title: Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care.
abstract: OBJECTIVE
  In a randomized trial, early palliative care (EPC) in patients with metastatic non-small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression.
  
  
  METHODS
  In total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models.
  
  
  RESULTS
  At baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model.
  
  
  CONCLUSIONS
  Depression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.
authors.affiliation: Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Yawkey 9A, 55 Fruit St, Boston, MA 02114, USA. wpirl@partners.org
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.forename: Lara
authors.initials: L
authors.lastname: Traeger
authors.forename: Vicki
authors.initials: V
authors.lastname: Jackson
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.forename: Emily R
authors.initials: ER
authors.lastname: Gallagher
authors.forename: Pedro
authors.initials: P
authors.lastname: Perez-Cruz
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Heist
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000523:psychology* / Q000556:secondary*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D012016:Reference Values; D018570:Risk Assessment; D055502:Secondary Prevention; D012737:Sex Factors; D016019:Survival Analysis; D019452:Terminally Ill / Q000523:psychology; D013997:Time Factors