W Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer
W Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer
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DOI：
10.1016/j.jpainsymman.2017.04.010
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发表时间：
2017-12-01
影响因子：
4.7
通讯作者：
Loge, Jon Havard
中科院分区：
文献类型：
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作者：
Grotmol, Kjersti S.;Lie, Hanne C.;Loge, Jon Havard
上下文。生活质量(QOL)和抑郁是癌症护理中患者报告的重要结果。然而，由于很少有方法学上可靠的研究，抑郁严重程度在预测生活质量中的相对重要性仍不清楚。无论预后因素和症状负担如何，检查抑郁是否对生活质量的损害有贡献。共有563名患者来自欧洲姑息治疗研究协作性-计算机化症状评估研究，这是一项国际性、多中心、横断面研究。采用分级多元回归模型评估预后因素(全身炎症[改良格拉斯哥预后评分-MGPS])、合并症和体能(卡诺夫斯基表现状态)、症状负担(食欲不振、呼吸困难、恶心[埃德蒙顿症状评估量表]和疼痛[简明疼痛问卷])和抑郁严重程度(患者健康问卷9)在预测全球健康/生活质量(欧洲癌症研究与治疗组织核心生活质量问卷[EORTC-QLQ-C30])中的相对重要性。55%为女性，中位年龄为，87%有转移性疾病，卡诺夫斯基表现状态中位数为70，全球平均生活质量为50.5(SD=23.3)。较差的生活质量与全身炎症增加(MGPS=1β=-0.12，P=0.003；MGPS=2 Beta=-0.09，P=0.023)、较低的体能(Beta=0.17，P<；0.001)、食欲降低(Beta=-0.15，P<；0.001)、呼吸困难(Beta=-0.11，P=0.004)、疼痛(Beta=-0.14，P=0.002)和较高的抑郁程度(Beta=-0.27，P<；；0.001)。完整模型解释了观察到的生活质量评分变化的29%。抑郁程度是最强的预测因子，对变量的贡献率为5.8%。在考虑了广泛的临床相关变量后，抑郁症的严重程度是晚期癌症患者样本中较差的生活质量的最强单一预测因子。未来的研究应该调查心理社会变量对生活质量的影响。我们的发现强调了管理抑郁症的重要性，以实现这些患者可能的最佳生活质量。(C)2017年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies.Objectives. To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.Methods. A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models.Results. Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 beta = -0.12, P = 0.003; mGPS = 2 beta = -0.09, P = 0.023), lower physical performance (beta = 0.17, P < 0.001), reduced appetite (beta = -0.15, P < 0.001), breathlessness (beta = -0.11, P = 0.004), pain (beta = -0.14, P = 0.002), and higher depression severity (beta = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance.Conclusion. Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.