Depression—A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer

Abstract

Context: Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear due to few methodologically sound studies. Objectives:To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.Methods: 563 patients were included from the European Palliative Care Research Collaborative Study (EPCRC-CSA), an international, multi-centre, cross-sectional study. The relative importance of prognostic factors (systemic inflammation (mGPS), co-morbidities and physical performance (KPS), symptom burden (loss of appetite, breathlessness, nausea (ESAS) and pain (BPI)) and depression severity (PHQ-9) in predicting Global Health/QoL (EORTC-QLQ-C30) were assessed using hierarchical multiple regression models.Results: 55% were females, median age 64 years, 87% had metastatic disease, Conclusion:Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.

Integration of oncology and palliative care: a Lancet Oncology Commission

“…This contrasts recent findings on depression being the main factor associated with poor QOL in patients with advanced cancer. 419 Symptoms of depression, 336 demoralization, 420 and spiritual distress 421 are common in patients with advanced cancer and longitudinal research has shown that, without intervention, these symptoms tend to worsen with greater proximity to death. 422 There is a growing evidence base for the effectiveness of psychological interventions to alleviate depression and other manifestations of distress in patients with advanced disease.…”

Equitably improving outcomes for cancer survivors and supporting caregivers: A blueprint for care delivery, research, education, and policy

“…13,14 When left unaddressed, these problems lead to reduced work productivity, 15,16 quality of life, 12,17 and overall survival. 18 Survivors who are coping with advanced cancer [19][20][21][22] report ongoing symptom burden and poor physical functioning that affects quality of life. 23,24 This research has led to recommendations to facilitate referrals for early access to palliative care 25 and rehabilitation care 26,27 that can improve quality of life.…”

Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms

“…Having identified these patients, the preeminent aim was to detail and discuss the co-occurring negative emotions (stress), impairments (quality of life, functional status, symptoms), and negative perceptions of one's life and illness that co-occurred. To do this was significant because the latter factors foster the maintenance of depressive symptoms and, conversely, depressive symptoms increase the frequency/severity of these sources of impairment and disability [31,32,[34][35][36][37][38]. Moving beyond PHQ-9 classification, the goal was provision of clinical descriptions for providers and researchers alike of the common psychological, behavioral, and symptom comorbidities experienced by such individuals, ones that, along with depressive symptoms, may impair patients' coping and functioning when they are to make choices and begin lung cancer treatment [39].…”