Depression and Survival in Metastatic Non-Small-Cell Lung Cancer: Effects of Early Palliative Care
Depression and Survival in Metastatic Non-Small-Cell Lung Cancer: Effects of Early Palliative Care
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DOI：
10.1200/jco.2011.38.3166
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发表时间：
2012-04-20
影响因子：
45.3
通讯作者：
Temel, Jennifer S.
中科院分区：
文献类型：
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作者：
Pirl, William F.;Greer, Joseph A.;Temel, Jennifer S.
目的在一项随机试验中，观察转移性非小细胞肺癌(NSCLC)患者的早期姑息治疗(EPC)以提高生存率。在二次分析中，我们探索了这样一个假设，即改善抑郁对生存有好处。患者和方法总共有151名新诊断的转移性非小细胞肺癌患者参加了EPC结合标准肿瘤治疗与单纯标准肿瘤治疗的随机试验。在基线和12周时使用患者健康问卷-9(PHQ-9)对抑郁进行评估，并使用第四版精神障碍诊断和统计手册重度抑郁综合征标准(MDS)进行诊断性评分。抑郁反应被认为是在12周时PHQ-9评分下降50%。生存差异用LOG-RANK和COX比例风险模型检验。MDS显著预示着较差的生存(风险比，1.82；P=0.02)。被分配到EPC的患者在12周时PHQ-9得分有更大的改善(P<；.001)；在MDS患者中，那些接受EPC的患者在12周时有更高的抑郁反应率(P=.04)。然而，PHQ-9得分的改善与生存的改善并不相关，除了在敏感性分析中，12周前死亡的患者被建模为患有更严重的抑郁症。在将PHQ-9评分的改善添加到生存模型中后，随机分配到EPC的组仍然与生存独立相关。结论抑郁预测新诊断的转移性非小细胞肺癌患者的生存更差。尽管EPC与12周后抑郁症的更大改善有关，但数据并不支持抑郁症的治疗中介了EPC的观察到的生存益处的假设。
PurposeIn a randomized trial, early palliative care (EPC) in patients with metastatic non-small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression.Patients and MethodsIn total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered >= 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models.ResultsAt baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model.ConclusionDepression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.