title: Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer.
abstract: OBJECTIVE
  Although early intervention is increasingly advocated to prevent and relieve distress in patients with metastatic cancer, the risk factors for such symptoms and their trajectory are not well established. We therefore conducted a longitudinal study to determine the course and predictors of depressive symptoms.
  
  
  METHODS
  Patients (N = 365) with metastatic gastrointestinal or lung cancer completed measures of physical distress, self-esteem, attachment security, spiritual well-being, social support, hopelessness, and depression at baseline; physical distress, social support, hopelessness, and depression were subsequently assessed at 2-month intervals.
  
  
  RESULTS
  Of the sample, 35% reported at least mild depressive symptoms, with 16% reporting moderate to severe depressive symptoms that persisted in at least one third of such individuals. Moderate to severe depressive symptoms were almost three times more common in the final 3 months of life than > or = 1 year before death. Predictors of depressive symptoms included younger age, antidepressant use at baseline, lower self-esteem and spiritual well-being, and greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. The combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression.
  
  
  CONCLUSIONS
  Depressive symptoms in advanced cancer patients are relatively common and may arise as a final common pathway of distress in response to psychosocial vulnerabilities, physical suffering, and proximity to death. These findings support the need for an integrated approach to address emotional and physical distress in this population and to determine whether early intervention may prevent depression at the end of life.
authors.affiliation: Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lo
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.forename: Anne
authors.initials: A
authors.lastname: Rydall
authors.forename: Andrew
authors.initials: A
authors.lastname: Walsh
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Jones
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011788:Quality of Life; D012307:Risk Factors; D012649:Self Concept; D012944:Social Support; D029181:Spirituality; D015996:Survival Rate; D055815:Young Adult