Depression symptom trends and health domains among lung cancer patients in the CanCORS study.
Among lung cancer patients depression symptoms are common and impact outcomes. The aims of this study were to determine risk factors that contribute to persistent or new onset depression symptoms during lung cancer treatment, and examine interactions between depression symptoms and health domains that influence mortality.



Prospective observational study in five healthcare systems and 15 Veterans Affairs medical centers. Patients in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium with lung cancer were eligible. The 8-item Center for Epidemiologic Studies Depression (CES-D) scale was administered at baseline and follow-up. Scores ≥4 indicated elevated depressive symptoms. Health domains were measured using validated instruments. We applied logistic regression and Cox proportional hazards modeling to explore the association between depression symptoms, health domains, and mortality.



Of 1790 participants, 38% had depression symptoms at baseline and among those still alive, 31% at follow-up. Risk factors for depression symptoms at follow-up included younger age (OR=2.81), female sex (OR=1.59), low income (OR=1.45), not being married (OR=1.74) and current smoking status (OR=1.80); high school education was associated with reduced odds of depression symptoms at follow-up, compared with lesser educational attainment (OR=0.74) (all p values <0.05). Patients with depression symptoms had worse health-related quality of life, vitality, cancer-specific symptoms, and social support than patients without depression symptoms (all p<0.001). The association between depression symptoms and increased mortality is greater among patients with more lung cancer symptoms (p=0.008) or less social support (p=0.04).



Patient risk factors for depression symptoms at follow-up were identified and these subgroups should be targeted for enhanced surveillance. Patients with depression symptoms suffer across all health domains; however, only more lung cancer symptoms or less social support are associated with worse mortality among these patients. These potentially modifiable health domains suggest targets for possible intervention in future studies.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, United States; Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, United States. Electronic address: sullivad@ohsu.edu.
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Sullivan
Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, United States.
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Forsberg
Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, United States; Division of Geriatric Psychiatry, Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States.
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Ganzini
Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington, Seattle, WA, United States.
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Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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Gould
VA Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, and Duke University, Durham, NC, United States.
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Provenzale
School of Nursing, Oregon Health and Science University, Portland, OR, United States.
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Lyons
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, United States; Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, United States; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, United States.
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Slatore
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications* / Q000208:ethnology / Q000209:etiology / Q000401:mortality; D016021:Epidemiologic Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate
Depression symptoms; Health domains; Lung cancer; Quality of life; Risk factors; Survival