Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands.
Department of Clinical, Neuro and Development Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Psychooncology. 2018 Sep;27(9):2245-2256. doi: 10.1002/pon.4816. Epub 2018 Jul 23.
The objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).
Data from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12-month follow-up. Also, socio-demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS-depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12-month follow-up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.
In total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33-2.05), but this decreased after correcting for socio-demographic, clinical, and lifestyle-related factors (HR = 1.21; 95% CI 0.97-1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36-3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66-1.90) as the reference group who never experienced DS. After correcting for socio-demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09-2.53).
Pretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.
本研究旨在探讨治疗前抑郁症状（DS）与癌症诊断后第一年 DS 病程以及头颈部癌症（HNC）患者总生存之间的关系。
本研究使用了前瞻性临床队列研究 Head and Neck 5000 的数据。在治疗前、4 个月和 12 个月随访时使用医院焦虑和抑郁量表（HADS）测量抑郁症状。同时收集了社会人口统计学、临床、生活方式和死亡率数据。使用 Cox 回归分析治疗前 DS（HADS-抑郁评分>7）与病程（从未有 DS、从 DS 中恢复或在 12 个月随访时持续/复发/迟发性 DS）和生存之间的关系。进行了未调整和调整分析。
在 2144 人中，共有 384 人（18%）报告了治疗前的 DS。在 DS 病程方面，63%的人从未有 DS，16%的人恢复，20%的人持续/复发/迟发性 DS。与无 DS 的人相比，有治疗前 DS 的人死亡风险更高（风险比（HR）=1.65；95%置信区间（CI）1.33-2.05），但在校正社会人口统计学、临床和生活方式相关因素后，风险降低（HR=1.21；95%CI 0.97-1.52）。关于 DS 病程，持续/复发/迟发性 DS 的人死亡风险更高（HR=2.04；95%CI 1.36-3.05），而恢复的人风险相当（HR=1.12；95%CI 0.66-1.90），作为从未经历过 DS 的参考组。在校正社会人口统计学和临床因素后，持续/复发/迟发性 DS 的人死亡风险仍然更高（HR=1.66；95%CI 1.09-2.53）。
治疗前 DS 和持续/复发/迟发性 DS 与 HNC 患者的生存较差相关。
