The Association of Depression and Pain with Health-Related Quality of Life, Disability, and Health Care Use in Cancer Patients

Abstract

Context Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Objectives To determine the associations of pain and depression with health-related quality of life (HRQL), disability, and health care use in cancer patients. Methods The Indiana Cancer Pain and Depression (INCPAD) study is a randomized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and/or clinically significant depression. In this paper, baseline data on patients enrolled from 16 urban or rural community-based oncology practices are analyzed to test the associations of pain and depression with HRQL, disability, and health care use. Results Of the 405 participants, 32% had depression only, 24% pain only, and 44% both depression and pain. The average Hopkins Symptom Checklist 20-item (HSCL-20) depression score in the 309 depressed participants was 1.64 (on 0-4 scale), and the average Brief Pain Inventory (BPI) severity score in the 274 participants with pain was 5.2 (on 0-10 scale), representing at least moderate levels of symptom severity. Symptom-specific disability was high, with participants reporting an average of 16.8 days out of the past 28 (i.e., 60% of their days in the past four weeks) in which they were either confined to bed (5.6 days) or had to reduce their usual activities by 50% (11.2 days) due to pain or depression. Moreover, 176 (43%) reported being unable to work due to health-related reasons. Depression and pain had both individual and additive adverse associations with quality of life. Most patients were currently not receiving care from a mental health or pain specialist. Conclusion Depression and pain are prevalent and disabling across a wide range of types and phases of cancer, commonly co-occur, and have additive adverse effects. Enhanced detection and management of this disabling symptom dyad is warranted.

An Original Research about: The Associations of Depression and Fatigue with Quality of Life among Palestinian Patients with Cancer

“…This study also found differences between males and females in their reports of depression that also corresponds with previous studies [3,47]. Kroenke et al found significant difference between male and female regarding the depression in patients with cancer with more symptoms among female patients.…”

Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer

“…Pain accounted for an additional 21.7% of variance in fatigue; adding pain and depressive symptoms further improved the regression model, increasing the total explained variance to 73.9% (Table 3). Chronic pain and depression are both common symptoms in cancer survivors persisting long after curative treatment [45-47]. Interestingly, co-occurring symptoms can also influence each other and result in a synergistic negative impact on the QoL in cancer survivors [47].…”

Depressive Symptoms and Health-Related Quality of Life in Breast Cancer Survivors

“…3,4 Depression, in particular, has a strong and complex relationship with cancer. 3 Depression has been associated with disease severity, 5 level of patient disability, 6 physical impairment, 7,8 poor performance status [9][10][11] and survival. 12 It is also known that depression is a major source of distress and can have a profound impact on the quality of life (QOL) of breast cancer survivors.…”