Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment

Abstract

Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months’ follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.

Emotional Distress in Newly Diagnosed Cancer Outpatients: Do Depression and Anxiety Predict Mortality and Psychosocial Outcomes After 1 Year?

“…This was consistent with previous research which showed that baseline depression predicted 3-month and 6-month depression in a sample of newly diagnosed cancer patients; similarly, baseline anxiety predicted later anxiety [14]. However, compared to the specificity observed by HulbertWilliams and colleagues [14], the current study found that baseline clinical depression also predicted a six-fold increased risk of poor life satisfaction and a twelve-fold increased risk of clinical anxiety at 12-month follow-up.…”

“…Clinical depression and anxiety were not found to predict mortality. Our finding on depression and anxiety differed from studies which found support for the association between depression and mortality [8,14] as well as emotional distress (depression and anxiety) and mortality [15]. One possibility could be the presence of psychological resources such as hope, mindfulness, and spirituality [25][26][27].…”

“…Complementing the findings by Sullivan and colleagues [14], results from a large prospective population study comprising mixed cancer patients (range 1 to 10 years after receiving a diagnosis of either endometrial cancer, colorectal cancer, lymphoma, or multiple myeloma) show that clinical depression (measured on the Hospital Anxiety and Depression Scale) was an independent predictor for all-cause mortality (Adjusted HR = 2.07. 95% CI 1.56 to 2.74, p<0.0001) [13].…”

“…While psychological resources may not prevent the onset of depression and anxiety, they may encourage health help-seeking behaviors which could have influenced cancer mortality [8]. Alternatively, some patients may have experienced transient symptoms of depression and anxiety during the initial reaction to their diagnosis, and may have adjusted positively over time [14].…”

“…In a recent prospective study examining the effect of depression on cancer mortality among newly diagnosed (within 3 month of diagnosis) patients with lung cancer, Sullivan and colleagues observed that depression (measured on the Center for Epidemiologic Studies Depression scale) at baseline (5 months after diagnosis; adjusted HR=1.17, 95% CI 1.03 to 1.32, p=0.01) predicted cancer mortality, and persistent depression at follow-up (12 months after diagnosis; adjusted HR=1.42, 95% CI 1.15 to 1.75, p=0.001) predicted cancer mortality [14]. Complementing the findings by Sullivan and colleagues [14], results from a large prospective population study comprising mixed cancer patients (range 1 to 10 years after receiving a diagnosis of either endometrial cancer, colorectal cancer, lymphoma, or multiple myeloma) show that clinical depression (measured on the Hospital Anxiety and Depression Scale) was an independent predictor for all-cause mortality (Adjusted HR = 2.07.…”