases and outcomes-health resource utilization, cost and mortality.
Of the 50,147 patients newly diagnosed with prostate cancer, 4285 (8.54%) had a diagnosis of depression. A diagnosis of depression during treatment phase was associated with higher odds of emergency room visits (odds ratio (OR) = 4.45, 95% CI = 4.13, 4.80), hospitalizations (OR = 3.22, CI = 3.08, 3.37), outpatient visits (OR = 1.71, CI = 1.67, 1.75) and excess risk of death over the course of the follow-up interval (hazard ratio = 2.82, CI = 2.60, 3.06). Health care costs associated with depression remained elevated compared with costs for men without depression, over the course of the follow-up.
Depression during the treatment phase was associated with significant health resource utilization, costs and mortality among men with prostate cancer. These findings emphasize the need to effectively identify and treat depression in the setting of prostate cancer.
分析老年前列腺癌患者中抑郁的患病率和增量负担。
我们采用了回顾性队列设计，使用了 1995 年至 2003 年间的监测、流行病学和最终结果-医疗保险数据库。确定了 1995 年至 1998 年期间诊断为前列腺癌的患者，并对其进行了回顾性随访，随访时间为诊断前 1 年和诊断后 8 年。在这组前列腺癌患者中，使用国际疾病分类第九版与抑郁相关的代码确定治疗期间（前列腺癌诊断后 1 年）或随访期间的抑郁情况。使用泊松、广义线性（对数链接）和 Cox 回归模型来确定治疗和随访期间抑郁状态与结局（卫生资源利用、成本和死亡率）之间的关联。
在新诊断为前列腺癌的 50147 名患者中，有 4285 名（8.54%）被诊断为抑郁症。治疗期间诊断出抑郁症与急诊就诊（优势比（OR）=4.45，95%CI=4.13，4.80）、住院（OR=3.22，CI=3.08，3.37）、门诊就诊（OR=1.71，CI=1.67，1.75）的可能性更高，并且在随访期间的死亡风险更高（风险比（HR）=2.82，CI=2.60，3.06）。与没有抑郁症的男性相比，在随访期间，与抑郁症相关的医疗保健成本仍然居高不下。
治疗期间的抑郁与前列腺癌男性的卫生资源利用、成本和死亡率显著相关。这些发现强调了在前列腺癌治疗中有效识别和治疗抑郁的必要性。
