Andersen B L, Valentine T R, Lo S B, Carbone D P, Presley C J, Shields P G
Department of Psychology, The Ohio State University, United States.
Department of Psychology, The Ohio State University, United States.
Lung Cancer. 2020 Jul;145:195-204. doi: 10.1016/j.lungcan.2019.11.015. Epub 2019 Nov 21.
The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms.
Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms.
Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms.
Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.
本观察性研究的目的是：1）招募新诊断的晚期非小细胞肺癌（NSCLC）患者，等待一线治疗开始，并识别出有中度至重度抑郁症状的患者；2）对多种同时出现的心理和行为困难以及身体症状进行临床描述，这些症状可能会加重并维持抑郁症状。
IV期NSCLC患者（N = 186）参加了一项观察性研究（ClinicalTrials.gov标识符：NCT03199651），并完成了美国临床肿瘤学会推荐的抑郁症筛查量表（患者健康问卷-9 [PHQ-9]）。识别出无/轻度（n = 119；64%）、中度（n = 52；28%）和重度（n = 15；8%）抑郁症状的个体。患者还完成了绝望感、广泛性焦虑症（GAD）症状、压力、疾病认知、功能状态和症状的测量。
有重度抑郁症状的患者报告同时存在绝望感（增加自杀行为风险）、提示GAD的焦虑症状以及创伤性、癌症特异性压力。他们认为肺癌对其生活有重大影响且无法通过治疗控制。存在疼痛和多种严重症状，同时伴有严重的功能障碍。有中度抑郁症状的患者总体干扰水平较低，尽管仍然很严重。最显著的差异是中度症状患者的GAD症状严重程度较低且功能障碍较少。
中度至重度抑郁症状与焦虑症状、创伤性压力、功能状态受损以及疼痛和其他身体症状的临床水平同时出现。所有这些因素已被证明，单独或共同作用，都会导致抑郁症状的维持或加重。随着延长生命的靶向治疗和免疫治疗的应用不断扩大，及时识别有中度至重度抑郁症状的患者、转诊进行评估以及进行心理/行为治疗，对于使晚期NSCLC患者的治疗效果和生活质量最大化至关重要。
