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Low CE, Yau CE, Tan RY, Ong VCS, Ho RCM, Ho CSH, Lee ARYB, Chen MZ. Association of depression with all-cause and cancer-specific mortality in older adults with cancer: Systematic review, meta-analysis, and meta-regression. J Geriatr Oncol 2024; 15:101700. [PMID: 38218674 DOI: 10.1016/j.jgo.2023.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/30/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The incidence and mortality of cancer is increasing worldwide with studies reporting that cumulative risk of cancer rises as age increases. Against the backdrop of the increasing prevalence of cancer amongst older patients, we conducted a systematic review and meta-analysis examining the depression-mortality relationship in older adults with cancer (OAC). MATERIALS AND METHODS This PRISMA-adherent systematic review involved a systematic search of PubMed, Medline, EMBASE, and PsycINFO for prospective and retrospective cohort studies comparing the risk of all-cause and cancer-related mortality among OAC with depression. Random effects meta-analyses and meta-regressions were used for the primary analysis. RESULTS From 5,280 citations, we included 14 cohort studies. Meta-analyses of hazard ratios (HRs) showed an increased incidence of all-cause mortality in OAC with depression (pooled HR: 1.40; 95% confidence interval [CI]: 1.25, 1.55). Subgroup analyses of other categorical study-level characteristics were insignificant. While risk of cancer-related mortality in OAC with depression was insignificantly increased with a pooled HR of 1.21 (95% CI: 0.98, 1.49), subgroup analysis indicated that risk of cancer-related mortality in OAC with depression significantly differed with cancer type. Our systematic review found that having fewer comorbidities, a higher education level, greater socioeconomic status, and positive social supportive factors lowered risk of all-cause mortality in OAC with depression. DISCUSSION Depression in OAC significantly increases risk of all-cause mortality and cancer-related mortality among different cancer types. It is imperative for healthcare providers and policy makers to recognize vulnerable subgroups among older adults with cancer to individualize interventions.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ren Ying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Roger Chun Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | | | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore.
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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Jayani RV. How old is too old? Frailty and geriatric assessments of older patients undergoing allogeneic HCT. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:709-714. [PMID: 38066893 PMCID: PMC10727072 DOI: 10.1182/hematology.2023000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is a curative-intent treatment for many hematologic malignancies but carries a significant risk of morbidity and mortality. An increasing number of older adults are receiving HCT, but current pretransplant evaluations overlook the unique vulnerabilities that older adults face. Oncology-specific geriatric and frailty assessments provide a comprehensive evaluation of older adults, help better weigh the risks of HCT with patients, and guide personalized optimization strategies to minimize vulnerabilities. Geriatric assessments evaluate seven domains: comorbidities, physical function, mental health, cognition, nutrition, medications, and social support. Frailty indices provide unique evaluations into a patient's overall status. Various standardized measures have been used to evaluate these areas in older adults prior to HCT. Different care models exist for the integration of geriatrics and geriatric principles into HCT evaluation: a multidisciplinary consultative clinic, a geriatrician alongside the HCT clinic, or a primary geriatric hematologist/transplant physician. Future studies are needed to investigate the use of geriatric assessments in selecting the conditioning regimen and intensity and measuring the impact of geriatric assessment-driven interventions on quality of life and toxicities post transplant.
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Affiliation(s)
- Reena V. Jayani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Nakamura ZM, Small BJ, Zhai W, Ahles TA, Ahn J, Artese AL, Bethea TN, Breen EC, Cohen HJ, Extermann M, Graham D, Irwin MR, Isaacs C, Jim HSL, Kuhlman KR, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhou X, Mandelblatt JS, Carroll JE. Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study. J Cancer Surviv 2023:10.1007/s11764-023-01490-2. [PMID: 37924476 PMCID: PMC11068856 DOI: 10.1007/s11764-023-01490-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories. METHODS Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories. RESULTS Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms. CONCLUSIONS Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes. IMPLICATIONS FOR CANCER SURVIVORS Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA.
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Ashley L Artese
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Traci N Bethea
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael R Irwin
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Claudine Isaacs
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kate R Kuhlman
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychological Science, University of California, Irvine, CA, USA
- Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California, Irvine, CA, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita K Patel
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle B Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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Saracino RM, Tobias KG, Shuk E, Avildsen I, Emanu J, Demirjian C, Rosenfeld B, Roth AJ, Alici Y, Nelson CJ. On taking up space: a qualitative inquiry of depression in older adults with cancer. Aging Ment Health 2023; 27:1744-1751. [PMID: 36907588 PMCID: PMC10495533 DOI: 10.1080/13607863.2023.2187758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To identify the phenomenology of depression in older adults with cancer (OACs) in order to improve the accuracy of depression screening for this population. METHOD Inclusion criteria were: ≥70 years old, history of cancer, no cognitive impairment or severe psychopathology. Participants completed a demographic questionnaire, a diagnostic interview, and a qualitative interview. Using a Thematic Content Analysis framework, critical themes, passages, and phrases used by patients to describe their perceptions of depression and how it is experienced were identified. Particular attention was paid to divergences between depressed and non-depressed participants. RESULTS Among 26 OACs (13 depressed, 13 non-depressed), qualitative analyses revealed four major themes indicative of depression (i.e. anhedonia, reduction in social relationships/loneliness, lack of meaning and purpose, lack of usefulness/feeling like a burden) and four minor themes (i.e. attitude towards treatment, mood, regret/guilt, physical symptoms/limitations). Themes of adaptation and acceptance of symptoms also emerged. CONCLUSIONS Of the eight themes identified, only two overlap with DSM criteria. This supports the need to develop assessment methods of depression in OACs that are less reliant on DSM criteria and distinct from existing measures. This may improve the ability to identify depression in this population.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen G Tobias
- Department of Psychology, Fordham University, The Bronx, NY, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Isabelle Avildsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Emanu
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caraline Demirjian
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, The Bronx, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tack L, Maenhoudt AS, Ketelaars L, De Zutter J, Pinson S, Keunebrock L, Haaker L, Deckmyn K, Gheysen M, Kenis C, Wildiers H, Depoorter L, Geerts PJ, Chandler R, Boterberg T, Schofield P, Parris CN, Debruyne PR. Diagnostic Performance of Screening Tools for Depressive Symptoms in Vulnerable Older Patients with Cancer Undergoing Comprehensive Geriatric Assessment (CGA): Results from the SCREEN Pilot Study. Curr Oncol 2023; 30:1805-1817. [PMID: 36826101 PMCID: PMC9955591 DOI: 10.3390/curroncol30020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Depression is a common and disabling disorder in later life, particularly among people with poor physical health. There are many screening tools available that can be used to examine depressive symptoms; however, not all of them may be appropriate or accurate for older adults with cancer. This pilot study was designed to test the diagnostic performance of two screening tools and their short versions in a cohort of vulnerable (G8 score ≤ 14/17) older patients with cancer undergoing comprehensive geriatric assessment (CGA). The prospective analysis covered 50 vulnerable patients with cancer aged ≥70 years. The diagnostic performance of the Geriatric Depression Scale (GDS)-15, GDS-4, Patient Health Questionnaire (PHQ)-9 and PHQ-2 was compared to the 'gold standard' Structured Clinical Interview for DSM-5 Disorders (SCID-5-S) depression module A. The sensitivity and specificity in detecting depressive symptoms were the highest in the case of PHQ-2, with an area under the receiver operating characteristic curve (AUROC) of 92.7%. The AUROC for the 9-item version, PHQ-9, was 90.2%. For the GDS-15 and GDS-4, the AUROC was only 56.2% and 62.0%, respectively. The SCREEN pilot study illustrates the potential benefit of using a shorter screening tool, PHQ-2, to identify older patients with cancer who would benefit from a more in-depth emotional evaluation as part of a CGA.
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Affiliation(s)
- Laura Tack
- Department of Medical Oncology, OECI-designated Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | | | - Lore Ketelaars
- Department of Psychology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Jolien De Zutter
- Department of Psychology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Stefanie Pinson
- Department of Psychology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Laura Keunebrock
- Department of Psychology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Lorenz Haaker
- Department of Medical Oncology, OECI-designated Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Kathleen Deckmyn
- Department of Medical Oncology, OECI-designated Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Mathilde Gheysen
- Department of Medical Oncology, OECI-designated Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven-University of Leuven, 3000 Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Laurence Depoorter
- Department of Geriatrics, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Pieter-Jan Geerts
- Department of Psychiatry, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Rebecca Chandler
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Chelmsford CM1 1SQ, UK
| | - Tom Boterberg
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Patricia Schofield
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Christopher N. Parris
- Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Philip R. Debruyne
- Department of Medical Oncology, OECI-designated Kortrijk Cancer Centre, General Hospital Groeninge, 8500 Kortrijk, Belgium
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Correspondence: ; Tel.: +32-(0)56-63-39-00
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Men VY, Emery CR, Lam TC, Yip PSF. Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 2022; 52:2342-2351. [PMID: 33226318 DOI: 10.1017/s0033291720004250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
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Affiliation(s)
- Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Clifton Robert Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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Sharma H, Pankratz VS, Demark-Wahnefried W, Pestak CR, Blair CK. Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors. Healthcare (Basel) 2022; 10:1421. [PMID: 36011078 PMCID: PMC9407773 DOI: 10.3390/healthcare10081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.
