TY - JOUR
T1 - Treatment Receipt and Outcomes among Lung Cancer Patients with Depression
AU - Sullivan, D. R.
AU - Ganzini, L.
AU - Duckart, J. P.
AU - Lopez-Chavez, Ariel
AU - Deffebach, M. E.
AU - Thielke, S. M.
AU - Slatore, Christopher
N1 - Funding Information:
Dr Sullivan takes responsibility for the content of the manuscript, including the data and analysis. All authors have participated sufficiently in the conception and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript, to take public responsibility for it. All authors believe the manuscript represents valid work. All authors have reviewed the final version, and approve it for publication. Dr Sullivan is supported by a NIH T-32 ( 5 T32 HL083808-05-32 ). Dr Slatore is supported by a VA HSR&D Career Development Award . Dr Thielke is supported by an NIMH Beeson Career Development Award ( K23MH093591 ). This study is the result of work supported by resources from the Portland Veterans Affairs Medical Center, Portland, Oregon and the Veterans Affairs Puget Sound Healthcare System, Seattle, Washington. The Department of Veterans Affairs did not have a role in the conduct of the study, in the collection, management, analysis or interpretation of data, or in the preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2014/1
Y1 - 2014/1
N2 - Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95% confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95% confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95% confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95% confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95% confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.
AB - Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95% confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95% confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95% confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95% confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95% confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.
KW - Depression
KW - Epidemiology
KW - Lung cancer
KW - Lung cancer treatment
KW - Patient outcomes
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U2 - 10.1016/j.clon.2013.09.001
DO - 10.1016/j.clon.2013.09.001
M3 - Article
C2 - 24080122
AN - SCOPUS:84890801161
SN - 0936-6555
VL - 26
SP - 25
EP - 31
JO - Clinical Oncology
JF - Clinical Oncology
IS - 1
ER -