Duc S, Rainfray M, Soubeyran P, Fonck M, Blanc J F, Ceccaldi J, Cany L, Brouste V, Mathoulin-Pélissier S
Gerontology Department, University Hospital Xavier Arnozan, Pessac, France.
Université Bordeaux, Bordeaux, France.
Psychooncology. 2017 Jan;26(1):15-21. doi: 10.1002/pon.4090. Epub 2016 Feb 23.
Depression is the most common psychiatric disorder in geriatrics and oncology. For elderly cancer patients, it has a significant impact on quality of life, morbidity, and mortality. Nevertheless, depression is under-diagnosed and under-treated. Cancer management is key in improving the quality of care in this population. We aim to identify sociodemographic, clinical, and treatment-related factors of depression in elderly patients during chemotherapy, thus allowing early detection of patients in need of specific treatment. Further, we investigate whether chemotherapy efficacy and safety are associated with depression.
A prospective multicenter cohort composed of incident cases of cancer diagnosed in patients 70 years and older, receiving first-line chemotherapy. Depressive symptoms were measured by the Geriatric Depression Scale at baseline and after four chemotherapy cycles. Associations between depressive symptoms during chemotherapy and patients' clinical and treatment characteristics were identified by logistic regression.
Among 344 patients measured for depression before chemotherapy, 260 had a second assessment at the fourth treatment cycle. At baseline, 45.4% were depressed, and 44.6% were depressed after the fourth cycle. Independent factors of depression were depressive symptoms at baseline (odds ratio (OR) = 6.7, p < 0.001), malnutrition (OR = 5.1, p = 0.014), and risk of malnutrition (OR = 1.6, p = 0.014). After controlling for missing data, effective chemotherapy was associated with a lower risk of depression (OR = 0.4, p = 0.018).
We highlight the role of depressive symptoms and nutritional status at baseline, on the occurrence of depressive symptoms during chemotherapy. These factors should be taken into account in any pre-treatment consultation and appropriate nutritional and psychiatric preventative measures established. Copyright © 2016 John Wiley & Sons, Ltd.
抑郁症是老年医学和肿瘤学中最常见的精神障碍。对于老年癌症患者，它对生活质量、发病率和死亡率有重大影响。然而，抑郁症的诊断和治疗不足。癌症管理是改善这一人群护理质量的关键。我们旨在确定老年患者化疗期间抑郁症的社会人口统计学、临床和治疗相关因素，从而能够早期发现需要特殊治疗的患者。此外，我们研究化疗疗效和安全性是否与抑郁症有关。
一项前瞻性多中心队列研究，由70岁及以上诊断为癌症的初发病例组成，接受一线化疗。在基线和四个化疗周期后，通过老年抑郁量表测量抑郁症状。通过逻辑回归确定化疗期间抑郁症状与患者临床和治疗特征之间的关联。
在化疗前测量抑郁症的344例患者中，260例在第四个治疗周期进行了第二次评估。基线时，45.4%的患者抑郁，第四个周期后44.6%的患者抑郁。抑郁症的独立因素是基线时的抑郁症状（优势比（OR）=6.7，p<0.001）、营养不良（OR=5.1，p=0.014）和营养不良风险（OR=1.6，p=0.014）。在控制缺失数据后，有效的化疗与较低的抑郁症风险相关（OR=0.4，p=0.018）。
我们强调了基线时抑郁症状和营养状况对化疗期间抑郁症状发生的作用。在任何预处理咨询中都应考虑这些因素，并制定适当的营养和精神预防措施。版权所有©2016约翰威立父子有限公司。
