title: Negative psychological aspects and survival in lung cancer patients.
abstract: We conducted a prospective cohort study in Japan to investigate associations between negative psychological aspects and cancer survival. Between July 1999 and July 2004, a total of 1178 lung cancer patients were enrolled. The questionnaire asked about socioeconomic variables, smoking status, clinical symptoms, and psychological aspects after diagnosis. Negative psychological aspects were assessed for the subscales of helplessness/hopelessness and depression. Clinical stage, performance status (PS), and histologic type were obtained from medical charts. The subjects were followed up until December 2004, and 686 had died. A Cox regression model was used to estimate the hazards ratio (HR) of all-cause mortality. After adjustment for socioeconomic variables and smoking status in addition to sex, age, and histologic type, both helplessness/hopelessness and depression subscales showed significant linear positive associations with the risk of mortality (p for trend<0.001 for both). However, after adjustment for clinical state variables in addition to sex, age, and histologic type, these significant linear positive associations were no longer observed (p for trend=0.41 and 0.26, respectively). Our data supported the hypothesis that the association between helplessness/hopelessness and depression and the risk of mortality among lung cancer patients was largely confounded by clinical state variables including clinical stage, PS, and clinical symptoms.
authors.affiliation: Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakaya
authors.forename: Kumi
authors.initials: K
authors.lastname: Saito-Nakaya
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Inagaki
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kikuchi
authors.forename: Kanji
authors.initials: K
authors.lastname: Nagai
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nishiwaki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012803:Sick Role; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D015996:Survival Rate