title: Socioeconomic status is associated with depressive severity among patients with advanced non-small-cell lung cancer: treatment setting and minority status do not make a difference.
abstract: BACKGROUND
  Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related morbidity and mortality. Unfortunately, patients with NSCLC have relatively poor survival rates compared with patients diagnosed with most other types of cancer. Accordingly, managing physical and mental health symptoms are important treatment goals. In the current investigation, we sought to determine whether individual socioeconomic status (SES; as indexed by level of education), racial/ethnic minority status, and hospital type (public versus tertiary care center) were associated with NSCLC cancer patients' depressive severity. Importantly, we investigated whether NSCLC patients' individual SES was more or less prognostic of their depressive severity compared with minority status and the hospital context where they received treatment.
  
  
  METHODS
  Patients scheduled for chemotherapy were assessed for depressed mood by the Beck Depression Inventory-II (BDI-II). Data were collected at baseline and at approximately 6, 12, and 18 weeks.
  
  
  RESULTS
  NSCLC patients with less education had more depressive severity than those with more education. Treatment setting and minority status were not associated with depressive severity. The interaction between education level and treatment setting predicting depressive severity was not significant, suggesting that the association between education level and depressive severity did not differ by treatment setting.
  
  
  CONCLUSIONS
  Our study brings heightened awareness to the substantial, persistent SES differences that exist in depressive severity among late-stage NSCLC patients. Furthermore, these findings seem to persist, regardless of minority status and whether the patient is treated at a public hospital or tertiary cancer center.
authors.affiliation: Departments of *Health Disparities, †General Oncology, ‡Symptom Research, and §Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston,Texas.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fagundes
authors.forename: Desiree
authors.initials: D
authors.lastname: Jones
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vichaya
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics / Q000473:pathology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000191:economics / Q000209:etiology* / Q000523:psychology; D005260:Female; D005431:Florida; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics / Q000473:pathology / Q000523:psychology*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D012923:Social Class; D013781:Texas