title: Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer.
abstract: BACKGROUND
  Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC).
  
  
  METHODS
  This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard.
  
  
  RESULTS
  Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=-0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively).
  
  
  CONCLUSIONS
  The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.
authors.affiliation: Clinique Mon Repos, Clinea, Marseille, France.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.affiliation: Medical Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Freyer
authors.affiliation: Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvrelès-Nancy, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Adam
authors.affiliation: Palliative Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France.
authors.forename: Marilène
authors.initials: M
authors.lastname: Filbet
authors.affiliation: Institut Jean Godinot, Reims, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Derzelle
authors.affiliation: Tenon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Abgrall-Barbry
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bourcelot
authors.affiliation: Centre François Baclesse, Caen, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Machavoine
authors.affiliation: Centre Hospitalier de la région d'Annecy, Pringy, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Chomat-Neyraud
authors.affiliation: Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gisserot
authors.affiliation: Centre Azuréen de Cancérologie, Mougins, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Largillier
authors.affiliation: Medical Oncology, Hôpital Perpétuel Secours, Levallois-Perret, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Le Rol
authors.affiliation: Medical Oncology, Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Priou
authors.affiliation: Supportive Care Department, Centre Léon Bérard, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Saltel
authors.affiliation: Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Falandry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D008495:Medical Oncology / Q000379:methods*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D057566:Self Report / Q000592:standards*; D012680:Sensitivity and Specificity
keywords: cancer; depression; elderly; geriatric assessment; screening