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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: [email protected]
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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.

References

Andersen, B., DeRubeis, RJ, Berman, BS, et al. (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. Journal of Clinical Oncology 32, 1605–1619.Google Scholar
Brown, LF and Kroenke, K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50, 440–447.Google Scholar
Brown, LK, Theobald, DE, Wu, J, and Tu, W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19, 7314–7341.Google Scholar
Bruera, E (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. Journal of Palliative Care 7, 6–9.Google Scholar
Brændengen, M, Tveit, K, Hjermstad, M, et al. (2012). Health-related quality of life (HRQoL) after multimodal treatment for primarily non-resectable rectal cancer. Long-term results from a phase III study. European Journal of Cancer 48, 813–819.Google Scholar
Ciaramella, A and Poli, P (2001) Assessment of depression among cancer patients: The role of pain, cancer type and treatment. Psychooncology 10, 156–165.Google Scholar
Chochinov, HM., Wilson, KG, Enns, M, Lander, S (1997) 'Are you depressed?' Screening for depression in the terminally ill. The American Journal of Psychiatry 154, 674–676.Google Scholar
Delgado-Guay, M, Parsons, H, Li, Z, et al. (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive Care in Cancer 17, 573–579.Google Scholar
Detmar, SB (2000) How are you feeling? Who wants to know? Patients' and oncologists' preferences for discussing health-related quality-of-life issues. Journal of Clinical Oncology 18, 3295–3301.Google Scholar
Dodd, M, Janson, S, Facione, N, et al. (2001) Advancing the science of symptom management. Journal of Advanced Nursing 33, 668–676.Google Scholar
Ferreira, KASL, Kimura, M, Teixeira, M, et al. (2008) Impact of cancer-related symptom synergisms on health-related quality of life and performance status. Journal of Pain and Symptom Management 35, 604–616.Google Scholar
Fitzgerald, P, Li, M, Gagliese, L, et al. (2013) The relationship between depression and physical symptom burden in advanced cancer. BMJ Supportive Palliative Care 5, 1–8.Google Scholar
Folstein, MF, Folstein, SE, and McHugh, PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research 12, 189–198.Google Scholar
Greco, MT, Roberto, A, Corli, O, et al. (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. Journal of Clinical Oncology 32, 4149–4154.Google Scholar
Hjermstad, M, Lie, H, Caraceni, A, et al. (2012) Computer-based symptom assessment is feasible in patients with advanced cancer: results from an international multicenter study, the EPCRC-CSA. Journal of Pain and Symptom Management 44, 639–654.Google Scholar
Hui, D (2014) Definition of supportive care: does the semantic matter? Current Opinion in Oncology 26, 372–379.Google Scholar
Howren, MB and Suls, J (2011) The symptom perception hypothesis revised: depression and anxiety play different roles in concurrent and retrospective physical symptom reporting. Journal of Personality and Social Psychology 100, 182–195.Google Scholar
Johns, SA, Kroenke, K, Krebs, EE, et al. (2013) Longitudinal comparison of three depression measures in adult cancer patients. Journal of Pain and Symptom Management 45, 71–82.Google Scholar
Kaasa, S, Loge, JH, Fayers, P, et al. (2008). Symptom assessment in palliative care: a need for international collaboration. Journal of Clinical Oncology 26, 3867–3873.Google Scholar
Kadan-Lottick, NS, Vanderwerker, LC, Block, SD, et al. (2005) Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer 104, 2872–2881.Google Scholar
Karnofsky, D (1948) The use of nitrogen mustards in the palliative treatment of carcinoma with particular reference to bronchogenic carcinoma. Cancer 1, 634–656.Google Scholar
Katon, W, Lin, EHB, Kroenke, K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry 29, 147–155.Google Scholar
Kroenke, K and Rosmalen, JGM (2006) Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. The Medical Clinics of North America 90, 603–626.Google Scholar
Lie, HC, Hjermstad, MJ, Fayers, P, et al. (2015) Depression in advanced cancer – assessment challenges and associations with disease load. Journal of Affective Disorders 173, 176–184.Google Scholar
Lloyd Williams, M, Dennis, M, and Taylor, F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliative Medicine 18, 558–563.Google Scholar
Lloyd Williams, M, Shiels, C, Taylor, F, and Dennis, M (2009) Depression — an independent predictor of early death in patients with advanced cancer. Journal of Affective Disorders 113, 127–132.Google Scholar
Lo, C, Zimmermann, C, Rydall, A, et al. (2010). Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. Journal of Clinical Oncology 28, 3084–3089.Google Scholar
Maltoni, M (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations – a study by the Steering Committee of the European Association for Palliative Care. Journal of Clinical Oncology 23, 6240–6248.Google Scholar
McCabe, MP, Mellor, D, Davison, TE, et al. (2012) Detecting and managing depressed patients: palliative care nurses' self-efficacy and perceived barriers to care. Journal of Palliative Medicine 15, 463–467.Google Scholar
Mitchell, AJ, Chan, M, Bhatti, H, et al. (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncology 12, 160–174.Google Scholar
Novy, D, Berry, MP, Palmer, JL, et al. (2005) Somatic symptoms in patients with chronic non-cancer-related and cancer-related pain. Journal of Pain and Symptom Management 29, 603–612.Google Scholar
O'Connor, M, Weir, J, Butcher, I, et al. (2012) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. Journal of Pain and Symptom Management 43, 29–38.Google Scholar
Rayner, L, Price, A, Hotopf, M, Higginson, IJ (2011) The development of evidence-based European guidelines on the management of depression in palliative cancer care. European Journal of Cancer 47, 702–713.Google Scholar
Sanjida, S, Janda, M, Kissane, D, et al. (2016) A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients. Psychooncology 25, 1002–1016.Google Scholar
Spitzer, RL, Kroenke, K, and Williams, JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of American Medical Association 282, 1737–1744.Google Scholar
Teunissen, SCCM, de Graeff, A, Voest, EE, de Haes, JCJM (2007) Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliative Medicine 21, 341–346.Google Scholar
Walker, J, Hansen, CH, Martin, P, et al. (2014). Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncology 15, 1168–1176.Google Scholar
Wasteson, E, Brenne, E, Higginson, IJ, et al. (2009) Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliative Medicine 23, 739–753.Google Scholar
WHO (World Health Organization) (2002) Definition of palliative care. http://www.who.int/cancer/palliative/definition/en. Accessed 19 Aug 2017.Google Scholar
Young, P (2007) Caring for the whole patient: the Institute of Medicine proposes a new standard of care. Community Oncology 4, 748–751.Google Scholar
Zaza, C and Baine, N (2002) Cancer pain and psychosocial factors. Journal of Pain and Symptom Management 24, 526–542.Google Scholar
Zimmerman, M, Emmert-Aronson, BO, and Brown, TA (2011) Concordance between a simpler definition of major depressive disorder and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: an independent replication in an outpatient sample. Comprehensive Psychiatry 52, 261–264.Google Scholar