title: Impact of comorbid anxiety and depression on quality of life and cellular immunity changes in patients with digestive tract cancers.
abstract: OBJECTIVE
  A study was performed to investigate the impact of comorbid anxiety and depression (CAD) on quality of life (QOL) and cellular immunity changes in patients with digestive tract cancers.
  
  
  METHODS
  One hundred and fifty-six cases of both sexes with cancers of the digestive tract admitted between March 2001 and February 2004 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. All adult patients were evaluated with the Hamilton depressive scale (HAMD, the 24-item version), the Hamilton anxiety scale (HAMA, a modified 14-item version), quality of life questionnaire-core 30 (QLQ-C30), social support rating scale (SSRS), simple coping style questionnaire (SCSQ), and other questionnaires, respectively. In terms of HAMD > or = 20 and HAMA > or = 14, the patients were categorized, including CAD (n = 31) in group A, anxiety disorder (n = 23) in group B, depressive disorder (n = 37) in group C, and non-disorder (n = 65) in group D. Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared among the four groups.
  
  
  RESULTS
  The incidence of CAD was 21.15% in patients with digestive tract cancers. The average scores of social support was 43.67+/-7.05 for 156 cases, active coping 20.34+/-7.33, and passive coping 9.55+/-5.51. Compared with group D, subjective support was enhanced slightly in group A, but social support, objective support, and utilization of support reduced, especially utilization of support with significance (6.16 vs 7.80, P<0.05); total scores of active coping decreased, while passive coping reversed; granulocytes proliferated, monocytes declined, and lymphocytes declined significantly (32.87 vs 34.00, P<0.05); moreover, the percentage of CD3, CD4, CD8 and CD56 in T lymphocyte subsets was in lower level, respectively, and CD56 showed a significant decline in group A (26.02 vs 32.20, P<0.05), however, CD4/CD8 ratio increased. Physical function, role function, fatigue, sleeplessness and constipation had significant changes among different groups by one-way ANOVA, and group A was in poor QOL. It revealed that global health-related quality of life (QL) were positively correlated with active coping and CD56; CAD was negatively correlated with QL, active coping and CD56. Furthermore, the step-wise regression analysis suggested that utilization of support, CD56, active coping, fatigue, sleeplessness and depression were significant factors contributing to QOL.
  
  
  CONCLUSIONS
  CAD, which can impair QOL and cellular immunity, occurs with a higher incidence in patients with digestive tract cancers. Hence, it is essential to improve mental health for them with specifically tailored interventions.
authors.affiliation: Department of Hematology and Oncology, Second Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
authors.forename: Fu-Ling
authors.initials: FL
authors.lastname: Zhou
authors.forename: Wang-Gang
authors.initials: WG
authors.lastname: Zhang
authors.forename: Yong-Chang
authors.initials: YC
authors.lastname: Wei
authors.forename: Kang-Ling
authors.initials: KL
authors.lastname: Xu
authors.forename: Ling-Yun
authors.initials: LY
authors.lastname: Hui
authors.forename: Xu-Sheng
authors.initials: XS
authors.lastname: Wang
authors.forename: Ming-Zhong
authors.initials: MZ
authors.lastname: Li
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000276:immunology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000276:immunology* / Q000523:psychology; D004067:Digestive System Neoplasms / Q000453:epidemiology / Q000276:immunology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012944:Social Support; D013601:T-Lymphocytes / Q000276:immunology