Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France.
Oncologist. 2019 Jul;24(7):e458-e466. doi: 10.1634/theoncologist.2018-0322. Epub 2018 Dec 31.
The expression of depressive symptoms in older people with cancer is heterogeneous because of specific features of age or cancer comorbidity. We aimed to identify depressive symptom profiles in this population and describe the associated features including survival.
Patients ≥70 years who were referred to geriatric oncology clinics were prospectively included in the ELCAPA study. In this subanalysis, depressive symptoms were used as indicators in a latent class analysis. Multinomial multivariable logistic regression and Cox models examined the association of each class with baseline characteristics and mortality.
For the 847 complete-case patients included (median age, 79 years; interquartile range, 76-84; women, 47.9%), we identified five depressive symptom classes: "no depression/somatic only" (38.8%), "no depression/pauci-symptomatic" (26.4%), "severe depression" (20%), "mild depression" (11.8%), and "demoralization" (3%). Compared with the no depression/pauci-symptomatic class, the no depression/somatic only and severe depression classes were characterized by more frequent comorbidities with poorer functional status and higher levels of inflammation. "Severe" and "mild" depression classes also featured poorer nutritional status, more medications, and more frequent falls. Severe depression was associated with poor social support, inpatient status, and increased risk of mortality at 1 year (adjusted hazard ratio, 1.62, 95% confidence interval, 1.06-2.48) and 3 years (adjusted hazard ratio, 1.49; 95% confidence interval, 1.06-2.10).
A data-driven approach based on depressive symptoms identified five different depressive symptom profiles, including demoralization, in older patients with cancer. Severe depression was independently and substantially associated with poor survival.
Older patients with cancer present with distinct profiles of depressive symptomatology, including different severity levels of depression and the demoralization syndrome. Clinicians should use a systematic assessment of depressive symptoms to adequately highlight these distinct profiles. Geriatric and oncological features are differently associated with these profiles. For instance, severe depression was associated with more frequent comorbidities with poorer functional, poor nutritional status, polypharmacy, frequent falls, inpatient status and poor social support. Also, severe depression was independently and substantially associated with poor survival so that the identification and management of depression should be considered a high priority in this population.
老年人癌症患者的抑郁症状表现因年龄或癌症合并症的特殊特征而存在异质性。我们旨在确定该人群中的抑郁症状特征，并描述相关特征，包括生存情况。
≥ 70 岁并被转诊至老年肿瘤学诊所的患者前瞻性纳入 ELCAPA 研究。在这项亚分析中，抑郁症状被用作潜类别分析的指标。多变量逻辑回归和 Cox 模型检查了每个类别与基线特征和死亡率的关系。
在纳入的 847 例完整病例患者中（中位年龄为 79 岁；四分位间距为 76-84 岁；女性占 47.9%），我们确定了五个抑郁症状类别：“无抑郁/仅躯体症状”（38.8%）、“无抑郁/少症状”（26.4%）、“严重抑郁”（20%）、“轻度抑郁”（11.8%）和“意志消沉”（3%）。与“无抑郁/少症状”类别相比，“无抑郁/仅躯体症状”和“严重抑郁”类别具有更高的合并症发生率、较差的功能状态和更高的炎症水平。“严重”和“轻度”抑郁类别还表现出较差的营养状况、更多的药物治疗和更频繁的跌倒。严重抑郁与较差的社会支持、住院状态以及 1 年（调整后的危险比，1.62；95%置信区间，1.06-2.48）和 3 年（调整后的危险比，1.49；95%置信区间，1.06-2.10）时的死亡风险增加相关。
基于抑郁症状的数据分析方法确定了五种不同的抑郁症状模式，包括老年癌症患者的意志消沉。严重抑郁与较差的生存显著相关。
老年癌症患者表现出不同的抑郁症状模式，包括不同程度的抑郁和意志消沉综合征。临床医生应使用系统的抑郁症状评估来充分突出这些不同的模式。老年病学和肿瘤学特征与这些模式的相关性不同。例如，严重抑郁与更多的合并症、较差的功能、较差的营养状况、多药治疗、频繁跌倒、住院状态和较差的社会支持有关。此外，严重抑郁与较差的生存显著相关，因此，应将识别和管理抑郁作为该人群的高度优先事项。
