肺癌合并抑郁患者的治疗接受情况和结局。

Treatment receipt and outcomes among lung cancer patients with depression.

机构信息

Health Services Research & Development, Portland Veterans Affairs Medical Center, Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.

Health Services Research & Development, Portland Veterans Affairs Medical Center, Portland, OR, USA.

出版信息

Clin Oncol (R Coll Radiol). 2014 Jan;26(1):25-31. doi: 10.1016/j.clon.2013.09.001. Epub 2013 Sep 27.

DOI:10.1016/j.clon.2013.09.001

PMID:24080122

Abstract

AIMS

Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer.

MATERIALS AND METHODS

A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used.

RESULTS

In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio = 1.14, 95% confidence interval: 1.03-1.27, P = 0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P = 0.003). There was no association of depression diagnosis with surgery (odds ratio = 0.83, 95% confidence interval: 0.56-1.22, P = 0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio = 1.02, 95% confidence interval: 0.89-1.16, P = 0.78) or chemotherapy (odds ratio = 1.07, 95% confidence interval: 0.83-1.39, P = 0.59) or radiation (odds ratio = 1.04, 95% confidence interval: 0.81-1.34, P = 0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients.

CONCLUSIONS

Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.

摘要

目的

在肺癌患者中，抑郁与死亡率增加有关，尽管其机制尚不清楚。我们评估了抑郁与退伍军人肺癌患者死亡率和癌症治疗的相关性。

材料和方法

这是一项回顾性队列研究，纳入了 1995 年至 2010 年期间退伍军人事务部-西北卫生网络中的肺癌患者。在肺癌诊断前 24 个月内，通过 ICD-9 编码定义抑郁。采用多变量 Cox 比例分析和逻辑回归进行分析。

结果

总共评估了 3869 名肺癌患者，其中 14%的患者被诊断为抑郁。与所有阶段的肺癌患者相比，抑郁的诊断与死亡率增加相关（风险比=1.14，95%置信区间：1.03-1.27，P=0.01）。在早期（I 和 II 期）非小细胞肺癌（NSCLC）患者中，风险比为 1.37（95%置信区间：1.12-1.68，P=0.003）。在早期 NSCLC 患者中，抑郁诊断与手术之间没有关联（优势比=0.83，95%置信区间：0.56-1.22，P=0.34）。抑郁诊断与死亡率（风险比=1.02，95%置信区间：0.89-1.16，P=0.78）或化疗（优势比=1.07，95%置信区间：0.83-1.39，P=0.59）或放疗（优势比=1.04，95%置信区间：0.81-1.34，P=0.75）之间没有相关性在晚期（III 和 IV 期）NSCLC 患者中。抑郁患者的抑郁治疗利用率增加与死亡率增加相关。