Mark Lazenby, PhD, APRN, FAPOS
Symptoms of depression are common in patients newly diagnosed with lung cancer, and a new study has found that their survival is actually worse when these symptoms emerge or persist after their diagnosis.
Researchers found that when compared with patients with lung cancer who never developed depression, those with new-onset symptoms were 50% more likely to die. And of those whose depression at baseline persisted throughout the study period, 42% were more likely to die.
Using data from the Cancer Care Outcomes Research and Surveillance Consortium, this prospective, observational study looked at 1790 patients from 5 healthcare systems and 15 Veterans Administration medical centers newly diagnosed with lung cancer between 2003 and 2005. Of the study cohort, 57% were aged >65 years, 45% were women, and nearly 30% currently used tobacco.
Patients were given an 8-item depression assessment at diagnosis and then followed up with again after 12 months, using the Center for Epidemiologic Studies Depression Scale (CES-D).
Overall, the researchers found that 44% of study participants had depression symptoms at some point over the study period: 38% had depression symptoms at baseline (n = 681), and for 254 of these patients, symptoms persisted during follow-up. Fourteen percent of patients (n = 105) developed new-onset symptoms during treatment.
Depression in patients with cancer is not a new phenomenon, explained Mark Lazenby, PhD, APRN, FAPOS, an associate professor at the Yale School of Nursing and member of the Yale Cancer Center, in a statement.
“We have known since the 1970s that a cancer diagnosis sets off a period of existential plight,” said Lazenby, who was not involved in this research. “Although from this study we cannot say that treating depression would extend survival, previous studies have shown that care aimed at improving psychosocial well-being, which includes but is not limited to detecting and treating depression, does have a survival benefit.”
Notably, in the study reported here, patients who had depressive symptoms when they were diagnosed with lung cancer but who did not have them 1 year later, had a similar risk of death as those patients who were never depressed over the course of the study.
That, noted the study authors, suggests a need for better integration of depression treatment into the comprehensive cancer care of these patients.
“Clinicians have to do a better job of treating the whole person and not focusing on the disease only,” said lead author Donald Sullivan, MD, in a statement, adding that depression can also lead to missed appointments and lower adherence, factors which affect patient outcomes.
Sullivan, an assistant professor at Oregon Health and Science University, stressed that although “this study cannot prove causation, it lends support to the idea that surveillance for depression symptoms and treatment for depression could provide significant impact on patient outcomes, perhaps even a mortality benefit.”
He hopes that this study will help patients to realize that they are not alone in feeling depressed and that, “they will feel empowered to advocate for themselves and ask their clinicians for help or resources when they need it.”
Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment [published online ahead of print October 3, 2016]. J Clin Oncol.