Chief Physician Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.
Child and Adolescent Division, Geha Mental Health Center, Petah Tiqva, Israel.
Depress Anxiety. 2019 Oct;36(10):921-929. doi: 10.1002/da.22938. Epub 2019 Jul 22.
Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer.
We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality.
During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities.
The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.
抑郁症和焦虑症在癌症患者中很常见，抗抑郁药（AD）是有效的治疗方法。AD 依从性与癌症患者死亡率之间的关系尚不清楚。本研究旨在评估癌症患者人群中 AD 依从性与全因死亡率之间的关系。
我们进行了一项为期 4 年的历史前瞻性队列研究，纳入了在研究期间至少购买过一次 AD 的 42075 例癌症患者。AD 依从性模型为不依从（<20%）、差（20-50%）、中（50-80%）和高（>80%）依从。我们进行了多变量生存分析，调整了可能影响死亡率的人口统计学和临床变量。
在 1051489 人年的风险随访期间，与不依从组相比，死亡率的调整后危险比（HR）分别为 0.89（95%置信区间[CI]：0.83-0.95）、0.77（95%CI：0.66-0.72）和 0.80（95%CI：0.76-0.85），分别为差、中、高依从组。对整个样本和有抑郁症的亚组进行癌症亚型分析，发现乳腺癌、结肠癌、肺癌和前列腺癌的模式相似，但黑色素瘤患者则不然。过早死亡的多变量预测因素包括男性（HR 1.48 [95%CI：1.42-1.55]）、当前/过去吸烟状况（HR 1.1，[95%CI：1.04-1.15]；P<.0001）、低社会经济地位（HR 1.1，[95%CI：1.03-1.17]；P<.0001）和更多的身体合并症。
本研究首次证明，在大型全国性癌症患者队列中，AD 依从性越高，全因死亡率越低。我们的数据增加了迫切需要鼓励癌症患者服用 AD 的证据。
