Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data.
OBJECTIVE
To evaluate self-reported depression rates in patients with inoperable lung cancer and to explore demographic, clinical, and quality-of-life (QOL) factors associated with depression and thus identify patients at risk.


METHODS
Nine hundred eighty-seven patients from three palliative treatment trials conducted by the Medical Research Council Lung Cancer Working Party formed the study sample. 526 patients (53%) had poor prognosis small-cell lung cancer (SCLC) and 461 patients (47%) had good prognosis non-small-cell lung cancer (NSCLC). Hospital Anxiety and Depression Scale data and QOL items from the Rotterdam Symptom Checklist were analyzed, together with relevant demographic and clinical factors.


RESULTS
Depression was self-rated in 322 patients (33%) before treatment and persisted in more than 50% of patients. SCLC patients had a three-fold greater prevalence of case depression than those with NSCLC (25% v 9%; P <.0001). An increased rate for women was found for good performance status (PS) patients (PS of 0 or 1) but the sex difference reduced for poor PS patients (PS of 3 or 4) because of increased depression rates for men (chi(2) for trend, P <.0001). Multivariate analysis showed that functional impairment was the most important risk factor; depression increased by 41% for each increment on the impairment scale. Pretreatment physical symptom burden, fatigue, and clinician-rated PS were also independent predictors, but cell type was not.


CONCLUSIONS
Depression is common and persistent in lung cancer patients, especially those with more severe symptoms or functional limitations. Psychologic screening and appropriate intervention is an essential part of palliative care.
Hopwood
P
P
Cancer Research Campaign Psychological Medicine Group, Christie Hospital National Health Service Trust, Withington, Manchester, UK. penelope.hopwood@man.ac.uk
Stephens
R J
RJ
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D016009:Chi-Square Distribution; D003863:Depression / Q000523:psychology*; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D010166:Palliative Care; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012737:Sex Factors