Department of Gastrointestinal Oncology Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Hubei Province, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Wuhan, Wuhan 430079, Hubei, China.
Department of Nephrology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei, China.
Gen Hosp Psychiatry. 2024 Sep-Oct;90:150-156. doi: 10.1016/j.genhosppsych.2024.08.002. Epub 2024 Aug 13.
The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors.
Cancer survivors from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses.
This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0-4 ([OR] = 1.88, 95% [CI] = 1.20-2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036).
Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep.
本研究旨在探讨美国癌症幸存者抑郁症状与第二原发癌（SPC）之间的关联。
本横断面研究纳入了 2005-2018 年国家健康和营养调查（NHANES）中的癌症幸存者，并采用患者健康问卷 9 项（PHQ-9）来定义抑郁症状。通过多因素逻辑回归、限制性立方样条（RCS）、敏感性和亚组分析来评估抑郁症状与 SPC 之间的关系。
本研究共纳入 2315 名代表超过 1500 万非住院美国居民的参与者。多因素逻辑回归完全调整混杂因素后显示，PHQ-9 评分≥10 的癌症幸存者发生 SPC 的风险高于 PHQ-9 评分 0-4 的幸存者（OR=1.88，95%CI=1.20-2.89，p=0.005）。RCS 显示 PHQ-9 评分与 SPC 之间呈线性正相关（p 总=0.017）。通过对缺失数据进行多次插值和不同的聚类水平方法（即加权线性回归）进行敏感性分析，进一步证实了这种关联的稳健性。此外，亚组分析证实，这种相关性在睡眠时长<7 小时的参与者中更强（p 交互=0.036）。
癌症幸存者中中重度抑郁症状与发生 SPC 的风险增加相关，尤其是在睡眠时长<7 小时的情况下。
