Effect of depression on diagnosis, treatment, and survival of older women with breast cancer
Effect of depression on diagnosis, treatment, and survival of older women with breast cancer
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DOI：
10.1111/j.1532-5415.2004.52018.x
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发表时间：
2004-01-01
影响因子：
6.3
通讯作者：
Ostir, GV
中科院分区：
文献类型：
--
作者：
Goodwin, JS;Zhang, DD;Ostir, GV
目的：为了评估抑郁症的早期诊断对老年乳腺癌患者的诊断、治疗和生存的影响，设计：回顾性分析来自监测、流行病学和最终结果（SEER）和医疗保险索赔的记录。在1993年至1996年期间，共有24，696名年龄在67岁至90岁之间的女性被诊断患有乳腺癌，并被纳入SEER Medicare链接数据库。从SEER获得关于患者人口统计学、肿瘤特征、接受的治疗和生存的信息，并对诊断前2年的医疗保险住院和专业费用进行检索，以诊断抑郁症。在24，696名女性中，共有1，841名（7.5%）在诊断乳腺癌前2年的某个时候被诊断为抑郁症。抑郁症和非抑郁症女性在诊断时肿瘤大小或分期上没有差异。被诊断为抑郁症的女性接受治疗的可能性较低（59.7%对66.2%，P<0.0001），在控制了年龄、种族、合并症和SEER部位后，这种差异仍然存在。此外，在控制了可能影响生存的其他因素后，先前诊断为抑郁症的女性死亡风险较高（风险比=1.42; 95%置信区间= 1.13-1.79）。与抑郁症的先前诊断相关的死亡风险较高，也被认为是在分析中仅限于妇女谁收到了明确的treatment.CONCLUSION：最近诊断为抑郁症的妇女是在接受非确定性治疗的风险更大，经历更差的生存诊断后的乳腺癌，但治疗的差异并不能解释更差的生存。
OBJECTIVES: To assess the effect of a prior diagnosis of depression on the diagnosis, treatment, and survival of older women with breast cancer.DESIGN: Retrospective analysis of records from Surveillance, Epidemiology and End Results (SEER) and Medicare claims.SETTING: Registries from seven major cities and five states.PARTICIPANTS: A total of 24,696 women aged 67 to 90 diagnosed with breast cancer between 1993 and 1996 and included in the SEER Medicare linked database were studied.MEASUREMENTS: Information on patient demographics, tumor characteristics, treatment received, and survival were obtained from SEER, and the Medicare inpatient and professional charges for the 2 years before diagnosis were searched for a diagnosis of depression.RESULTS: A total of 1,841 of the 24,696 women (7.5%) had been given a diagnosis of depression sometime in the 2 years before the diagnosis of breast cancer. There was no difference in tumor size or stage at diagnosis between depressed and nondepressed women. Women diagnosed with depression were less likely to receive treatment generally considered definitive (59.7% vs 66.2%, P< .0001), and this difference remained after controlling for age, ethnicity, comorbidity, and SEER site. Also, women with a prior diagnosis of depression had a higher risk of death (hazard ratio=1.42; 95% confidence interval= 1.13-1.79) after controlling for other factors that might affect survival. The higher risk of death associated with a prior diagnosis of depression was also seen in analyses restricted to women who received definitive treatment.CONCLUSION: Women with a recent diagnosis of depression are at greater risk for receiving nondefinitive treatment and experience worse survival after a diagnosis of breast cancer, but differences in treatment do not explain the worse survival.