Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Psychooncology. 2022 Aug;31(8):1390-1398. doi: 10.1002/pon.5945. Epub 2022 May 6.
To determine the frequency of depression or anxiety preceding a diagnosis of pancreatic cancer (PC). Further, to examine the association of PC-associated depression or anxiety with treatment compliance and survival.
856 patients with PC from a single institution were identified using International Classification of Diseases (ICD) codes. For each case, two non-cancer age- and sex-matched controls were included. Dates of depression or anxiety diagnosis identified using ICD codes were compared to the date of PC diagnosis. The medical record was queried to further explore psychiatric symptoms. Multivariable analyses were performed to examine if prediagnosis depression or anxiety was associated with receipt of treatment or survival.
A greater proportion of patients with PC experienced depression or anxiety in the year preceding diagnosis than the overall frequency in controls (4.6% vs. 2.6%, p = 0.005) based on ICD codes. Patients with PC exhibited signs of prodromal depression or anxiety based on ICD codes, clinical documentation of psychiatric symptoms, or initiation of new psychiatric medications more often than controls (20.7% vs. 6.7%, p < 0.001). Prediagnosis depression or anxiety was associated with a reduced likelihood of receiving chemotherapy (OR = 0.58, p = 0.04). There was an associated decrease in overall survival among patients with metastatic disease who experienced depression or anxiety before PC diagnosis (HR = 1.32, p = 0.04).
The frequency of depression or anxiety among patients with PC was higher than the general population. Prediagnosis psychiatric symptoms were associated with reduced chemotherapy utilization and worse overall survival. Thus, timely identification and treatment of these symptoms may improve outcomes.
确定在诊断胰腺癌 (PC) 之前出现抑郁或焦虑的频率。此外，还研究了与 PC 相关的抑郁或焦虑与治疗依从性和生存的关系。
使用国际疾病分类 (ICD) 代码在一家医疗机构中确定了 856 例 PC 患者。对于每个病例，纳入了两名年龄和性别匹配的非癌症对照者。使用 ICD 代码确定的抑郁或焦虑诊断日期与 PC 诊断日期进行比较。查询病历以进一步探讨精神科症状。进行多变量分析以检查诊断前的抑郁或焦虑是否与接受治疗或生存有关。
根据 ICD 代码，在诊断前一年经历抑郁或焦虑的 PC 患者比例高于对照组的总体频率 (4.6% vs. 2.6%，p = 0.005)。根据 ICD 代码、精神科症状的临床记录或新的精神科药物的开始，PC 患者表现出前驱性抑郁或焦虑的迹象比对照组更常见 (20.7% vs. 6.7%，p < 0.001)。诊断前的抑郁或焦虑与接受化疗的可能性降低相关 (OR = 0.58，p = 0.04)。在经历 PC 诊断前抑郁或焦虑的转移性疾病患者中，总体生存率降低 (HR = 1.32，p = 0.04)。
PC 患者中抑郁或焦虑的频率高于一般人群。诊断前的精神科症状与化疗使用率降低和总体生存率降低有关。因此，及时识别和治疗这些症状可能会改善结局。
