Grotmol Kjersti Støen, Lie Hanne C, Loge Jon Håvard, Aass Nina, Haugen Dagny Faksvåg, Stone Patrick C, Kaasa Stein, Hjermstad Marianne Jensen
Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital.
Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway.
Palliat Support Care. 2019 Apr;17(2):143-149. doi: 10.1017/S1478951517001183. Epub 2018 Jan 10.
Clinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.
The sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative - Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.
Patients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = -0.14, p < 0.001), and greater weight loss (β = -0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.
Depression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.
临床观察表明，晚期癌症伴抑郁症患者报告的症状负担高于无抑郁症患者。这很少经过实证检验。本研究旨在探讨自我报告的抑郁症（DD）与晚期癌症患者症状之间的关联，并对预后因素进行控制。
样本包括来自一项国际多中心观察性研究（欧洲姑息治疗研究协作组 - 疼痛、抑郁和身体功能的计算机化症状评估与分类）的935名患者，平均年龄62岁，男性占52%。通过患者健康问卷-9评估DD，并根据《精神疾病诊断与统计手册》第5版中重度抑郁症的算法进行评分，不包括躯体症状。通过将埃德蒙顿症状评估量表（ESAS）躯体症状（不包括抑郁、焦虑和幸福感）的得分相加来评估症状负担。使用非参数曼-惠特尼U检验比较有DD和无DD患者的逐项得分及症状负担。通过分层多元回归分析评估社会人口学、医学和预后因素以及DD在预测症状负担方面的相对重要性。
与无DD的患者相比，有DD的患者在ESAS项目上的得分显著更高，症状负担高出两倍。与较高症状负担相关的因素如下。诊断：肺癌（β = 0.15，p < 0.001）或乳腺癌（β = 0.08，p < 0.05）；预后较差：高C反应蛋白（β = 0.08，p < 0.05）、较低的卡氏功能状态（β = -0.14，p < 0.001）和更大的体重减轻（β = -0.15，p < 0.001）；服用阿片类药物（β = 0.11，p < 0.01）；以及患有DD（β = 0.23，p < 0.001）。完整模型解释了症状负担方差的18%。DD解释了比所有其他变量多4.4%的方差。
晚期癌症患者的抑郁症与更高的症状负担相关。这些结果鼓励改进识别和治疗抑郁症患者的常规方法。
