From Psychological Medicine Research (Walker, Burke, van Niekerk, Toynbee, Sharpe), University of Oxford Department of Psychiatry, Warneford Hospital, Oxford; Department of Non-Communicable Disease Epidemiology (Mulick, Quartagno), London School of Hygiene and Tropical Medicine; Department of Medical Statistics (Magill, Belot, Frost), London School of Hygiene and Tropical Medicine, London; and Cancer Research UK Edinburgh Centre (Symeonides, Gourley), University of Edinburgh, Edinburgh, United Kingdom.
Psychosom Med. 2021 Jun 1;83(5):410-416. doi: 10.1097/PSY.0000000000000942.
The question of whether depression is associated with worse survival in people with cancer remains unanswered because of methodological criticism of the published research on the topic. We aimed to study the association in a large methodologically robust study.
We analyzed data on 20,582 patients with breast, colorectal, gynecological, lung, and prostate cancers who had attended cancer outpatient clinics in Scotland, United Kingdom. Patients had completed two-stage screening for major depression as part of their cancer care. These data on depression status were linked to demographic, cancer, and subsequent mortality data from national databases. We estimated the association of major depression with survival for each cancer using Cox regression. We adjusted for potential confounders and interactions between potentially time-varying confounders and the interval between cancer diagnosis and depression screening, and used multiple imputation for missing depression and confounder data. We pooled the cancer-specific results using fixed-effects meta-analysis.
Major depression was associated with worse survival for all cancers, with similar adjusted hazard ratios (HRs): breast cancer (HR = 1.42, 95% confidence interval [CI] = 1.15-1.75), colorectal cancer (HR = 1.47, 95% CI = 1.11-1.94), gynecological cancer (HR = 1.36, 95% CI = 1.08-1.71), lung cancer (HR = 1.39, 95% CI = 1.24-1.56), and prostate cancer (HR = 1.76, 95% CI = 1.08-2.85). The pooled HR was 1.41 (95% CI = 1.29-1.54, p < .001, I2 = 0%). These findings were not materially different when we only considered the deaths (90%) that were attributed to cancer.
Major depression is associated with worse survival in patients with common cancers. The mechanisms of this association and the clinical implications require further study.
由于对该主题已发表研究的方法学批评，抑郁症是否与癌症患者的生存预后更差相关的问题仍未得到解答。我们旨在通过一项大型方法学稳健研究来研究这种关联。
我们分析了英国苏格兰癌症门诊就诊的 20582 例乳腺癌、结直肠癌、妇科癌症、肺癌和前列腺癌患者的数据。患者在接受癌症治疗的过程中完成了两阶段的主要抑郁症筛查。这些关于抑郁状况的数据与来自国家数据库的人口统计学、癌症和随后的死亡率数据相关联。我们使用 Cox 回归估计了主要抑郁症与每种癌症生存的相关性。我们针对潜在的混杂因素进行了调整，并考虑了潜在的时变混杂因素与癌症诊断和抑郁筛查之间的间隔之间的相互作用，并用多重插补法处理缺失的抑郁和混杂因素数据。我们使用固定效应荟萃分析汇总癌症特异性结果。
对于所有癌症，主要抑郁症与较差的生存相关，具有相似的调整后的危险比（HR）：乳腺癌（HR = 1.42，95%置信区间 [CI] = 1.15-1.75）、结直肠癌（HR = 1.47，95% CI = 1.11-1.94）、妇科癌症（HR = 1.36，95% CI = 1.08-1.71）、肺癌（HR = 1.39，95% CI = 1.24-1.56）和前列腺癌（HR = 1.76，95% CI = 1.08-2.85）。汇总的 HR 为 1.41（95% CI = 1.29-1.54，p <.001，I2 = 0%）。当我们仅考虑归因于癌症的（90%）死亡时，这些发现并没有实质性差异。
主要抑郁症与常见癌症患者的生存预后更差相关。这种关联的机制和临床意义需要进一步研究。
