Depression in advanced cancer--assessment challenges and associations with disease load

H C Lie; M J Hjermstad; P Fayers; A Finset; S Kaasa; J H Loge; European Palliative Care Research Collaborative (EPCRC)

doi:10.1016/j.jad.2014.11.006

Depression in advanced cancer--assessment challenges and associations with disease load

J Affect Disord. 2015 Mar 1:173:176-84. doi: 10.1016/j.jad.2014.11.006. Epub 2014 Nov 15.

Authors

H C Lie¹, M J Hjermstad², P Fayers³, A Finset⁴, S Kaasa⁵, J H Loge⁶; European Palliative Care Research Collaborative (EPCRC)

Collaborators

European Palliative Care Research Collaborative (EPCRC):
Stein Kaasa, Frank Skorpen, Marianne Jensen Hjermstad, Jon Håvard Loge, Geoffrey Hanks, Augusto Caraceni, Franco De Conno, Irene Higginson, Florian Strasser, Lukas Radbruch, Kenneth Fearon, Hellmut Samonigg, Ketil Bø, Irene Rech-Weichselbraun, Odd Erik Gundersen, Neil Aaronson, Vickie Baracos, Robin Fainsinger, Patrick C Stone, Mari Lloyd-Williams, Stein Kaasa, Ola Dale, Dagny F Haugen

Affiliations

¹ Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway. Electronic address: h.c.lie@medisin.uio.no.
² European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.
³ European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁴ Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.

PMID: 25462414
DOI: 10.1016/j.jad.2014.11.006

Abstract

Background: Patients with advanced cancer commonly experience multiple somatic symptoms and declining functioning. Some highly prevalent symptoms also overlap with diagnostic symptom-criteria of depression. Thus, assessing depression in these patients can be challenging. We therefore investigated 1) the effect of different scoring-methods of depressive symptoms on detecting depression, and 2) the relationship between disease load and depression amongst patients with advanced cancer.

Methods: The sample included 969 patients in the European Palliative Care Research Collaborative-Computer Symptom Assessment Study (EPCRC-CSA). Inclusion criteria were: incurable metastatic/locally advanced cancer and ≥ 18 years. Biomarkers and length of survival were registered from patient-records. Depression was assessed using the Patient Health Questionnaire (PHQ-9) and applying three scoring-methods: inclusive (algorithm scoring including the somatic symptom-criteria), exclusive (algorithm scoring excluding the somatic symptom-criteria) and sum-score (sum of all symptoms with a cut-off ≥ 8).

Results: Depression prevalence rates varied according to scoring-method: inclusive 13.7%, exclusive 14.9% and sum-score 45.3%. Agreement between the algorithm scoring-methods was excellent (Kappa = 0.81), but low between the inclusive and sum scoring-methods (Kappa = 0.32). Depression was significantly associated with more pain (OR-range: 1.09-1.19, p < 0.001-0.04) and lower performance status (KPS-score, OR-range = 0.68-0.72, p < 0.001) irrespective of scoring-method.

Limitations: Depression was assessed using self-report, not clinical interviews.

Conclusions: The scoring-method, not excluding somatic symptoms, had the greatest effect on assessment outcomes. Increasing pain and poorer than expected physical condition should alert clinicians to possible co-morbid depression. The large discrepancy in prevalence rates between scoring-methods reinforces the need for consensus and validation of depression definitions and assessment in populations with high disease load.

Keywords: Advanced cancer; Depression; Disease load; Somatic symptoms; Symptom-overlap.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Comorbidity
Depression / diagnosis
Depression / epidemiology*
Depression / mortality
Depressive Disorder / diagnosis
Depressive Disorder / epidemiology*
Depressive Disorder / mortality
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Male
Middle Aged
Neoplasms / epidemiology*
Neoplasms / mortality
Neoplasms / psychology
Palliative Care
Prevalence
Severity of Illness Index
Survival Rate