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Affiliation(s)
- Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
| | - Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Claire R. Pestak
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
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Assessing psychological health and social support in older adults with cancer, a how-to guide - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative. J Geriatr Oncol 2022; 13:1050-1053. [PMID: 35717534 DOI: 10.1016/j.jgo.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
Abstract
Older adults with cancer frequently have several unmet needs related to overlapping vulnerabilities caused by medical and social health challenges which are often overlooked in typical oncological assessments 1. Social support and psychological health are critical considerations for older adults with cancer and are therefore key components of a geriatric assessment.
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10
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Boudin G, Solem Laviec H, Ghewy L, Le Bon P, Lebaube S, Machavoine JL, Denhaerynck J, Morello R, Beauplet B. A prospective observational cohort study to screen major depressive disorders in geriatric oncology-Comparison of different scales. Eur J Cancer Care (Engl) 2022; 31:e13591. [PMID: 35415901 PMCID: PMC9541160 DOI: 10.1111/ecc.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 12/20/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
Objective Systematic depression screening is recommended for older patients with cancer. The objective of this study was to evaluate the performance of three mood disorder screening scales frequently used in geriatric oncology to help in diagnosing major depressive disorder (MDD). Methods A prospective multicentre study was conducted in patients 70 years of age and over with cancer, comparing three self‐report questionnaires: the 15‐item Geriatric Depression Scale (GDS‐15), the Hospital Anxiety and Depression Scale – Depression (HADS‐D) and the Distress Thermometer (DT). In the event of abnormal scores, a psychologist consultation was suggested and a reassessment of the patient's mood was planned within 3 weeks. Potential differences between initial abnormal screening score and confirmed MDD (according to the Diagnostic and Statistical Manual of Mental Disorders criteria [DSM‐5]) were assessed using variance analysis for each screening scale. Results Ninety‐three patients with a median age of 81 years (70–95) were included. Sixty‐six patients had at least one abnormal score on one of the screening scales. MDD was confirmed in 10 of the 36 reassessed patients. Analysis of ROC curves showed that the HADS‐D significantly predicted MDD (AUC = 0.760, IC95%: 0.603–0.917; p = 0.017), but not the GDS‐15 or the initial DT. Conclusion The HADS‐D could better detect MDD, to confirm in a larger sample.
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Affiliation(s)
- Guillaume Boudin
- Department of Geriatric Medicine, Robert Bisson General Hospital, Lisieux, France
| | - Heidi Solem Laviec
- Normandy Interregional Oncogeriatric Coordination Unit, Caen, France.,Oncology and Supportive Care Unit, François Baclesse Regional Cancer Center, Caen, France
| | - Lauriane Ghewy
- Department of Geriatric Medicine, Caen University Hospital Center, Caen, France
| | - Priscille Le Bon
- Normandy Interregional Oncogeriatric Coordination Unit, Caen, France.,Oncology and Supportive Care Unit, François Baclesse Regional Cancer Center, Caen, France
| | - Soazig Lebaube
- Department of Geriatric Medicine, Caen University Hospital Center, Caen, France
| | - Jean-Luc Machavoine
- Oncology and Supportive Care Unit, François Baclesse Regional Cancer Center, Caen, France
| | - Julie Denhaerynck
- Department of Geriatric Medicine, Caen University Hospital Center, Caen, France
| | - Remy Morello
- Biostatistics and Clinical Research Unit, Caen University Hospital Center, Caen, France
| | - Bérengère Beauplet
- Normandy Interregional Oncogeriatric Coordination Unit, Caen, France.,Department of Geriatric Medicine, Caen University Hospital Center, Caen, France.,Normandie Univ, UniCaen, INSERM, U1086, ANTICIPE, Caen, France
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11
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Towards a Better Understanding of the Factors Associated with Distress in Elderly Cancer Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063424. [PMID: 35329112 PMCID: PMC8949443 DOI: 10.3390/ijerph19063424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
This study presents a systematic review of the sociodemographic, clinical, and psychosocial factors associated with distress in elderly cancer patients. Relevant studies were identified using four electronic databases: PubMed, Scopus, Web of Science and ProQuest. Cross-sectional and longitudinal studies exploring factors associated with distress in people over 60 years of age were included and independently assessed using the Joanna Briggs Institute Critical Assessment Checklists. A total of 20 studies met the inclusion criteria. Research showed that being a woman, being single, divorced or widowed, having low income, having an advanced diagnosis, having functional limitations, having comorbidities, and having little social support were factors consistently associated with emotional distress. Data further showed that the impact of age, cancer type, and cancer treatment on symptoms of anxiety and/or depression in elderly patients is not yet well established. The findings of this review suggest that the emotional distress of elderly cancer patients depends on a myriad of factors that are not exclusive, but coexisting determinants of health. Future research is still needed to better understand risk factors for distress in this patient population, providing the resources for healthcare providers to better meet their needs.
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12
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Massa E, Donisi C, Liscia N, Madeddu C, Impera V, Mariani S, Scartozzi M, Lai E. The Difficult Task of Diagnosing Depression in Elderly People with Cancer: A Systematic Review. Clin Pract Epidemiol Ment Health 2021; 17:295-306. [PMID: 35444712 PMCID: PMC8985471 DOI: 10.2174/1745017902117010295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Background:
Depression is a common psychiatric problem in the elderly and oncology patients. In elderly people with cancer, depression has a peculiar phenomenology. It has a significant impact on the quality of life. Moreover, it is associated with poor adherence to treatments, increased risk of suicide, and mortality. Nevertheless, the topic of depression in elderly people with cancer remains unexplored.
Objective:
The main goal of this article is to review the literature from the past 20 years on the relationships between depression, cancer, and aging.
Methods:
The methods followed the Prisma model for eligibility of studies. The articles in which the keywords “depression”, “cancer”, “ elderly, aging, or geriatric” were present, either in the text or in the abstract, were selected. 8.056 articles, by matching the keywords “depression and elderly and cancer,” were identified. Only 532 papers met the eligibility criteria of search limits and selection process. Out of 532 papers, 467 were considered irrelevant, leaving 65 relevant studies. Out of 65 suitable studies, 39 (60.0%) met our quality criteria and were included.
Results:
The risk factors associated with depression in elderly people with cancer can be divided into 4 groups: 1) tumor-related; 2) anticancer treatment-related; 3) patients-related; 4) number and type of comorbidity. The main obstacles in diagnosing depression in elderly patients with cancer are the overlap of the symptoms of cancer and side effects of treatment with the symptoms of depression but also the different ways of reporting depressive symptoms of elderly people and the different clinical types of depression. There is a lack of data regarding validated scales to assess depression in geriatric patients with cancer. Any mental illness, specifically co-occurring anxiety and depression, increases the risk of diagnosis delay and anticancer treatment adherence. Cancer and the diagnosis of mental disorders prior to cancer diagnosis correlate with an increased risk for suicide. A non-pharmacological therapeutic approach, pharmacological treatment and/or a combination of both can be used to treat elderly patients with cancer, but a detailed analysis of comorbidities and the assessment of polypharmacy is mandatory in order to avoid potential side-effects and interactions between antidepressants and the other drugs taken by the patients.
Conclusion:
Future research should be conducted with the aim of developing a modified and adapted assessment method for the diagnosis and treatment of depression in elderly people with cancer in order to improve their clinical outcomes and quality of life.
