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Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients

Published online by Cambridge University Press:  10 January 2018

Kjersti Støen Grotmol ,
Hanne C. Lie ,
Jon Håvard Loge ,
Nina Aass ,
Dagny Faksvåg Haugen ,
Patrick C. Stone ,
Stein Kaasa  and
Marianne Jensen Hjermstad
Kjersti Støen Grotmol*
Affiliation:
Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital
Hanne C. Lie
Affiliation:
Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
Jon Håvard Loge
Affiliation:
Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
Nina Aass
Affiliation:
Faculty of Medicine, University of Oslo, Oslo, Norway Department of Oncology, Oslo University Hospital, Oslo, Norway
Dagny Faksvåg Haugen
Affiliation:
Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
Patrick C. Stone
Affiliation:
Marie Curie Palliative Care Research Department, University College London, UK
Stein Kaasa
Affiliation:
European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Department of Oncology, Oslo University Hospital, Oslo, Norway
Marianne Jensen Hjermstad
Affiliation:
Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
*
Author for correspondence: Kjersti Støen Grotmol, Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway. E-mail: k.s.grotmol@medisin.uio.no
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Abstract

Objective

Clinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.

Method

The sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.

Result

Patients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.

Significance of results

Depression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.

Keywords

Advanced cancerdepressionprognosissymptoms
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 143 - 149
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

Joint first authorship.

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