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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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Hu H, Zhao Y, Sun C, Wang P, Yu L, Peng K. Symptom profiles and related factors among patients with advanced cancer: A latent profile analysis. Asia Pac J Oncol Nurs 2023; 10:100296. [PMID: 37885766 PMCID: PMC10597764 DOI: 10.1016/j.apjon.2023.100296] [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: 03/29/2023] [Accepted: 08/18/2023] [Indexed: 10/28/2023] Open
Abstract
Objective This study aimed to investigate symptom subgroups and associated influencing factors in patients with advanced cancer. Methods A cross-sectional study was conducted, involving 416 patients with advanced cancer. The study examined five symptoms: fatigue, pain, sleep impairment, anxiety, and depression. Latent Profile Analysis (LPA) was utilized to classify symptom subgroups. A multiple logistic regression analysis was conducted to explore factors associated with the identified symptom subgroups. Results The analysis revealed three distinct subgroups among the participants: "all low" (58.2%), characterized by normal symptoms except for moderate sleep quality; "all moderate" (35.1%), exhibiting normal symptoms except for poor sleep quality and fatigue; and "all high" (6.7%), experiencing normal pain, moderate depression, moderate anxiety, poor sleep quality, and fatigue. Malnutrition risk, cancer diagnosis, and cancer survivorship duration were found to be associated with a more severe symptom burden. Conclusions Patients in the "all high" subgroup faced an increased risk of malnutrition and a longer cancer survivorship duration. Additionally, patients in the "all moderate" subgroup were distinguished by having a breast cancer diagnosis. These findings have significant implications for allocating medical resources and implementing person-centered symptom management strategies.
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Affiliation(s)
- Huixiu Hu
- Department of Nursing, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yajie Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Sun
- Department of Nursing, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Wang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijuan Yu
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ke Peng
- Department of Emergency, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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3
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Depression and anxiety in older adults with cancer: Systematic review and meta-summary of risk, protective and exacerbating factors. Gen Hosp Psychiatry 2023; 81:32-42. [PMID: 36724695 DOI: 10.1016/j.genhosppsych.2023.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically evaluate the risk factors of depression and anxiety in older adults with cancer. METHOD This PRISMA-adherent systematic review (PROSPERO CRD42022372747) involved a systematic database search for prospective and retrospective cohort studies. RESULTS We included 33 cohort studies with 31 evaluating depression and seven evaluating anxiety. Systematic synthesis yielded various protective and exacerbating factors for depression and anxiety amongst older adults with cancer. These factors span a range of domains: (1) Cancer and associated treatment-related factors; (2) Medical, physical and functional factors; (3) Demographic factors and; (4) Social and lifestyle factors. At the individual-level, the most significant factors were the presence of chronic medical comorbidities, having pre-existing psychological symptoms, and poor baseline physical and functional status. Within the social unit, the degree of social support and presence of a partner were most significant. CONCLUSION The deleterious impact comorbid psychological symptoms can have on older adults with cancer can be profound. In this review, we highlight a range of protective and exacerbating factors identified from cohort studies that may enable policymakers to tailor and individualise interventions to manage depression, anxiety and associated burden in this vulnerable population. The relative paucity of studies evaluating anxiety highlights an important research gap.
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Felipe LRR, Barbosa KSS, Virtuoso Junior JS. Sintomatologia depressiva e mortalidade em idosos da América Latina: uma revisão sistemática com metanálise. Rev Panam Salud Publica 2022; 46:e205. [PMCID: PMC9733709 DOI: 10.26633/rpsp.2022.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/11/2022] [Indexed: 12/13/2022] Open
Abstract
Objetivo.
Averiguar a associação entre sintomatologia depressiva e mortalidade em idosos da América Latina.
Métodos.
Realizou-se uma revisão sistemática com metanálise de estudos indexados nas bases PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O estudo foi registrado na base PROSPERO (International Prospective Register of Systematic Reviews) e estruturado de acordo com o referencial metodológico PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A metanálise foi realizada usando modelos de efeitos aleatórios, e os dados analisados incluíram as medidas de risco relativo (RR) bruto e heterogeneidade, com estimativas pontuais e intervalos de confiança de 95% (IC95%).
Resultados.
Cinco estudos, realizados no Brasil e no México, foram incluídos na metanálise, abrangendo 8 954 idosos. O RR para mortalidade na presença de sintomatologia depressiva foi de 1,44 (IC95%: 1,16; 1,78). A heterogeneidade encontrada foi de 80,87%. As metarregressões mostraram que quanto maior a proporção de mulheres nas amostras dos estudos, maior o risco de mortalidade associada à sintomatologia depressiva, e quanto maior o tempo de acompanhamento do estudo, menor o risco de mortalidade associada à sintomatologia depressiva.