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13
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Gilmore N, Kehoe L, Bauer J, Xu H, Hall B, Wells M, Lei L, Culakova E, Flannery M, Grossman VA, Sardari RA, Subramanya H, Kadambi S, Belcher E, Kettinger J, O'Rourke MA, Dib EG, Vogelzang NJ, Dale W, Mohile S. The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer. Oncologist 2021; 26:e2181-e2191. [PMID: 34510642 DOI: 10.1002/onco.13975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Aging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population. METHODS This was a secondary analysis of baseline data from a nationwide cluster randomized trial. Patients were aged ≥70 years with incurable stage III/IV solid tumors or lymphomas, had ≥1 geriatric assessment (GA) domain impairment, and had completed the Geriatric Depression Scale, Generalized Anxiety Disorder-7, and Distress Thermometer. Frailty was assessed using a Deficit Accumulation Index (DAI; range 0-1) based on GA, which did not include emotional health variables (depression and anxiety), and participants were stratified into robust, prefrail, and frail categories. Multivariate logistic regression models examined the association of frailty with emotional health outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS Five hundred forty-one patients were included (mean age: 77 years; 70-96). DAI ranged from 0.04 to 0.94; 27% of patients were classified as robust, 42% prefrail, and 31% frail. Compared with robust patients, frail patients had an increased risk of screening positive for depression (aOR = 12.8; 95% CI = 6.1-27.0), anxiety (aOR = 6.6; 95% CI = 2.2-19.7), and emotional distress (aOR = 4.62; 95% CI = 2.9-8.3). Prefrail compared with robust patients also had an increased risk of screening positive for depression (aOR = 2.22; 95% CI = 1.0-4.8) and distress (aOR = 1.71; 95% CI = 1.0-2.8). CONCLUSION In older patients with advanced cancer, frailty is associated with poorer emotional health, which indicates a need for an integrated care approach to treating these patients. IMPLICATIONS FOR PRACTICE A relationship exists between frailty and poor emotional health in older adults with advanced cancer. Identifying areas of frailty can prompt screening for emotional health and guide delivery of appropriate interventions. Alternatively, attention to emotional health may also improve frailty.
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Affiliation(s)
- Nikesha Gilmore
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lee Kehoe
- University of Rochester Medical Center, Rochester, New York, USA
| | - Jessica Bauer
- University of Rochester Medical Center, Rochester, New York, USA
| | - Huiwen Xu
- University of Rochester Medical Center, Rochester, New York, USA
| | - Bianca Hall
- University of Rochester Medical Center, Rochester, New York, USA
| | - Megan Wells
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lianlian Lei
- University of Michigan, Ann Arbor, Michigan, USA
| | - Eva Culakova
- University of Rochester Medical Center, Rochester, New York, USA
| | - Marie Flannery
- University of Rochester Medical Center, Rochester, New York, USA
| | - Valerie Aarne Grossman
- University of Rochester Medical Center, Rochester, New York, USA.,SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Himal Subramanya
- University of Rochester Medical Center, Rochester, New York, USA
| | - Sindhuja Kadambi
- University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - Mark A O'Rourke
- Cancer Centers of the Carolinas, Greenville, South Carolina, USA
| | - Elie G Dib
- Michigan Cancer Research Consortium, Ypsilanti, Michigan, USA
| | | | - William Dale
- City of Hope National Medical Center, Duarte, California, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, New York, USA
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14
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Lafont C, Chah Wakilian A, Lemogne C, Gouraud C, Fossey-Diaz V, Orvoen G, Lhuillier N, Paillaud E, Bastuji-Garin S, Zebachi S, Hanon O, Goldwasser F, Boudou-Rouquette P, Canouï-Poitrine F. Diagnostic Performance of the 4-Item Geriatric Depression Scale for Depression Screening in Older Patients with Cancer: The ELCAPA Cohort Study. Oncologist 2021; 26:e983-e991. [PMID: 33683759 DOI: 10.1002/onco.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In older patients with cancer, depression is difficult to assess because of its heterogeneous clinical expression. The 4-item version of the Geriatric Depression Scale (GDS-4) is quick and easy to administer but has not been validated in this population. The present study was designed to test the diagnostic performance of the GDS-4 in a French cohort of older patients with cancer before treatment. MATERIALS AND METHODS Our cross-sectional analysis of data from the Elderly Cancer Patient cohort covered all patients with cancer aged ≥70 years and referred for geriatric assessment at two centers in France between 2007 and 2018. The GDS-4's psychometric properties were evaluated against three different measures of depression: the geriatrician's clinical diagnosis (based on a semistructured interview), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and a cluster analysis. The scale's sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated. RESULTS In a sample of 2,293 patients (median age, 81 years; women, 46%), the GDS-4's sensitivity and specificity for detecting physician-diagnosed depression were, respectively, 90% and 89%. The positive and negative likelihood ratios were 8.2 and 0.11, and the AUROC was 92%. When considering the subset of patients with data on all measures of depression, the sensitivity and specificity values were, respectively, ≥90% and ≥72%, the positive and negative likelihood ratios were, respectively, ≥3.4 and ≤ 0.11, and the AUROC was ≥91%. CONCLUSION The GDS-4 appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. IMPLICATIONS FOR PRACTICE Considering the overlap between symptoms of cancer and symptoms of depression, depression is particularly difficult to assess in older geriatric oncology and is associated with poor outcomes; there is a need for a routine psychological screening. Self-report instruments like the 4-item version of the Geriatric Depression Scale appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. Asking four questions might enable physicians to screen older patients with cancer for depression and then guide them toward further clinical evaluation and appropriate care if required.
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Affiliation(s)
- Charlotte Lafont
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | | | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Clément Gouraud
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, Paris, France
| | | | - Galdric Orvoen
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - Nathalie Lhuillier
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, HEGP, Service de Gériatrie, F-75015, Paris, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Olivier Hanon
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - François Goldwasser
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | | | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
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15
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Men VY, Emery CR, Yip PSF. Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records. Psychooncology 2021; 30:1051-1058. [PMID: 33655563 DOI: 10.1002/pon.5634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Cancer patients have elevated suicide risk compared to the general population. However, little is known about the characteristics of cancer patients who have died by suicide. The objectives of the study were to compare the characteristics of suicide cases with, and without cancer, and determine whether age was associated with differences in characteristics. METHODS A total of 14,446 suicide cases between 2003 and 2017 in Hong Kong were identified using Coroner's Court reports. Cases were grouped by cancer status, based on medical history in the reports. Information extracted from the reports included sociodemographic variables and detailed descriptions of the suicide event. Univariate analyses and overall and subgroup multiple logistic regressions were performed to compare characteristics between the two groups. RESULTS Of the 14,446 suicide cases, 1,461 (10.11%) had a cancer history. Compared to noncancer cases, cancer patients were generally older and less likely to live alone; more likely to use violent methods; less likely to have histories of physical and psychiatric problems; and more likely to communicate about their suicidal intent before death. Age was significantly associated with differences between cancer and noncancer cases. CONCLUSIONS Cancer suicide cases have different characteristics from noncancer cases. Mental health screening may not be sufficient for suicide prevention among cancer patients. Healthcare professionals and caregivers should be aware of cancer patients' suicide risk, even when there are no signs of psychiatric disturbance.
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Affiliation(s)
- Vera Y Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Clifton R Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
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16
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Fusco D, Ferrini A, Pasqualetti G, Giannotti C, Cesari M, Laudisio A, Ballestrero A, Scabini S, Odetti PR, Colloca GF, Monzani F, Nencioni A, Antonelli Incalzi R, Monacelli F. Comprehensive geriatric assessment in older adults with cancer: Recommendations by the Italian Society of Geriatrics and Gerontology (SIGG). Eur J Clin Invest 2021; 51:e13347. [PMID: 32648990 DOI: 10.1111/eci.13347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimizing the approach to older adults with cancer is now a priority given the increasing frequency of new cancer diagnoses that are made in the older population. The comprehensive geriatric assessment (CGA) represents the gold-standard for (1) defining prognosis and ability to withstand cancer treatments, (2) exploring the multiple aspects that define the complexity of frail older persons, and (3) designing person-tailored interventions. MATERIALS AND METHODS In this document, based on a comprehensive revision of the literature, the Italian Society for Geriatrics and Gerontology proposes a CGA model (ONCOGER CGA) to be adopted by oncology centers for their routine approach to older patients with cancer. RESULTS AND DISCUSSION A widespread use of this standardized CGA format will facilitate comparisons across institutions, promote studies based on a multidimensional patient assessment, and foster the inclusion of geriatric endpoints in oncological clinical trials. Furthermore, we predict that the use of a standardized CGA approach will increase the integration of geriatricians into oncology care teams with the final result of improving therapeutic choices and clinical outcomes.
