Yen Yung-Chieh, Huang Chin-Yu, Chan Hsue-Wei, Wang You-Yu, Changchien Te-Chang, Wang Deng-Wu, Lin Po-Chun, Chang Ting-Ting, Chiu Yu-Wen
Department of Psychiatry, E-Da Hospital, Kaohsiung 824, Taiwan.
School of Medicine, I-Shou University, Kaohsiung 824, Taiwan.
J Pers Med. 2022 Jul 26;12(8):1213. doi: 10.3390/jpm12081213.
Evidence for clinical screening and intervention for depression in cancer and the effect of this intervention on cancer prognosis is suboptimal. This study substantialized a complete model with universal screening and intervention for major depressive disorder (MDD) and explored its effect on survival in patients. This longitudinal study recruited cancer patients routinely screened for MDD with a two-stage model. Data including sex, age, cancer diagnosis, first diagnosis date, date of death, cancer stage, and MDD diagnosis and treatment were collected from medical records and the national registration system for cancer. Kaplan−Meier’s survival analysis and the Cox proportional hazards regression model were applied to analyze the effects of associated factors on survival. Further subgroup analysis for 14 types of cancer primary site was also performed. Overall, the hazard for patients adhering to psychiatric treatment for MDD before cancer diagnosis was not statistically different from that for patients without MDD (hazard ratio (HR) = 1.061, 95% CI: 0.889−1.267, p = 0.512). The hazard for patients adhering to psychiatric treatment after cancer diagnosis was significantly lower than that for patients without MDD (HR = 0.702, 95% CI: 0.607−0.812, p < 0.001). Those who were diagnosed with MDD after cancer diagnosis and adhered poorly to psychiatric treatment had the greatest hazard (HR = 1.829, 95% CI: 1.687−1.984, p < 0.001). The effect of intervention for MDD varied across different primary cancer types.
癌症患者抑郁症临床筛查及干预的证据以及这种干预对癌症预后的影响并不理想。本研究构建了一个针对重度抑郁症（MDD）的全面筛查与干预完整模型，并探讨了其对患者生存的影响。这项纵向研究招募了采用两阶段模型进行MDD常规筛查的癌症患者。从医疗记录和国家癌症登记系统收集了包括性别、年龄、癌症诊断、首次诊断日期、死亡日期、癌症分期以及MDD诊断和治疗等数据。应用Kaplan - Meier生存分析和Cox比例风险回归模型分析相关因素对生存的影响。还对14种癌症原发部位进行了进一步的亚组分析。总体而言，癌症诊断前接受MDD精神治疗的患者的风险与未患MDD的患者相比无统计学差异（风险比（HR）= 1.061，95%置信区间：0.889 - 1.267，p = 0.512）。癌症诊断后接受精神治疗的患者的风险显著低于未患MDD的患者（HR = 0.702，95%置信区间：0.607 - 0.812，p < 0.001）。癌症诊断后被诊断为MDD且精神治疗依从性差的患者风险最高（HR = 1.829，95%置信区间：1.687 - 1.984，p < 0.001）。MDD干预效果因不同原发癌症类型而异。
