Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
J Geriatr Oncol. 2021 May;12(4):599-604. doi: 10.1016/j.jgo.2020.10.020. Epub 2020 Nov 4.
Depression among older adults with cancer is under recognized and under treated. This study characterizes the burden of depression in older adults with gastrointestinal (GI) malignancies prior to chemotherapy and its relationship with geriatric assessment (GA) domains, health-related quality of life (HRQOL), and self-reported healthcare utilization.
Patients ≥60 years in GI oncology clinics at UAB were asked to complete a GA entitled the Cancer & Aging Resilience Evaluation (CARE). We examined depression using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Depression four-item short form; moderate/severe depression was defined by a t-score ≥ 60. Multivariate analysis was used to examine associations between those with and without moderate/severe depression.
Of 355 included patients, 46 had mild depression (13%) and an additional 46 patients had moderate/severe depression (13%). After adjustment for age, sex, education, cancer type, and cancer stage, those who reported moderate/severe depression had a significantly increased odds of reporting falls (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.94-8.26), dependence in IADLs (aOR 7.06,CI 2.91-17.1), dependence in ADLs (aOR 6.23, CI 2.89-13.4), malnutrition (aOR 5.86, CI 2.40-14.3), frailty (aOR 13.7, CI 5.80-32.1), and fatigue (aOR 11.2, CI 3.31-37.6). Moderate/severe depression was also significantly associated with worse physical (aOR 7.58, CI 3.30-17.4) and mental (aOR 26.3, CI 10.1-68.8) HRQOL sub-scores, without significant differences in healthcare utilization.
More than one out of eight older adults with a GI malignancy reported moderate/severe depression prior to chemotherapy, which was associated with impairments in several GA domains and HRQOL.
老年人癌症患者的抑郁症状未得到充分认识和治疗。本研究描述了化疗前老年胃肠道（GI）恶性肿瘤患者的抑郁负担及其与老年评估（GA）领域、健康相关生活质量（HRQOL）和自我报告的医疗保健利用之间的关系。
UAB 的 GI 肿瘤学诊所中年龄≥60 岁的患者被要求完成一项名为癌症与衰老弹性评估（CARE）的 GA。我们使用患者报告的结果测量信息系统（PROMIS®）抑郁四项简短形式来检查抑郁情况；中度/重度抑郁的定义是 t 评分≥60。使用多变量分析来检查有和没有中度/重度抑郁的患者之间的关联。
在 355 名纳入的患者中，46 名患有轻度抑郁（13%），另有 46 名患有中度/重度抑郁（13%）。在校正年龄、性别、教育程度、癌症类型和癌症分期后，报告中度/重度抑郁的患者报告跌倒的可能性显著增加（调整后的优势比[aOR]4.01，95%置信区间[CI]1.94-8.26）、依赖 IADL（aOR 7.06，CI 2.91-17.1）、依赖 ADL（aOR 6.23，CI 2.89-13.4）、营养不良（aOR 5.86，CI 2.40-14.3）、虚弱（aOR 13.7，CI 5.80-32.1）和疲劳（aOR 11.2，CI 3.31-37.6）。中度/重度抑郁与身体（aOR 7.58，CI 3.30-17.4）和精神（aOR 26.3，CI 10.1-68.8）HRQOL 亚评分明显相关，而在医疗保健利用方面没有显著差异。
超过八分之一的胃肠道恶性肿瘤老年患者在化疗前报告有中度/重度抑郁，这与多个 GA 领域和 HRQOL 的损伤有关。