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Affiliation(s)
- Domenico Fusco
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | | | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Laudisio
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Patrizio R Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe F Colloca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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17
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Beauplet B, Soulie O, Niemier JY, Pons-Peyneau C, Belhadi D, Couffignal C, Fossey-Diaz V. Dealing with the lack of evidence to treat depression in older patients with cancer: French Societies of Geriatric Oncology (SOFOG) and PsychoOncology (SFFPO) position paper based on a systematic review. Support Care Cancer 2020; 29:563-571. [DOI: 10.1007/s00520-020-05682-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
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18
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O'Donovan A, Morris L. Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations. Clin Oncol (R Coll Radiol) 2020; 32:766-774. [PMID: 32641244 DOI: 10.1016/j.clon.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
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Affiliation(s)
- A O'Donovan
- Applied Radiation Therapy Trinity (ARTT) research group, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland.
| | - L Morris
- Department of Radiation Oncology, St George Hospital, Sydney, NSW 2217, Australia
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19
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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20
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Gu D, Morgan RO, Li R, Weber ES, Shen C. Association between depression and healthcare expenditures among elderly cancer patients. BMC Psychiatry 2020; 20:131. [PMID: 32293366 PMCID: PMC7092441 DOI: 10.1186/s12888-020-02527-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Both depression and cancer are economically burdensome. However, how depression affects the healthcare expenditures of elderly cancer patients from payers' and patients' perspectives is largely unknown. This study investigated whether depression resulted in higher healthcare expenditures among these patients from both payers' and patients' perspectives and identified health service use categories associated with increased expenditures. METHODS From the Medicare Current Beneficiary Survey (MCBS)-Medicare database, we identified breast, lung and prostate cancer patients aged 65 years and over who were newly diagnosed between 2007 and 2012. Presence of depression was based on self-reports from the surveys. We used generalized linear models (GLM) and two-part models to examine the impact of depression on healthcare expenditures during the first two years of cancer diagnosis controlling for a vast array of covariates. We stratified the analyses of total healthcare expenditures by healthcare services and payers. RESULTS Out of the 710 elderly breast, lung and prostate cancer patients in our study cohort, 128 (17.7%) reported depression. Individuals with depression had $11,454 higher total healthcare expenditures, $8213 higher medical provider expenditures and $405 higher other services expenditures compared to their counterparts without depression. Also, they were significantly more likely to have inpatient services. For payers, they incurred $8280 and $1270 higher expenditures from Medicare's and patients' perspectives, respectively. CONCLUSIONS Elderly cancer patients with depression have significantly higher healthcare expenditures from both payers' and patients' perspectives and over different expenditure types. More research is needed in depression screening, diagnosis and treatment for this population.
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Affiliation(s)
- Dian Gu
- Department of Health Services Research, University of Texas M. D. Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, TX 77030, USA. .,Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA.
| | - Robert O. Morgan
- grid.267308.80000 0000 9206 2401Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX USA
| | - Ruosha Li
- grid.267308.80000 0000 9206 2401Division of Biostatistics, University of Texas School of Public Health, Houston, TX USA
| | - Ellerie S. Weber
- grid.267308.80000 0000 9206 2401Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX USA
| | - Chan Shen
- grid.29857.310000 0001 2097 4281Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, PA USA
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Jayani R, Rosko A, Olin R, Artz A. Use of geriatric assessment in hematopoietic cell transplant. J Geriatr Oncol 2019; 11:225-236. [PMID: 31761694 DOI: 10.1016/j.jgo.2019.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
Hematopoietic cell transplant (HCT) is an important aspect of treatment for many hematologic malignancies. As cancer is a disease associated with aging, and hematologic malignancies are no exception, rates of autologous and allogeneic HCT utilization in older adults are on the rise. The most common indications for autologous HCT are multiple myeloma and lymphoma, and for allogenic HCT are acute myeloid leukemia and myelodysplastic syndrome. Older adults into their eighth decade of life can have favorable outcomes after autologous and allogeneic HCT, at least among select patients. Evaluation of older adults prior to HCT can be aided by utilizing a geriatric assessment (GA). GA can identify areas of vulnerability in older adults prior to HCT not captured by more traditional measures. In the future, GA may be utilized to guide interventions prior to HCT to improve outcomes of older adults. Further studies are needed to expand the paucity of data in utilizing GA to identify three groups of patients: those who clearly benefit from HCT, those who would clearly be harmed, and those who might benefit but would require additional support during and after HCT.
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Affiliation(s)
- Reena Jayani
- Moffitt Cancer Center, Blood and Marrow Transplant and Cellular Immunotherapy Program, 12902 USF Magnolia Dr, Tampa, FL 33612, United States of America; Vanderbilt University Medical Center, Division of Hematology and Oncology, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232-6307, United States of America.
| | - Ashley Rosko
- The Ohio State University, Department of Internal Medicine, Division of Hematology, 460 W 10th Ave, Columbus, OH 43210, United States of America.
| | - Rebecca Olin
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, 400 Parnassus Ave., Fourth Floor, San Francisco, CA 94143, United States of America.
| | - Andrew Artz
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, 1500 E. Duarte Road, Duarte, CA 91010, United States of America.
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22
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Magnuson A, Sattar S, Nightingale G, Saracino R, Skonecki E, Trevino KM. A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression. Am Soc Clin Oncol Educ Book 2019; 39:e96-e109. [PMID: 31099668 DOI: 10.1200/edbk_237641] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.
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Affiliation(s)
- Allison Magnuson
- 1 Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
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Saracino RM, Nelson CJ. Identification and treatment of depressive disorders in older adults with cancer. J Geriatr Oncol 2019; 10:680-684. [PMID: 30797709 DOI: 10.1016/j.jgo.2019.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023]
Abstract
The increasing number of older adults living with cancer will inevitably include vulnerable subgroups who experience a range of depressive symptoms throughout the care continuum. It is well established that depression can lead to decreased quality of life, poor treatment adherence, increased length of hospital stay and health service utilization, and in severe cases, suicide. Thus, clinicians working in oncology must be able to identify, conceptualize, and treat (or connect to services) the mental health concerns of their older patients. This brief review describes the unique etiologies, features, and treatments for depressive syndromes among older adults in the oncology setting, drawing on the literature and prevailing depression management guidelines from both psycho-oncology and geriatric depression research.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
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Gouraud C, Paillaud E, Martinez-Tapia C, Segaux L, Reinald N, Laurent M, Corsin L, Hoertel N, Gisselbrecht M, Mercadier E, Boudou-Rouquette P, Chahwakilian A, Bastuji-Garin S, Limosin F, Lemogne C, Canouï-Poitrine F. Depressive Symptom Profiles and Survival in Older Patients with Cancer: Latent Class Analysis of the ELCAPA Cohort Study. Oncologist 2018; 24:e458-e466. [PMID: 30598501 DOI: 10.1634/theoncologist.2018-0322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/18/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The expression of depressive symptoms in older people with cancer is heterogeneous because of specific features of age or cancer comorbidity. We aimed to identify depressive symptom profiles in this population and describe the associated features including survival. MATERIALS AND METHODS Patients ≥70 years who were referred to geriatric oncology clinics were prospectively included in the ELCAPA study. In this subanalysis, depressive symptoms were used as indicators in a latent class analysis. Multinomial multivariable logistic regression and Cox models examined the association of each class with baseline characteristics and mortality. RESULTS For the 847 complete-case patients included (median age, 79 years; interquartile range, 76-84; women, 47.9%), we identified five depressive symptom classes: "no depression/somatic only" (38.8%), "no depression/pauci-symptomatic" (26.4%), "severe depression" (20%), "mild depression" (11.8%), and "demoralization" (3%). Compared with the no depression/pauci-symptomatic class, the no depression/somatic only and severe depression classes were characterized by more frequent comorbidities with poorer functional status and higher levels of inflammation. "Severe" and "mild" depression classes also featured poorer nutritional status, more medications, and more frequent falls. Severe depression was associated with poor social support, inpatient status, and increased risk of mortality at 1 year (adjusted hazard ratio, 1.62, 95% confidence interval, 1.06-2.48) and 3 years (adjusted hazard ratio, 1.49; 95% confidence interval, 1.06-2.10). CONCLUSION A data-driven approach based on depressive symptoms identified five different depressive symptom profiles, including demoralization, in older patients with cancer. Severe depression was independently and substantially associated with poor survival. IMPLICATIONS FOR PRACTICE Older patients with cancer present with distinct profiles of depressive symptomatology, including different severity levels of depression and the demoralization syndrome. Clinicians should use a systematic assessment of depressive symptoms to adequately highlight these distinct profiles. Geriatric and oncological features are differently associated with these profiles. For instance, severe depression was associated with more frequent comorbidities with poorer functional, poor nutritional status, polypharmacy, frequent falls, inpatient status and poor social support. Also, severe depression was independently and substantially associated with poor survival so that the identification and management of depression should be considered a high priority in this population.
