Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Support Care Cancer. 2021 Sep;29(9):4969-4977. doi: 10.1007/s00520-021-06017-y. Epub 2021 Feb 11.
While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM.
This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4-11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively.
Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment.
Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.
虽然继续使用来那度胺和低剂量地塞米松（Rd）治疗可以改善多发性骨髓瘤（MM）患者的生存结局，但迄今为止，尚未研究抑郁与骨髓瘤患者对 Rd 方案的依从性之间的关系，尽管抑郁是 MM 患者的常见症状。本研究旨在评估 Rd 治疗前抑郁对 MM 患者治疗依从性的影响。
这项多中心队列研究于 2015 年 1 月至 2018 年 10 月在韩国的五所三级医院进行。将完成少于 4 个周期、4-11 个周期和多于 12 个周期的患者分别归类为依从性差组（PAG）、中度依从性组（MAG）和良好依从性组（GAG）。
在 141 名患者中，41.8%的患者在开始 Rd 治疗前患有抑郁症，46%的参与者处于 GAG 组。与 GAG 组患者（30.3%）相比，PAG 组患者基线时更有可能患有抑郁症（90.0%），且焦虑评分更高（6.35 分比 4.28 分，P < 0.01）。在调整年龄、性别、教育程度、ECOG、ISS 分期、之前治疗次数以及 Rd 治疗前疾病状态后，Rd 治疗前存在抑郁与依从性差显著相关（IRR=6.67，95%CI=1.45，30.61）。
与无抑郁的患者相比，患有抑郁症的患者依从性差的风险显著更高。鉴于 Rd 治疗主要在门诊进行，在 Rd 治疗前，应考虑针对 MM 患者采取积极的干预措施来减轻抑郁。
