title: The relationship between depression and physical symptom burden in advanced cancer.
abstract: BACKGROUND
  Although an association between depression and physical burden has been demonstrated in advanced cancer, it remains unclear to what extent this is limited to specific physical symptoms, such as pain and fatigue, and is mediated by disease and treatment-related factors. We therefore investigated the relationship between depression and physical burden across a multitude of physical symptoms in this population, while controlling for cancer-related factors including disease severity and proximity to death.
  
  
  METHODS
  A secondary analysis was performed on cross-sectional data in 487 patients with advanced cancer. Measures included the Beck Depression Inventory II and the Memorial Symptom Assessment Scale, which measured physical burden across 24 common cancer symptoms. Disease severity was assessed by survival time and by functional status using the Karnofsky Performance Status scale.
  
  
  RESULTS
  Depression severity significantly correlated with number of physical symptoms, symptom distress and symptom severity independent of cancer type, functional status, chemotherapy status and survival time (all p<0.001). Depression was associated with increased incidence, severity and distress across multiple physical symptoms and was an independent predictor of physical burden on multiple regression analysis.
  
  
  CONCLUSIONS
  These findings support the view that a synergistic relationship exists between depression and a broad array of physical symptoms in patients with advanced cancer.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Fitzgerald
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Lo
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Madeline
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada School of Kinesiology and Health Science, York University, Toronto, Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D005221:Fatigue / Q000150:complications; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000150:complications; D016019:Survival Analysis
keywords: Advanced Cancer; Physical Burden; Supportive care; Symptoms and symptom management