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Affiliation(s)
- Clément Gouraud
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
| | - Elena Paillaud
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Geriatric Department, Henri-Mondor Hospital, AP-HP, Créteil, France
| | | | - Lauriane Segaux
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Clinical Research Unit (URC-Mondor), Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Nicoleta Reinald
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Geriatric Department, Henri-Mondor Hospital, AP-HP, Créteil, France
- Public Health Department, Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Marie Laurent
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Geriatric Department, Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Lola Corsin
- Geriatric Department, Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Nicolas Hoertel
- Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Service de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, AP-HP, Paris, France
- Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France
| | - Mathilde Gisselbrecht
- Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Division of Geriatrics, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Elise Mercadier
- Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Division of Geriatrics, European Georges Pompidou Hospital, AP-HP, Paris, France
| | | | - Anne Chahwakilian
- Department of Gerontology, Geriatric Oncology Unit, Broca Hospital, AP-HP, Paris, France
| | - Sylvie Bastuji-Garin
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Clinical Research Unit (URC-Mondor), Henri-Mondor Hospital, AP-HP, Créteil, France
- Public Health Department, Henri-Mondor Hospital, AP-HP, Créteil, France
| | - Frédéric Limosin
- Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Service de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, AP-HP, Paris, France
- Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France
| | - Cédric Lemogne
- Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Service de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, AP-HP, Paris, France
- Centre Psychiatrie et Neurosciences, Inserm, U894, Paris, France
| | - Florence Canouï-Poitrine
- Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
- Public Health Department, Henri-Mondor Hospital, AP-HP, Créteil, France
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Atag E, Mutlay F, Soysal P, Semiz HS, Kazaz SN, Keser M, Ellidokuz H, Karaoglu A. Prevalence of depressive symptoms in elderly cancer patients receiving chemotherapy and influencing factors. Psychogeriatrics 2018; 18:365-370. [PMID: 29998465 DOI: 10.1111/psyg.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/12/2017] [Accepted: 02/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression is one of the most prevalent causes of distress in the geriatric population. The purpose of this study was to examine the prevalence of depressive symptoms in elderly cancer patients and to determine the possible associated factors. METHODS Cancer patients 65 years or older and on active chemotherapy completed the Yesavage Geriatric Depression Scale. We examined the relationship of depressive symptoms with age, gender, marital status, educational background, type of cancer, stage of disease, comorbidities, types of treatment for cancer, the duration after diagnosis of cancer, social support, and pain status. RESULTS The study included 170 patients with a mean age of 71 years, and 47.1% were women. The prevalence of a high depressive symptom score was 19.4%. Of the patients who had a high depressive symptom score based on the Yesavage Geriatric Depression Scale, 18.2% had already been diagnosed with depression and used antidepressants. The mean pain score was significantly higher in patients who had a high depressive symptom score compared to others (P = 0.012). CONCLUSION The prevalence of depressive symptoms in elderly cancer patients receiving chemotherapy was similar to that in the geriatric population without cancer. It was also consistent with previous studies on elderly cancer population. Pain was found to be a factor related to depressive symptoms. The prevalence of depression may be reduced by pain control. The treatment of depression may both improve the patient's quality of life and enhance their compliance with treatment.
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Affiliation(s)
- Elif Atag
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Feyza Mutlay
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Huseyin S Semiz
- Department of Medical Oncology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Seher N Kazaz
- Department of Medical Oncology, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Murat Keser
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Biostatistics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aziz Karaoglu
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Riblet N, Shiner B, Mills P, Rusch B, Hemphill R, Watts BV. Systematic and organizational issues implicated in post-hospitalization suicides of medically hospitalized patients: A study of root-cause analysis reports. Gen Hosp Psychiatry 2017. [PMID: 28622819 DOI: 10.1016/j.genhosppsych.2017.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Medical hospitalization is a high risk period for suicide. It is important to understand system-level factors that may be associated with suicide after a medical hospitalization. METHOD Retrospective study of root-cause analysis (RCA) reports of suicide occurring within three months of Veterans Administration (VA) medical hospitalization, 2002-2015. We collected patient and system-level factors to characterize events. RESULTS There were 96 RCA reports pertaining to suicide within three months of medical hospitalization. A total of 168 root causes for suicide were identified and fell into three major themes including: management of known suicide risk (N=73, 43%), decision making to monitor suicide risk (N=48, 29%), and patient engagement in treatment (N=47, 28%). RCA reports raised concerns that medical teams did not provide mental health treatment when indicated and lacked a standardized process for assessing psychological well-being in patients with a serious medical illness. In 25 cases, patients declined recommended treatment and in 15 cases, patients left against medical advice (AMA). CONCLUSIONS Challenges with patient engagement in treatment and lack of standardized processes for assessing and managing suicide risk may play an important role in suicide risk after medical hospitalization. Additional high quality studies are needed to confirm our findings.
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Affiliation(s)
- Natalie Riblet
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States.
| | - Brian Shiner
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States
| | - Peter Mills
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States; VA National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States
| | - Brett Rusch
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States
| | - Robin Hemphill
- VA National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, United States; VA National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States
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27
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Chou YT, Winn AN, Rosenstein DL, Dusetzina SB. Assessing disruptions in adherence to antidepressant treatments after breast cancer diagnosis. Pharmacoepidemiol Drug Saf 2017; 26:676-684. [PMID: 28317314 DOI: 10.1002/pds.4198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Long-term treatment with antidepressants can lessen the symptoms of depression, but health-related crises-such as a cancer diagnosis-may disrupt ongoing depression care. The study aims to estimate the effect of receiving a breast cancer diagnosis on antidepressant adherence among women with depression. METHODS Using SEER-Medicare administrative claims, we identified women aged 65+ with newly diagnosed breast cancer between 2008 and 2011, who were diagnosed with depression and used antidepressants during the year before pre-diagnosis year. We compared antidepressant adherence among women with breast cancer to similar women without cancer using generalized estimation equations. Antidepressant adherence was estimated using the proportion of days covered 1 year before and after the index date. RESULTS We included 1142 women with breast cancer and pre-existing depression and 1142 matched non-cancer patients with pre-existing depression. Mean antidepressant adherence was similar for both groups in the year before and after the index date (all around 0.71); adherence decreased by approximately 0.01 following breast cancer diagnosis in cancer group, with similar reductions among non-cancer group (p = 0.19). However, substantial proportion of patients had inadequate adherence to antidepressants in the post-diagnosis period, and almost 40% of patients in each group discontinued antidepressants over the study period. CONCLUSIONS Antidepressant adherence was not associated with receiving a breast cancer diagnosis beyond what would have been expected in a similar cohort of women without cancer; however, adherence was poor among both groups. Ensuring adequate ongoing depression care is important to improve cancer care and patient quality of life in the long term. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yi-Ting Chou
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aaron N Winn
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stacie B Dusetzina
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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28
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Saracino RM, Rosenfeld B, Nelson CJ. Towards a new conceptualization of depression in older adult cancer patients: a review of the literature. Aging Ment Health 2016; 20:1230-1242. [PMID: 26312455 PMCID: PMC4925309 DOI: 10.1080/13607863.2015.1078278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. METHOD PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. RESULTS The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. CONCLUSIONS Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
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Affiliation(s)
- Rebecca M. Saracino
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA,Corresponding author.
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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29
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Saracino RM, Weinberger MI, Roth AJ, Hurria A, Nelson CJ. Assessing depression in a geriatric cancer population. Psychooncology 2016; 26:1484-1490. [PMID: 27195436 DOI: 10.1002/pon.4160] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/26/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. METHOD Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). RESULTS In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these scores will miss as many as 33%-83% of geriatric cancer patients who are depressed. Revised cutoff scores were lower than published cutoff scores. CONCLUSION Although these measures produced good internal consistency and were better than chance at predicting depression in a geriatric cancer sample, the published cutoff scores for these measures did not perform well in predicting MDD nor minor depression. Of the three measures, the CES-D appeared to have the most utility. This data suggests that these popular screening measures may be inadequate for reliably identifying depression in a geriatric cancer population. Researchers and clinicians, therefore, should use caution when selecting depression measures for geriatric cancer patients and consider using the lower cut-off scores presented here.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark I Weinberger
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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30
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Rhondali W, Freyer G, Adam V, Filbet M, Derzelle M, Abgrall-Barbry G, Bourcelot S, Machavoine JL, Chomat-Neyraud M, Gisserot O, Largillier R, Le Rol A, Priou F, Saltel P, Falandry C. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer. Clin Interv Aging 2015. [PMID: 26203235 PMCID: PMC4506027 DOI: 10.2147/cia.s71690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). Methods This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. Results Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=−0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). Conclusion The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.