Conclusão.
A presença de sintomatologia depressiva associou-se positivamente à mortalidade em idosos latino-americanos, com RR de óbito 44% maior em relação aos idosos sem sintomatologia depressiva. As principais limitações do estudo foram o pequeno número de trabalhos encontrados na revisão sistemática e a variação entre as escalas utilizadas para determinar a presença de sintomatologia depressiva.
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Affiliation(s)
| | | | - Jair Sindra Virtuoso Junior
- Universidade Federal do Triângulo Mineiro (UFTM), Programa de Pós-Graduação em Atenção à Saúde, Uberaba (MG), Brasil
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Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee CS. Symptom Classes in Decompensated Liver Disease. Clin Gastroenterol Hepatol 2022; 20:2551-2557.e1. [PMID: 34813941 PMCID: PMC9120261 DOI: 10.1016/j.cgh.2021.11.023] [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: 02/18/2021] [Revised: 09/26/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. METHODS Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. RESULTS The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child-Turcotte-Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P < .05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P < .001). CONCLUSIONS Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon.
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Arnab Mitra
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
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6
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Borza T, Harneshaug M, Kirkhus L, Šaltytė Benth J, Selbæk G, Bergh S, Slaaen M. The course of depressive symptoms and mortality in older patients with cancer. Aging Ment Health 2022; 26:1153-1160. [PMID: 34139140 DOI: 10.1080/13607863.2021.1932739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The Geriatric Depression Scale (GDS-15), a self-report questionnaire, emphasizes the psychological dimension of depression. We aimed to investigate whether GDS-15 scores were associated with mortality in older patients with cancer and describe the course of individual symptoms on the GDS-15. METHODS An observational, multicenter, prospective study of 288 patients 70 years or older with cancer followed over 24 months. The patients were assessed with the GDS-15 at inclusion, and after four and 12 months. An extended Cox regression model assessed the association between time-dependent GDS-15 scores and mortality. RESULTS After adjusting for cancer-related prognostic factors, a one-point increase in GDS-15 sum score increased risk of death by 12%. GDS-15 mean score increased during the first four months of the study, as did odds for the presence of the GDS-15 symptoms 'feel you have more problems with memory than most', 'not feel full of energy', and 'think that most people are better off than you'. The most prevalent and persistent GDS-15 symptom was 'prefer to stay at home, rather than going out and doing new things', and 'not to be in good spirits most of the time' was the least prevalent. CONCLUSIONS More severe depressive symptoms, as measured by the GDS-15, were associated with higher mortality in older patients with cancer. The importance of emotional distress and how to alleviate it should be investigated further in these patients.
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Affiliation(s)
- Tom Borza
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Magnus Harneshaug
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene Kirkhus
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Geir Selbæk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marit Slaaen
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Palliative Team, Department of Internal Medicine, Innlandet Hospital Trust, Hamar Hospital, Hamar, Norway
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7
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Canouï-Poitrine F, Martinez-Tapia C, Paillaud E, Mathoulin-Pelissier S, Pamoukdjian F, Frasca M, Tolppanen AM, Bringuier M, Brain E, Broussier A, Bastuji-Garin S, Laurent M, Audureau E. Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis. J Clin Epidemiol 2022; 148:17-26. [DOI: 10.1016/j.jclinepi.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
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8
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Paillaud E, Caillet P, Conti C, Mebarki S. Spécificités onco-gériatriques des soins de support. Bull Cancer 2022; 109:568-578. [DOI: 10.1016/j.bulcan.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
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Fadoir NA, Marie L, Basu N, Schuler K, Granato S, Smith PN. Exploring interpersonal theory of suicide typologies in patients with cancer: A latent profile analysis. DEATH STUDIES 2021; 47:1-10. [PMID: 34971345 DOI: 10.1080/07481187.2021.2021567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current study examined patterns of endorsement of Interpersonal Theory of Suicide constructs in a group of patients with cancer (N = 133) via Latent Profile Analysis. Four profiles were identified: (1) Interpersonally Distressed (n = 7; 5.2%), (2) Burdened (n = 11; 8.3%), (3) Fearless About Death (n = 40; 30.1%), (4) Non-Distressed (n = 75; 56.4%). Profiles with higher levels of thwarted belongingness, perceived burdensomeness, and hopelessness were associated with greater suicide ideation. Results also suggest there may be characteristics of patients with cancer that require unique consideration about the potential meaning and relevance of such constructs.
