The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients.
BACKGROUND
Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20%-30% of oncology patients.


OBJECTIVE
To determine the associations of pain and depression with health-related quality of life (HRQL), disability, and health care use in cancer patients.


METHODS
The Indiana Cancer Pain and Depression study is a randomized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and/or clinically significant depression. In this article, baseline data on patients enrolled from 16 urban or rural community-based oncology practices are analyzed to test the associations of pain and depression with HRQL, disability, and health care use.


RESULTS
Of the 405 participants, 32% had depression only, 24% pain only, and 44% both depression and pain. The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 (on 0-4 scale), and the average Brief Pain Inventory (BPI) severity score in the 274 participants with pain was 5.2 (on 0-10 scale), representing at least moderate levels of symptom severity. Symptom-specific disability was high, with participants reporting an average of 16.8 of the past 28 days (i.e., 60% of their days in the past four weeks) in which they were either confined to bed (5.6 days) or had to reduce their usual activities by 50% (11.2 days) because of pain or depression. Moreover, 176 (43%) participants reported being unable to work because of health-related reasons. Depression and pain had both individual and additive adverse associations with quality of life. Most patients were currently not receiving care from a mental health or pain specialist.


CONCLUSIONS
Depression and pain are prevalent and disabling across a wide range of types and phases of cancer, commonly co-occur, and have additive adverse effects. Enhanced detection and management of this disabling symptom dyad is warranted.
Kroenke
Kurt
K
Regenstrief Institute, Inc., 1050 Wishard Blvd., 6th Floor, Indianapolis, IN 46202, USA. kkroenke@regenstrief.org
Theobald
Dale
D
Wu
Jingwei
J
Loza
Julie K
JK
Carpenter
Janet S
JS
Tu
Wanzhu
W
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012959:Socioeconomic Factors; D017216:Telemedicine
D000700:Analgesics; D000928:Antidepressive Agents