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Affiliation(s)
| | - Gilles Freyer
- Medical Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France
| | - Virginie Adam
- Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvrelès-Nancy, France
| | - Marilène Filbet
- Palliative Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France
| | | | | | | | | | | | | | | | - Annick Le Rol
- Medical Oncology, Hôpital Perpétuel Secours, Levallois-Perret, France
| | - Frank Priou
- Medical Oncology, Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France
| | - Pierre Saltel
- Supportive Care Department, Centre Léon Bérard, Lyon, France
| | - Claire Falandry
- Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France
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31
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Deckx L, van Abbema DL, van den Akker M, van den Broeke C, van Driel M, Bulens P, Tjan-Heijnen VCG, Kenis C, de Jonge ET, Houben B, Buntinx F. A cohort study on the evolution of psychosocial problems in older patients with breast or colorectal cancer: comparison with younger cancer patients and older primary care patients without cancer. BMC Geriatr 2015; 15:79. [PMID: 26156892 PMCID: PMC4496825 DOI: 10.1186/s12877-015-0071-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/10/2015] [Indexed: 12/27/2022] Open
Abstract
Background Although older cancer survivors commonly report psychosocial problems, the impact of both cancer and ageing on the occurrence of these problems remains largely unknown. The evolution of depression, cognitive functioning, and fatigue was evaluated in a group of older cancer patients in comparison with a group of younger cancer patients and older persons without cancer. Methods Older (≥70 years) and younger cancer patients (50 – 69 years) with breast or colorectal cancer stage I - III, and older persons without cancer (≥70 years) were included. Data were collected at baseline and one year follow-up and were available for 536 persons. Depression was evaluated with the 15-item Geriatric Depression Scale. Cognitive functioning was measured with the cognitive functioning subscale of the European Organization for Research and Treatment of Cancer. Fatigue was measured with a Visual Analogue Scale. Risk factors for depression, cognitive functioning, and fatigue were analysed using multivariate logistic regression analyses. Risk factors included cancer- and ageing-related factors such as functional status, cancer treatment, and comorbidities. Results The evolution of psychosocial problems was similar for the group of older (N = 125) and younger cancer patients (N = 196): an increase in depression (p < 0.01), slight worsening in cognitive functioning (p = 0.01), and no clear change in fatigue. Also, compared to the group of people without cancer (N = 215), the differences were small and after one year of follow-up only depression was more frequent in older cancer patients compared to older persons without cancer (18 % versus 9 %, p = 0.04). In multivariate analyses the main risk factors for psychosocial problems after one year follow-up were changes in functional status and presence of baseline depression, fatigue, or cognitive impairment. Conclusion Over the course of one year after a diagnosis of cancer, cancer patients face increasing levels of depression and increasing difficulties in cognitive functioning. The main risk factor for psychosocial problems was presence of the problem at baseline. This calls for regular screening for psychosocial problems and exchange of information on psychosocial functioning between different health care providers and settings during the treatment and follow-up trajectory of cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0071-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Deckx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Doris L van Abbema
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Marjan van den Akker
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. .,Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Carine van den Broeke
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Building 16/910, Royal Brisbane and Women's Hospital, Brisbane, 4029, QLD, Australia.
| | - Paul Bulens
- Limburgs Oncologisch Centrum, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, UZ Herestraat 49 - box 815, 3000, Leuven, Belgium.
| | - Eric T de Jonge
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Bert Houben
- Department of Abdominal and Oncological Surgery, Jessa Hospital - Campus Salvator, Salvatorstraat 20, 3500, Hasselt, Belgium.
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. .,Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
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32
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Deckx L, van den Akker M, Vergeer D, van Abbema D, van den Berkmortel F, Linsen L, de Jonge E, Houben B, van Driel M, Buntinx F. The Value of Fatigue Severity to Rule Out Depression in Older Adult Patients With Cancer. Oncol Nurs Forum 2015; 42:E302-9. [DOI: 10.1188/15.onf.e302-e309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Canoui-Poitrine F, Reinald N, Laurent M, Guery E, Caillet P, David JP, Tournigand C, Lagrange JL, Bastuji-Garin S, Lemogne C, Paillaud E. Geriatric assessment findings independently associated with clinical depression in 1092 older patients with cancer: the ELCAPA Cohort Study. Psychooncology 2015; 25:104-11. [PMID: 26123351 DOI: 10.1002/pon.3886] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aim to assess the prevalence and associated factors of clinical depression in older patients with cancer. METHODS We studied a prospective cohort of cancer patients aged ≥ 70 years and referred to geriatric oncology clinics between 2007 and 2012. A multidimensional geriatric assessment was performed before choosing the cancer-treatment strategy. Clinical depression was diagnosed by senior geriatricians by a semi-structured interview. It encompassed criteria of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and of the International Classification of Diseases (10th edition). Multivariate logistic regression was performed. RESULTS Of 1121 consecutive patients, 1092 had available data (mean age, 80.4 years; women, 48.8%; metastases, 51.3%; cancer location: colorectal 21.1%, breast 16.8%, kidney, bladder or urinary tract 14.0%, and prostate 11.4%). The overall prevalence of clinical depression was 28.4% (95% confidence interval, 25.7-31.2). Factors independently associated with clinical depression by multivariate analysis adjusting for all following factors plus gender, and metastasis were impaired mobility (adjusted odds ratio [aOR], 2.35; 1.59-3.46), impaired functional status defined as Eastern Cooperative Oncology Group Performance Status ≥ 2 (aOR, 2.39; 1.66-3.43) or as activities of daily living < 6 (aOR, 2.43; 1.73-3.41), inpatient status (aOR, 1.68; 1.20-2.37), inadequate social support (aOR, 1.66; 1.16-2.37), cognitive impairment (aOR, 1.76; 1.24-2.49), polypharmacy defined as five or more non-antidepressant drugs (aOR, 1.65; 1.14-2.38), multimorbidity (aOR additional CIRS-G point , 1.08; 1.04-1.12), and cancer-related pain (aOR, 1.76; 1.26-2.46). CONCLUSION In older patients with as-yet untreated cancer at various sites and stages, clinical depression was highly prevalent. Clinical depression was independently associated with several geriatric assessment findings (impaired mobility and function, inadequate social support, cognitive impairment, polypharmacy, and multimorbidity) independently from gender, tumor site, and metastatic status.
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Affiliation(s)
- Florence Canoui-Poitrine
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France
| | - Nicoleta Reinald
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Marie Laurent
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Esther Guery
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Unité de Recherche Clinique (URC-Mondor), F-94000, Créteil, France
| | - Philippe Caillet
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
| | - Jean-Philippe David
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Emile-Roux, Département de Gériatrie, F-94450, Limeil-Brévannes, France
| | - Christophe Tournigand
- APHP, Hôpital Henri-Mondor, Service d'Oncologie Médicale, F-94010, Créteil, France.,Université Paris Est, UPEC, DHU VIC, unité EC2M3, F-94000, Créteil, France
| | - Jean-Leon Lagrange
- APHP, Hôpital Henri-Mondor, Service de Radiothérapie, F-94000, Créteil, France.,Université Paris Est, UPEC, Faculté de Médecine, F-94000, Créteil, France
| | - Sylvie Bastuji-Garin
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, F-94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Unité de Recherche Clinique (URC-Mondor), F-94000, Créteil, France
| | - Cedric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, F-75015, Paris, France.,Inserm, U894, Centre Psychiatrie et Neurosciences, F-75015, Paris, France
| | - Elena Paillaud
- Université Paris-Est, UPEC, DHU A-TVB, IMRB, EA493 CEpiA (Clinical Epidemiology And Ageing), F-94000, Créteil, France.,APHP, Hôpital Henri-Mondor, Département de Gériatrie, Unité de Coordination en Onco-Gériatrie UCOG Sud Val-de-Marne, F-94000, Créteil, France
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Tobin MB, Steinberg GD. A review of incidence and relevant risk factors in genitourinary malignancies. Cancer 2015; 121:1731-4. [PMID: 25690768 DOI: 10.1002/cncr.29273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Marie B Tobin
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Gary D Steinberg
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
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35
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Yates P, Miaskowski C, Cataldo JK, Paul SM, Cooper BA, Alexander K, Aouizerat B, Dunn L, Ritchie C, McCarthy A, Skerman H. Differences in Composition of Symptom Clusters Between Older and Younger Oncology Patients. J Pain Symptom Manage 2015; 49:1025-34. [PMID: 25582681 DOI: 10.1016/j.jpainsymman.2014.11.296] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/13/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Older oncology patients have unique needs associated with the many physical, psychological, and social changes associated with the aging process. The mechanisms underpinning and the impact of these changes are not well understood. Identification of clusters of symptoms is one approach that has been used to elicit hypotheses about the biological and/or psychological basis for variations in symptom experiences. OBJECTIVES The purposes of this study were to identify and compare symptom clusters in younger (<60 years) and older (≥60 years) patients undergoing cancer treatment. METHODS Symptom data from one Australian study and two U.S. studies were combined to conduct this analysis. A total of 593 patients receiving active treatment were dichotomized into younger (<60 years) and older (≥60 years) groups. Separate exploratory factor analyses (EFAs) were undertaken within each group to identify symptom clusters from occurrence ratings of the 32 symptoms assessed by the Memorial Symptom Assessment Scale. RESULTS In both groups, a seven-factor solution was selected. Four partially concordant symptom clusters emerged in both groups (i.e., mood/cognitive, malaise, body image, and genitourinary). In the older patients, the three unique clusters reflected physiological changes associated with aging, whereas in the younger group the three unique clusters reflected treatment-related effects. CONCLUSION The symptom clusters identified in older patients typically included a larger and more diverse range of physical and psychological symptoms. Differences also may be reflective of variations in treatment approaches between age groups. Findings highlight the need for better understanding of variation in treatment and symptom burden between younger and older adults with cancer.
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Affiliation(s)
- Patsy Yates
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Kimberly Alexander
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bradley Aouizerat
- School of Nursing, University of California, San Francisco, California, USA; Institute for Human Genetics, University of California, San Francisco, California, USA
| | - Laura Dunn
- School of Medicine, University of California, San Francisco, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
| | - Alexandra McCarthy
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Helen Skerman
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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36
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Aarts JWF, Deckx L, van Abbema DL, Tjan-Heijnen VCG, van den Akker M, Buntinx F. The relation between depression, coping and health locus of control: differences between older and younger patients, with and without cancer. Psychooncology 2015; 24:950-7. [PMID: 25644618 DOI: 10.1002/pon.3748] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Depression is an important health issue in cancer patients. People use different coping strategies and health locus of control to manage stressful situations, which relate to different risks of depression. Coping strategies and health locus of control can be changed by cognitive behavioral interventions. METHODS In a cohort study, we investigated differences in coping strategy and health locus of control in older (≥70 years) and middle-aged (50-69 years) cancer patients, and older patients without cancer (≥70 years), and their association with presence of depression. We also investigated how these factors interact. We used the short version of the Utrecht Coping List, the Multidimensional Health Locus of Control scale, and the 15-item Geriatric Depression Scale. RESULTS Data were available from 1317 participants. Overall prevalence of depression was 12%. Older cancer patients tended to use an avoiding coping strategy more frequently than middle-aged cancer patients. This was associated with higher risk of depression. Older cancer patients less often used an active coping strategy, in comparison with middle-aged cancer patients, which was associated with a lower risk of depression. Especially in women using a seeking social support strategy, there was a lower risk of depression. Overall, the internal health locus of control was associated with higher and the external 'powerful others' locus with lower risk of depression. CONCLUSIONS Older cancer patients strongly differ from middle-aged cancer patients, in particular with respect to coping. Interventions to prevent or alleviate depression should incorporate these differences.
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Affiliation(s)
- Jurian W F Aarts
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Laura Deckx
- Department of General Practice, KU Leuven, Leuven, Belgium
| | - Doris L van Abbema
- Department of Medical Oncology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
| | - Frank Buntinx
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
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Mystakidou K, Tsilika E, Parpa E, Galanos A. The influence of sense of control and cognitive functioning in older cancer patients' depression. Psychooncology 2014; 24:311-7. [PMID: 25082558 DOI: 10.1002/pon.3642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to evaluate the associations between depression, sense of control, and cognitive functioning, as well as the predictive power of sense of control and cognitive functioning in older cancer patients' depression. METHODS Eighty-six cancer patients were referred to a palliative care unit. They completed the 15-item Geriatric Depression Scale, the Cancer Locus of Control, and the Mini Mental State Examination questionnaires. RESULTS Higher perceived control over the 'course of illness' was associated with higher levels of depressive symptoms (p < 0.0005), whereas lower perceived control over the 'cause of illness' was associated with higher depressive symptoms. The same results were found for 'cause of illness' between non-depressed and depressed patients (p = 0.001). Multivariate analysis revealed that whereas an external orientation in 'course of illness' increased the likelihood of depression (p = 0.002), an external orientation in 'cause of illness' decreased the likelihood of depression (p = 0.05). CONCLUSIONS Older cancer patients' sense of control orientation over the course of illness and the cause of illness predicted the levels of depressive symptomatology.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, Kapodistrian University of Athens, Athens, Greece
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Thomas H, Randolph M, Pruemer J. The effects of a palliative care program on antidepressant use and continuing maintenance medications in near end-of-life oncology patients (the HEALED study). J Oncol Pharm Pract 2014; 21:331-8. [DOI: 10.1177/1078155214531608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rational The use of antidepressants and maintenance medications for cancer patients in a palliative care setting is controversial. The effectiveness of antidepressants and consequences of discontinuing maintenance medications are unknown in this population. Objective Compare the quality of life of patients taking and not taking antidepressants at entry to a palliative care clinic, and to observe maintenance medication use in this population, along with consequences of stopping them. Methods Prospective, monthly review of medications, quality of life, and hospitalizations were recorded from oncology patients that attended a palliative care clinic. In addition, a retrospective chart review of medications and hospitalizations of oncology patients that did and did not attend a palliative care clinic was performed. Results Forty-three prospective patients were enrolled. Patients had similar quality of life whether or not they were taking antidepressants ( p = 0.52). Number of maintenance medications at entry and at final evaluation did not change ( p = 0.45). No hospitalizations were caused by discontinuation of maintenance medications. QOL of patients did not decline after coming to the clinic based on the baseline and second FACT-G questionnaires ( p = 0.84). Fifty-six patients were included in the retrospective portion of this study. The non-palliative care patients had higher proportions of maintenance medications and rates of hospitalizations when compared to the palliative care patients. Conclusion Quality of life is essentially the same between palliative care patients, whether they are receiving antidepressants or not.
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Affiliation(s)
- Hilary Thomas
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Jane Pruemer
- University of Cincinnati Medical Center, Cincinnati, OH, USA
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Abstract
One of the most challenging roles for the psychiatrist is to help guide terminally ill patients physically, psychologically and spiritually through the dying process. Patients with advanced cancer, and other life-threatening medical illnesses are at increased risk for developing major psychiatric complications and have an enormous burden of both physical as well as psychological symptoms. In fact, surveys suggest that psychological symptoms such as depression, anxiety, and hopelessness are as frequent, if not more so, than pain and other physical symptoms in palliative care settings. Psychiatrists have a unique role and opportunity to offer competent and compassionate palliative care to those with life-threatening illness. In this article we provide a comprehensive review of basic concepts and definitions of palliative care and the experience of dying, and the role of the psychiatrist in palliative care including assessment and management of common psychiatric disorders in the terminally ill, with an emphasis on suicide and desire for hastened death. Psychotherapies developed for use in palliative care settings, and management of grief and bereavement are also reviewed.
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Affiliation(s)
- Reena Jaiswal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center , New York , USA
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Findley PA, Shen C, Sambamoorthi U. Depression Treatment Patterns among Elderly with Cancer. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:676784. [PMID: 22970357 PMCID: PMC3434374 DOI: 10.1155/2012/676784] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/05/2012] [Accepted: 07/08/2012] [Indexed: 01/26/2023]
Abstract
Little is known about cancer treatment patterns among the elderly as depression and cancer in this older population have not been well explored. This study seeks to fill a gap in the literature by using data from the Medicare Current Beneficiary Survey from years 2000-2005 to examine depression treatment patterns among elderly diagnosed with both cancer and depression. Depression treatments examined include antidepressants with and without psychotherapy. We found that of those with both cancer and depression, 57.7% reported antidepressant use only, 19.7% received psychotherapy with or without antidepressants, and 22.6% had no depression treatment. We found those with greater comorbidity, of a minority race, with lower levels of education, and living in rural areas were less likely to receive treatment for depression. These findings highlight the need to address disparities in the treatment of depression in the elderly population with cancer.
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Affiliation(s)
| | - Chan Shen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
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Mystakidou K, Parpa E, Tsilika E, Panagiotou I, Zygogianni A, Giannikaki E, Gouliamos A. Geriatric depression in advanced cancer patients: the effect of cognitive and physical functioning. Geriatr Gerontol Int 2012; 13:281-8. [PMID: 22694340 DOI: 10.1111/j.1447-0594.2012.00891.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients. METHODS A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients. RESULTS The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99-10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%. CONCLUSIONS The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece.
