title: Depressive Symptoms in Patients Scheduled for Hyperthermic Intraperitoneal Chemotherapy With Cytoreductive Surgery: Prospective Associations With Morbidity and Mortality.
abstract: OBJECTIVE
  The current study examined prospective relationships between preoperative depressive symptoms and short-term (30-day morbidity and readmission) and long-term (overall survival) outcomes after hyperthermic intraperitoneal chemotherapy with cytoreductive surgery (HIPEC + CS).
  
  
  METHODS
  Ninety-eight patients scheduled for HIPEC + CS completed the Center for Epidemiologic Studies-Depression (CES-D) scale before surgery. Demographic and disease-specific factors and information about morbidity and readmission within 30 days after discharge were gathered from medical records. Survival was measured from date of surgery to death.
  
  
  RESULTS
  Twenty-eight percent of patients had CES-D scores indicative of clinically significant depressive symptoms. Thirty-day morbidity occurred in 31.9% of patients and readmission in 22.2%. At the time of analysis (median follow-up of 49 months), 71.6% of patients were deceased, with median survival time of 11 months for those who died. After adjusting for relevant preoperative demographic and disease-specific factors, depressive symptoms were associated with greater odds of 30-day morbidity (n = 68; odds ratio, 5.50; 95% CI, 1.23 to 24.73; P = .03) and greater likelihood of 30-day readmission (n = 72; odds ratio, 5.92; 95% CI, 1.27 to 27.64; P = .02). Depressive symptoms were associated with shorter survival after adjustment for preoperative demographic and disease-specific factors (n = 87; hazard ratio, 1.88; 95% CI, 1.07 to 3.31; P = .03). This association was no longer significant when intraoperative/postoperative prognostic variables were added to the statistical model (n = 87; hazard ratio, 1.31; 95% CI, 0.72 to 2.37; P = .37).
  
  
  CONCLUSIONS
  Patients with clinically significant levels of preoperative depressive symptoms are at risk for poor clinical outcomes after HIPEC + CS, including greater risk of 30-day morbidity and readmission. Further research is warranted to determine biobehavioral mechanisms and examine whether effective interventions targeting preoperative depressive symptoms can reduce postoperative risk in this patient population.
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA. lowca@upmc.edu.
authors.forename: Carissa A
authors.initials: CA
authors.lastname: Low
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steven
authors.initials: S
authors.lastname: Ahrendt
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Sara
authors.initials: S
authors.lastname: Alhelo
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Haroon
authors.initials: H
authors.lastname: Choudry
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Holtzman
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jones
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: All authors: University of Pittsburgh, Pittsburgh, PA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D015986:Confounding Factors, Epidemiologic; D065426:Cytoreduction Surgical Procedures; D003863:Depression / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D016017:Odds Ratio; D010529:Peritoneal Cavity; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology