Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway.
Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway; Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.
J Pain Symptom Manage. 2017 Dec;54(6):889-897. doi: 10.1016/j.jpainsymman.2017.04.010. Epub 2017 Aug 10.
Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies.
To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.
A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models.
Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 β = -0.12, P = 0.003; mGPS = 2 β = -0.09, P = 0.023), lower physical performance (β = 0.17, P < 0.001), reduced appetite (β = -0.15, P < 0.001), breathlessness (β = -0.11, P = 0.004), pain (β = -0.14, P = 0.002), and higher depression severity (β = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance.
Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.
生活质量（QoL）和抑郁是癌症护理中重要的患者报告结果。然而，由于缺乏方法严谨的研究，抑郁严重程度对 QoL 的预测作用仍不清楚。
研究抑郁是否与预后因素和症状负担无关，从而导致 QoL 受损。
这项研究纳入了来自欧洲姑息治疗研究协作组织-计算机化症状评估研究的 563 名患者，这是一项国际性的、多中心的、横断面研究。使用层次多重回归模型评估预后因素（系统炎症[改良格拉斯哥预后评分-mGPS]）、合并症和身体机能（卡诺夫斯基表现状态）、症状负担（食欲减退、呼吸困难、恶心[埃德蒙顿症状评估量表]和疼痛[简明疼痛量表]）以及抑郁严重程度（患者健康问卷 9）对全球健康/生活质量（欧洲癌症研究与治疗组织核心生活质量问卷[EORTC-QLQ-C30]）的相对重要性。
55%为女性，中位年龄为 64 岁，87%患有转移性疾病，卡诺夫斯基表现状态中位数为 70，全球 QoL 平均值为 50.5（标准差=23.3）。较差的 QoL 与更高的系统炎症（mGPS=1β=-0.12，P=0.003；mGPS=2β=-0.09，P=0.023）、较低的身体机能（β=0.17，P<0.001）、食欲减退（β=-0.15，P<0.001）、呼吸困难（β=-0.11，P=0.004）、疼痛（β=-0.14，P=0.002）和更高的抑郁严重程度（β=-0.27，P<0.001）相关。全模型解释了 QoL 评分中 29%的可观测方差。最强的预测因素是抑郁严重程度，占方差的 5.8%。
在考虑了广泛的临床相关变量后，在本研究的晚期癌症患者样本中，抑郁严重程度是 QoL 较差的最强单一预测因素。未来的研究应该调查心理社会变量对 QoL 的贡献。我们的研究结果强调了管理抑郁以实现这些患者最佳 QoL 的重要性。
