Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky.
James Graham Brown Cancer Center, Louisville, Kentucky.
Cancer. 2018 Mar 1;124(5):1053-1060. doi: 10.1002/cncr.31109. Epub 2018 Jan 22.
Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long-term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined.
Patients (n = 134) reported depressive symptomatology at treatment planning. Clinical data were reviewed at the 2-year follow-up.
Greater depressive symptoms were associated with significantly shorter survival (hazard ratio, 0.868; 95% confidence interval [CI], 0.819-0.921; P < .001), higher rates of chemoradiation interruption (odds ratio, 0.865; 95% CI, 0.774-0.966; P = .010), and poorer treatment response (odds ratio, 0.879; 95% CI, 0.803-0.963; P = .005). The poorer treatment response partially explained the depression-survival relation. Other known prognostic indicators did not challenge these results.
Depressive symptoms at the time of treatment planning predict overall 2-year mortality. Effects are partly influenced by the treatment response. Depression screening and intervention may be beneficial. Future studies should examine parallel biological pathways linking depression to cancer survival, including endocrine disruption and inflammation. Cancer 2018;124:1053-60. © 2018 American Cancer Society.
头颈部癌症与高抑郁率相关，这可能增加更差的近期和远期结局风险。在此假设更大的抑郁症状会预测更早的死亡率，并检查行为（治疗中断）和生物学（治疗反应）的中介因素。
患者（n=134）在治疗计划时报告抑郁症状。临床数据在 2 年随访时进行了回顾。
更大的抑郁症状与显著更短的生存时间相关（风险比，0.868；95%置信区间[CI]，0.819-0.921；P<0.001），更高的放化疗中断率（比值比，0.865；95%CI，0.774-0.966；P=0.010）和更差的治疗反应（比值比，0.879；95%CI，0.803-0.963；P=0.005）。更差的治疗反应部分解释了抑郁与生存的关系。其他已知的预后指标并不挑战这些结果。
治疗计划时的抑郁症状预测了整体 2 年死亡率。影响部分受到治疗反应的影响。抑郁筛查和干预可能是有益的。未来的研究应检查将抑郁与癌症生存联系起来的平行生物学途径，包括内分泌失调和炎症。癌症 2018；124:1053-60。©2018 美国癌症协会。
