Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Geriatric Research Education and Clinical Center, Greater Los Angeles Veterans Affairs Health Care System, Los Angeles, California, USA.
Cancer. 2024 Nov 15;130(22):3894-3901. doi: 10.1002/cncr.35482. Epub 2024 Aug 4.
Depression and anxiety are prevalent in older adults with cancer but are often undertreated. Older adults are also at increased risk of chemotherapy toxicity (CT). This study evaluated the impact of depression and anxiety symptoms on severe CT risk in older adults with cancer.
This is a secondary analysis of a randomized trial (2:1) evaluating geriatric assessment-driven intervention (GAIN) versus standard of care (SOC) to reduce grade 3+ CT in older adults with cancer. Mental health was assessed via the Mental Health Inventory 13. CT was graded by National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.
A total of 605 patients enrolled (402 GAIN; 203 SOC). Overall, 35% were depressed and 47% were anxious. Patients with depression had increased CT in the SOC arm (70.7% vs. 54.3%; p = .02) but not in the GAIN arm (54.3% vs. 48.5%; p = .27). CT was more likely in SOC patients with depression (odds ratio [OR], 2.03; 95% CI, 1.10-3.72). This association persisted after adjusting for Cancer and Aging Research Group toxicity score (OR, 1.98; 95% CI, 1.07-3.65) and for demographic, disease, and treatment factors (OR, 2.00; 95% CI, 1.03-3.85). Depression and CT were not associated in the GAIN arm (OR, 1.26; 95% CI, 0.84-1.91). Anxiety and CT were not associated in either arm.
Elevated depression symptoms are associated with increased risk of severe CT in older adults with cancer, which was mitigated with GAIN. This suggests that treating depression symptoms may lower toxicity risk. Future studies are needed to confirm and investigate the impact of depression-specific interventions on outcomes.
抑郁和焦虑在老年癌症患者中很常见，但往往治疗不足。老年人发生化疗毒性（CT）的风险也增加。本研究评估了抑郁和焦虑症状对老年癌症患者严重 CT 风险的影响。
这是一项评估老年评估驱动干预（GAIN）与标准护理（SOC）降低老年癌症患者 3+ 级 CT 风险的随机试验（2:1）的二次分析。通过心理健康量表 13 评估心理健康。CT 按国立癌症研究所不良事件通用术语标准 4.0 分级。
共纳入 605 例患者（402 例 GAIN；203 例 SOC）。总体而言，35%的患者抑郁，47%的患者焦虑。SOC 组中抑郁患者 CT 发生率更高（70.7% vs. 54.3%；p = 0.02），但 GAIN 组中没有（54.3% vs. 48.5%；p = 0.27）。SOC 组中抑郁患者 CT 更有可能（优势比 [OR]，2.03；95%置信区间，1.10-3.72）。在调整癌症和衰老研究组毒性评分（OR，1.98；95%置信区间，1.07-3.65）以及人口统计学、疾病和治疗因素后，这种关联仍然存在（OR，1.98；95%置信区间，1.07-3.65）。GAIN 组中抑郁和 CT 之间没有关联（OR，1.26；95%置信区间，0.84-1.91）。两个治疗组的焦虑与 CT 均无关联。
在老年癌症患者中，较高的抑郁症状与严重 CT 风险增加相关，而 GAIN 可降低这种风险。这表明治疗抑郁症状可能降低毒性风险。需要进一步的研究来证实并探讨针对抑郁症状的干预措施对结局的影响。
