title: Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer.
abstract: BACKGROUND
  Symptoms of depression and anxiety are common in patients with lung cancer and may produce an impact on both health-related quality of life (HRQL) and survival. The aim of the present study was to evaluate the association of depression and anxiety on HRQL, treatment adherence, and prognosis in patients with non-small cell lung cancer (NSCLC).
  
  
  METHODS
  This is a prospective study of patients with stage IIIB or IV NSCLC. Depression and anxiety were measured using the hospital anxiety and depression scale, the International Neuropsychiatric Interview, and the HRQL with the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Instruments were applied before treatment and repeated at 3 and 6 months. Lack of treatment adherence was considered as patients who stopped going to their consultation appointments.
  
  
  RESULTS
  A total of 82 patients were included. At the initial evaluation, depression and anxiety were found in 32.9 and 34.1 % of patients, respectively. Depression was associated with feminine gender (p = 0.034) and poor performance status (p = 0.048). Depression and anxiety showed an association with HRQL. Patients with depression showed median overall survival of 6.8 months, whereas that for nondepressed patients was 14 months (hazard ratio [HR], 1.9; 95 % confidence interval (95 % CI), 1.03-3.7; p = 0.042). The 58 % of patients with depression had poor treatment adherence versus 42 % of patients without depression (p = 0.004).
  
  
  CONCLUSIONS
  Depression and anxiety were present in one-third of patients with recently diagnosed NSCLC. Depression and anxiety were associated with decreased HRQL scales, and depression was independently associated with treatment adherence and with poor prognosis.
authors.affiliation: Thoracic Oncology Clinic, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. ogar@servidor.unam.mx
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
authors.forename: Laura P
authors.initials: LP
authors.lastname: Angulo
authors.forename: Carolina
authors.initials: C
authors.lastname: Núñez-Valencia
authors.forename: Yuzmiren
authors.initials: Y
authors.lastname: Dorantes-Gallareta
authors.forename: Eleazar O
authors.initials: EO
authors.lastname: Macedo
authors.forename: Dulce
authors.initials: D
authors.lastname: Martínez-López
authors.forename: Salvador
authors.initials: S
authors.lastname: Alvarado
authors.forename: José-Francisco
authors.initials: JF
authors.lastname: Corona-Cruz
authors.forename: Luis F
authors.initials: LF
authors.lastname: Oñate-Ocaña
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000523:psychology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires