Chen Jue, Li Weichun, Cui Lin, Qian Yayun, Zhu Yaodong, Gu Hao, Chen Gaoyang, Shen Yi, Liu Yanqing
1. Institute of Traditional Chinese Medicine and Western Medicine, School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China; ; 2. The Second People's Hospital of Taizhou affiliated to Yangzhou University, Taizhou, Jiangsu, China.
2. The Second People's Hospital of Taizhou affiliated to Yangzhou University, Taizhou, Jiangsu, China.
J Cancer. 2015 Sep 15;6(11):1121-9. doi: 10.7150/jca.11239. eCollection 2015.
The current study examined quality of life, progression of disease, and survival rate during chemotherapy in newly diagnosed non-small cell lung cancer (NSCLC) patients with depression (n=48) and without depression (n=78). Further, the study explored the hypothesis that the survival benefit resulted from the chemotherapy of docetaxel and cisplatin (the DC regimen).
In total, 126 patients with newly diagnosed NSCLC participated in a cross-sectional study of DC chemotherapy integrated with standard oncology care in depression and non-depression groups. The health-related quality of life (HR-QOL) was assessed using the quality of life questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC). Depression was self-rated using the Zung Self-Rating Depression Scale (Z-SDS). Both HR-QOL and Z-SDS were completed before the first and after the last cycle of chemotherapy. Association between depression and quality of life, treatment responses, adverse effects and survival rate was considered positive at the significance level of p<0.05. Pearson and Spearman correlation coefficient, t-test and other statistical analysis were performed using the SPSS software version 13.0 for Windows.
In total, 126 lung cancer patients were evaluated, 38% had a diagnosis of depression. The presence of depression was associated with reduced quality of life, increased progression of disease, nausea and fatigue and reduced survival rate by nearly 90 days on follow-up. Therefore, depression significantly predicted worse survival (P=0.009).In addition, the chemotherapy DC regimen did not appear to improve the quality of life in depressed patients (SDS 94.96±18.14 before chemotherapy vs. SDS 100.04±16.61 after therapy, P=0.155). In a secondary analysis, there was a positive relationship between depression and nausea and fatigue but there was no significant difference in hematologic toxicities between the depression and non-depression groups.
Depression was associated with worse survival in patients with newly diagnosed NSCLC. Also, the chemotherapy DC regimen did not improve quality of life in depressed patients and the data do not support the hypothesis that treatment responses of NSCLC patients with depression mediated the observed survival benefit from the DC regimen. There were more cases of progressed disease in the depressed group. Findings suggest that NSCLC patients with depression are at increased risk for decline in HR-QOL and survival rate during chemotherapy than patients without depression.
本研究调查了新诊断的非小细胞肺癌（NSCLC）伴抑郁（n = 48）和不伴抑郁（n = 78）患者在化疗期间的生活质量、疾病进展和生存率。此外，该研究探讨了生存获益源于多西他赛和顺铂化疗（DC方案）的假设。
总共126例新诊断的NSCLC患者参与了一项横断面研究，该研究将DC化疗与抑郁组和非抑郁组的标准肿瘤治疗相结合。使用接受化学生物治疗的中国癌症患者生活质量问卷（QLQ - CCC）评估健康相关生活质量（HR - QOL）。使用zung自评抑郁量表（Z - SDS）进行抑郁自评。HR - QOL和Z - SDS均在化疗的第一个周期之前和最后一个周期之后完成。在p<0.05的显著性水平下，抑郁与生活质量、治疗反应、不良反应和生存率之间的关联被认为是显著的。使用适用于Windows的SPSS软件版本13.0进行Pearson和Spearman相关系数、t检验及其他统计分析。
总共评估了126例肺癌患者，38%被诊断为抑郁。抑郁的存在与生活质量下降、疾病进展增加、恶心和疲劳相关，并且随访期间生存率降低近90天。因此，抑郁显著预示着更差的生存率（P = 0.009）。此外，化疗DC方案似乎并未改善抑郁患者的生活质量（化疗前SDS为94.96±18.14，治疗后为100.04±16.61，P = 0.155）。在二次分析中，抑郁与恶心和疲劳之间存在正相关，但抑郁组和非抑郁组之间血液学毒性无显著差异。
抑郁与新诊断的NSCLC患者较差的生存率相关。此外，化疗DC方案并未改善抑郁患者的生活质量，并且数据不支持抑郁的NSCLC患者的治疗反应介导了观察到的DC方案生存获益这一假设。抑郁组疾病进展的病例更多。研究结果表明，与无抑郁的患者相比，抑郁的NSCLC患者在化疗期间HR - QOL下降和生存率降低的风险增加。
