Lafont Charlotte, Chah Wakilian Anne, Lemogne Cédric, Gouraud Clément, Fossey-Diaz Virginie, Orvoen Galdric, Lhuillier Nathalie, Paillaud Elena, Bastuji-Garin Sylvie, Zebachi Sonia, Hanon Olivier, Goldwasser François, Boudou-Rouquette Pascaline, Canouï-Poitrine Florence
Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.
AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France.
Oncologist. 2021 Jun;26(6):e983-e991. doi: 10.1002/onco.13746. Epub 2021 Mar 23.
In older patients with cancer, depression is difficult to assess because of its heterogeneous clinical expression. The 4-item version of the Geriatric Depression Scale (GDS-4) is quick and easy to administer but has not been validated in this population. The present study was designed to test the diagnostic performance of the GDS-4 in a French cohort of older patients with cancer before treatment.
Our cross-sectional analysis of data from the Elderly Cancer Patient cohort covered all patients with cancer aged ≥70 years and referred for geriatric assessment at two centers in France between 2007 and 2018. The GDS-4's psychometric properties were evaluated against three different measures of depression: the geriatrician's clinical diagnosis (based on a semistructured interview), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and a cluster analysis. The scale's sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated.
In a sample of 2,293 patients (median age, 81 years; women, 46%), the GDS-4's sensitivity and specificity for detecting physician-diagnosed depression were, respectively, 90% and 89%. The positive and negative likelihood ratios were 8.2 and 0.11, and the AUROC was 92%. When considering the subset of patients with data on all measures of depression, the sensitivity and specificity values were, respectively, ≥90% and ≥72%, the positive and negative likelihood ratios were, respectively, ≥3.4 and ≤ 0.11, and the AUROC was ≥91%.
The GDS-4 appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer.
Considering the overlap between symptoms of cancer and symptoms of depression, depression is particularly difficult to assess in older geriatric oncology and is associated with poor outcomes; there is a need for a routine psychological screening. Self-report instruments like the 4-item version of the Geriatric Depression Scale appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. Asking four questions might enable physicians to screen older patients with cancer for depression and then guide them toward further clinical evaluation and appropriate care if required.
在老年癌症患者中，由于抑郁症临床表现具有异质性，故难以评估。老年抑郁量表4项版（GDS - 4）使用快速简便，但尚未在该人群中得到验证。本研究旨在测试GDS - 4在法国一组老年癌症患者治疗前的诊断性能。
我们对老年癌症患者队列的数据进行横断面分析，涵盖了2007年至2018年期间在法国两个中心接受老年评估的所有年龄≥70岁的癌症患者。根据三种不同的抑郁测量方法评估GDS - 4的心理测量特性：老年科医生的临床诊断（基于半结构化访谈）、《精神障碍诊断与统计手册》第4版以及聚类分析。计算该量表的敏感性、特异性、阳性和阴性似然比以及受试者工作特征曲线下面积（AUROC）。
在2293例患者样本中（中位年龄81岁；女性占46%），GDS - 4检测医生诊断抑郁症的敏感性和特异性分别为90%和89%。阳性和阴性似然比分别为8.2和0.11，AUROC为92%。当考虑所有抑郁测量指标均有数据的患者亚组时，敏感性和特异性值分别≥90%和≥72%，阳性和阴性似然比分别≥3.4和≤0.11，AUROC≥91%。
GDS - 4似乎是老年癌症患者常规抑郁筛查中一种具有临床相关性且易于使用的工具。
考虑到癌症症状与抑郁症状的重叠，在老年肿瘤学中抑郁症尤其难以评估，且与不良预后相关；因此需要进行常规心理筛查。像老年抑郁量表4项版这样的自我报告工具似乎是老年癌症患者常规抑郁筛查中一种具有临床相关性且易于使用的工具。询问四个问题可能使医生能够对老年癌症患者进行抑郁筛查，然后在需要时引导他们进行进一步的临床评估和适当护理。