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Affiliation(s)
- Nicholas A Fadoir
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Laura Marie
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Natasha Basu
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Kaitlyn Schuler
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Stephani Granato
- Oklahoma City VA Health Care System, Oklahoma City, Oklahoma, USA
| | - Phillip N Smith
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
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Ono R, Makiura D, Nakamura T, Okumura M, Fukuta A, Saito T, Inoue J, Oshikiri T, Kakeji Y, Sakai Y. Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer. J Am Med Dir Assoc 2021; 22:1825-1830.e1. [PMID: 33932352 DOI: 10.1016/j.jamda.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer. DESIGN This was a prospective cohort study. SETTING AND PARTICIPANTS This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years. METHODS The outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following-going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (-/-), frailty without social frailty (+/-), no frailty with social frailty (-/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors. RESULTS Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (-/-)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS. CONCLUSIONS AND IMPLICATIONS Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.
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Affiliation(s)
- Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
| | - Daisuke Makiura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maho Okumura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Akimasa Fukuta
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Saito
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Junichiro Inoue
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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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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12
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Hagège M, Canouï-Poitrine F, Derbez B. Including older patients in cancer trials: A qualitative study of collaboration between geriatricians and oncologists. J Geriatr Oncol 2021; 12:945-951. [PMID: 33714724 DOI: 10.1016/j.jgo.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The under-representation of older patients in cancer trials remains an important obstacle to the generation of data on efficacy and safety in this growing patient population. In France, geriatric oncology coordination units (UCOGs) have been created to help oncologists and geriatricians work together on research, best practice, and continuing medical education. Taking these units as a case study, this paper sheds light on the collaboration between geriatricians and oncologists in the inclusion process of older patients in cancer trials. MATERIALS AND METHODS Empirical data were gathered in a series of sociological interviews with all 16 oncologists, geriatricians and unit coordinators in the five UCOGs in the greater Paris region of France. RESULTS The case of French geriatric oncology coordination units shows the gap between professional research cultures in oncology and geriatrics that may account for the low observed inclusion rates. It is easier to include patients in randomized clinical trials than in observational studies. UCOGs have the potential to improve research in geriatric oncology by catalyzing the development and implementation of effective collaboration tools (such as frailty assessments). The units also have the potential to promote Phase IV trials and observational research that are suitable for older patients with cancer. DISCUSSION Bridging the cultural gap between oncologists (the dominant force in setting the cancer research agenda) and geriatricians (a source of specific knowledge and know-how) is essential for producing relevant trial protocols that match the specific yet diverse features of older patient populations.
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Affiliation(s)
- Meoïn Hagège
- Université Paris Est Créteil, UFR Médecine, 8 Rue du Général Sarrail, 94000 Créteil, France; Hôpital Henri Mondor, CEpiA/Unité de Santé publique, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
| | - Florence Canouï-Poitrine
- Université Paris Est Créteil, UFR Médecine, 8 Rue du Général Sarrail, 94000 Créteil, France; Hôpital Henri Mondor, CEpiA/Unité de Santé publique, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Benjamin Derbez
- Université Paris 8, 2 avenue de la liberté, 93000 Saint Denis, France; CRESPPA-CSU, 59-61 rue Pouchet, 75018 Paris, France
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Hoertel N, Rotenberg L, Schuster JP, Blanco C, Lavaud P, Hanon C, Hozer F, Teruel E, Manetti A, Costemale-Lacoste JF, Seigneurie AS, Limosin F. Generalizability of pharmacologic and psychotherapy trial results for late-life unipolar depression. Aging Ment Health 2021; 25:367-377. [PMID: 31726850 DOI: 10.1080/13607863.2019.1691146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite evidence of low representativeness of clinical trial results for depression in adults, the generalizability of clinical trial results for late-life depression is unknown. This study sought to quantify the representativeness of pharmacologic and psychotherapy clinical trial results for late-life unipolar depression. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults from the United States population. To assess the generalizability of clinical trial results for late-life depression, we applied a standard set of eligibility criteria representative of pharmacologic and psychotherapy clinical trials to all individuals aged 65 years and older in NESARC with a DSM-IV diagnosis of MDE and no lifetime history of mania/hypomania (n = 273) and in a subsample of individuals seeking help for depression (n = 78). RESULTS More than four of ten respondents and about two of ten respondents would have been excluded by at least one exclusion criterion in a typical pharmacologic and psychotherapy efficacy trial, respectively. Similar results (i.e.41.1% and 25.9%, respectively) were found in the subsample of individuals seeking help for depression. Excess percentage of exclusion in typical pharmacologic studies was accounted for by the criterion "significant medical condition". We also found that populations typically included in pharmacologic and psychotherapy clinical trials for late-life unipolar depression may substantially differ. CONCLUSION Psychotherapy trial results may be representative of most patients with late-life unipolar depression in routine clinical practice. By contrast, pharmacologic clinical trials may not be readily generalizable to community samples.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Léa Rotenberg
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Pierre Lavaud
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Franz Hozer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Elisabeth Teruel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Aude Manetti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | | | - Anne-Sophie Seigneurie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
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14
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Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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