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Meisner RC, Khin EK, Dorfman J, Norris L. A 60-Year-Old Male with Hairy-Cell Leukemia and Existential Distress. Psychiatr Ann 2012. [DOI: 10.3928/00485713-20120323-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deckx L, van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Robaeys G, de Jonge ET, Houben B, Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, van den Berkmortel F, Tjan-Heijnen VC, Buntinx F, van den Akker M. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Public Health 2011; 11:825. [PMID: 22026575 PMCID: PMC3215168 DOI: 10.1186/1471-2458-11-825] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/25/2011] [Indexed: 12/27/2022] Open
Abstract
Background Cancer is mainly a disease of older patients. In older cancer patients, additional endpoints such as quality of survival and daily functioning might be considered equally relevant as overall or disease free survival. However, these factors have been understudied using prospective designs focussing on older cancer patients. Therefore, this study will focus on the impact of cancer, ageing, and their interaction on the long-term wellbeing of older cancer patients. Methods/Design This study is an observational cohort study. We aim to recruit 720 cancer patients above 70 years with a new diagnosis of breast, prostate, lung or gastrointestinal cancer and two control groups: one control group of 720 patients above 70 years without a previous diagnosis of cancer and one control group of 720 cancer patients between 50 - 69 years newly diagnosed with breast, prostate, lung or gastrointestinal cancer. Data collection will take place at inclusion, after six months, after one year and every subsequent year until death or end of the study. Data will be collected through personal interviews (consisting of socio-demographic information, general health information, a comprehensive geriatric assessment, quality of life, health locus of control and a loneliness scale), a handgrip test, assessment of medical records, two buccal swabs and a blood sample from cancer patients (at baseline). As an annex study, caregivers of the participants will be recruited as well. Data collection for caregivers will consist of a self-administered questionnaire examining depression, coping, and burden. Discussion This extensive data collection will increase insight on how wellbeing of older cancer patients is affected by cancer (diagnosis and treatment), ageing, and their interaction. Results may provide new insights, which might contribute to the improvement of care for older cancer patients.
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Affiliation(s)
- Laura Deckx
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33, bus 7001, 3000 Leuven, Belgium.
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Abstract
Patients with cancer and depression experience more physical symptoms, have poorer quality of life, and are more likely to have suicidal thoughts or a desire for hastened death than are cancer patients who are not depressed. Despite the ubiquity of depressive symptoms in cancer patients at the end of life, critical questions remain unanswered with respect to etiopathogenesis, diagnosis, and treatment of depression in these vulnerable patients. The pharmacotherapy of depression in patients with advanced cancer should be guided by a palliative care approach focused on symptom reduction, irrespective of whether the patient meets diagnostic criteria for major depression. Earlier and more intensive supportive care for patients with cancer reduces symptom burden and may prolong life for patients with advanced disease. Symptom-oriented clinical trials are needed to improve end-of-life cancer care.
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Affiliation(s)
- Donald L Rosenstein
- Comprehensive Cancer Support Program, Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599-7305, USA.
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Weinberger MI, Bruce ML, Roth AJ, Breitbart W, Nelson CJ. Depression and barriers to mental health care in older cancer patients. Int J Geriatr Psychiatry 2011; 26:21-6. [PMID: 21157847 PMCID: PMC3052769 DOI: 10.1002/gps.2497] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the literature on depression in cancer patients with a particular focus on depression assessment and barriers to mental health treatment in older cancer patients. DESIGN We conducted a review of the literature on depression and barriers to mental health treatment in older cancer patients. RESULTS Depression is prevalent in cancer patients. However, little is known about prevalence rates of depression in older adults with cancer, assessing depression in older cancer patients and barriers that impede proper mental health treatment in this sample. CONCLUSION Improved diagnostic clarity and a better understanding of barriers to mental health treatment can help clarify and facilitate mental health referrals and ultimately improve access to care among older cancer patients in need. Continuing to consider the complexities associated with diagnosing depression in older cancer patients is necessary. Further work may be needed to develop new diagnostic measures for such detection, determine the prevalence of depression among older cancer and ways in which to overcome barriers to mental health care.
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Affiliation(s)
- Mark I. Weinberger
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA
| | - Andrew J. Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Christian J. Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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Psychische Komorbidität bei Menschen mit chronischen Erkrankungen im höheren Lebensalter unter besonderer Berücksichtigung von Krebserkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 54:75-82. [DOI: 10.1007/s00103-010-1192-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nelson CJ, Mulhall JP, Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. J Sex Med 2010; 8:560-6. [PMID: 21155979 DOI: 10.1111/j.1743-6109.2010.02127.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The relationship between erectile dysfunction (ED) and depressive symptoms is well established. However, this relationship is not well explored in men with prostate cancer. Limited data suggest men with prostate cancer may experience less ED bother than men with ED who do not have prostate cancer, implying that ED and depressive symptoms may not be associated in men with prostate cancer. AIM To determine if ED is associated with depressive symptoms in men with prostate cancer. MAIN OUTCOME MEASURES Assessments of quality-of-life (The Functional Assessment of Cancer Therapy [FACT-P]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), and erectile function. Erectile function was measured with one question from the FACT-P similar to that used by the Massachusetts Male Aging Study. METHODS Men with prostate cancer, and naïve of hormone treatment, completed the study questionnaires at a single time point. RESULTS The average age of the 339 men was 67±10 years. The average time since diagnosis was 3.9±3 years. When answering the question, "I am able to have and maintain an erection" on a 1 to 5 scale (5 representing the best function), the mean score was 2 indicating "a little bit." On univariate analysis, erectile function and depression were associated, r=-0.12, P<0.05. Other variables associated with depression were marital status, r=0.11, P<0.05; anxiety scores, r=0.56, P<0.01; and social support, r=-0.42, P<0.01. On multivariate analysis, erectile function remained a significant predictor of depression, beta=-0.10, P<0.05. CONCLUSIONS Erectile function was associated with depressive symptoms in both univariate and multivariate analysis, indicating that ED is independently associated with depressive symptoms even though patients were approximately 4 years post diagnosis. These cross-sectional data suggest ED in men with prostate cancer can have lasting psychological effects.
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Affiliation(s)
- Christian J Nelson
- Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, New York, NY 10021, USA.
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Nelson CJ, Cho C, Berk AR, Holland J, Roth AJ. Are gold standard depression measures appropriate for use in geriatric cancer patients? A systematic evaluation of self-report depression instruments used with geriatric, cancer, and geriatric cancer samples. J Clin Oncol 2010; 28:348-56. [PMID: 19996030 PMCID: PMC2815722 DOI: 10.1200/jco.2009.23.0201] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 09/15/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Geriatric issues in cancer are becoming prominent. Depression is a significant concern for both the elderly and patients with cancer, yet identifying depression in these patients is difficult and often leads to under-recognition. We conducted a systematic review to determine which depression instruments are appropriate for use in geriatric patients with cancer. METHODS We identified the most commonly used self-report depression instruments. We then used the criteria established in the US Food and Drug Administration Draft Guidance on Patient-Reported Outcome Measures to determine the extent of validation evidence of these measures in geriatric cancer populations. Finally, we determined which instruments captured depressive symptoms that are common among elderly patients with cancer. RESULTS Eight measures were selected as the most commonly used instruments. These were the Beck Depression Inventory-II, Brief Symptom Inventory-18, Center for Epidemiologic Studies-Depression Scale, Geriatric Depression Scale-15, Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Profile of Mood States-Short Form, and Zung Self-Rating Depression Scale. Many have been validated for use with geriatric adults and patients with cancer; however, data addressing content validity and responder definition were lacking. To date, there is no validation information for geriatric patients with cancer. Furthermore, symptom profile analysis revealed that these measures do not identify many symptoms signaling depression in geriatric patients with cancer. CONCLUSION The validation evidence for use of common depression instruments in geriatric patients with cancer is lacking. This, and the possibility that these measures may not assess common depressive symptoms in geriatric patients with cancer, questions the adequacy of these scales in this population.
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Affiliation(s)
- Christian J Nelson
- Dept of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, 7th floor, New York, NY 10022, USA.
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Nelson CJ, Weinberger MI, Balk E, Holland J, Breitbart W, Roth AJ. The chronology of distress, anxiety, and depression in older prostate cancer patients. Oncologist 2009; 14:891-9. [PMID: 19738000 DOI: 10.1634/theoncologist.2009-0059] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Current research suggests that older cancer patients report less distress than younger cancer patients. However, this research has generally not teased apart the differences among general distress, anxiety, and depression. METHODS We conducted a secondary analysis of merged datasets using cross-sectional data on 716 men with prostate cancer (mean age, 68 +/- 10 years; range, 50-93 years). Approximately half the participants were recruited from doctors' offices throughout the U.S. and the other half were from Memorial Sloan-Kettering Cancer Center (New York). Participants were asked to complete the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-Prostate Quality of Life questionnaire, and a demographic questionnaire. RESULTS Aging was related to less distress (r = -0.14), less anxiety (r = -0.22), and greater emotional quality of life (r = 0.16). In contrast, aging was associated with greater depressive symptoms in these cancer patients (r = 0.18). The mean depression scores of 5-year cohorts consistently trended upward. The significant association between age and depression remained after controlling for stage of disease, hormone therapy use, time since diagnosis, and social, physical, and functional well-being. CONCLUSIONS Despite theoretical and empirical evidence that older cancer patients may cope more effectively than younger cancer patients, depressive symptoms remain an important concern for aging cancer patients, and greater attention to this area is warranted. The increase in depression is in contrast to some findings in the general aging literature, raising the possibility that this trend is unique to older cancer patients.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Seventh Floor, New York, New York 10022, USA.
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