The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma

Casey A. Boyd, Jaime Benarroch-Gampel, Kristin M. Sheffield, Yimei Han, Yong Fang Kuo, Taylor S. Riall

Research output: Contribution to journalArticle

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Abstract

Background: Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. Methods: Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International Classification of Diseases, 9th edition, Clinical Modification codes were used to evaluate depression during the 3 to 27 months before the diagnosis of cancer. The effect of depression on receipt of therapy and survival was evaluated in univariate and multivariate models. Results: Of patients with pancreatic cancer in our study, 7.9% had a diagnosis of depression (N = 1,868). Depression was associated with increased age, female sex, white race, single or widowed status, and advanced stage disease (P <.0001). In an adjusted model, patients with locoregional disease and depression had 37% lower odds of undergoing surgical resection (odds ratio, 0.63; 95% confidence interval, 0.52-0.76). In patients with locoregional disease, depression was associated with lower 2-year survival (hazard ratio, 1.20; 95% confidence interval, 1.09-1.32). After adjusting for surgical resection, this association was attenuated (hazard ratio, 1.14; 95% confidence interval, 1.04-1.26). In patients who underwent surgical resection, depression was a significant predictor of survival (hazard ratio, 1.34; 95% confidence interval, 1.04-1.73). Patients with distant disease and depression had 21% lower odds of receiving chemotherapy (odds ratio, 0.79; 95% confidence interval, 0.70-0.90). After adjusting for chemotherapy for distant disease, depression was no longer a significant predictor of survival (hazard ratio, 1.03; 95% confidence interval, 0.97-1.09). Conclusion: The decreased survival associated with depression appears to be mediated by a lower likelihood of appropriate treatment in depressed patients. Accurate recognition and treatment of pancreatic cancer patients with depression may improve treatment rates and survival.

Original languageEnglish (US)
Pages (from-to)403-413
Number of pages11
JournalSurgery (United States)
Volume152
Issue number3
DOIs
StatePublished - Sep 2012

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Adenocarcinoma
Depression
Survival
Confidence Intervals
Therapeutics
Pancreatic Neoplasms
Odds Ratio
Drug Therapy
Widowhood
International Classification of Diseases
Medicare
Neoplasms
Epidemiology
Survival Rate

ASJC Scopus subject areas

  • Surgery

Cite this

The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. / Boyd, Casey A.; Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Han, Yimei; Kuo, Yong Fang; Riall, Taylor S.

In: Surgery (United States), Vol. 152, No. 3, 09.2012, p. 403-413.

Research output: Contribution to journalArticle

Boyd, Casey A. ; Benarroch-Gampel, Jaime ; Sheffield, Kristin M. ; Han, Yimei ; Kuo, Yong Fang ; Riall, Taylor S. / The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. In: Surgery (United States). 2012 ; Vol. 152, No. 3. pp. 403-413.
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abstract = "Background: Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. Methods: Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International Classification of Diseases, 9th edition, Clinical Modification codes were used to evaluate depression during the 3 to 27 months before the diagnosis of cancer. The effect of depression on receipt of therapy and survival was evaluated in univariate and multivariate models. Results: Of patients with pancreatic cancer in our study, 7.9{\%} had a diagnosis of depression (N = 1,868). Depression was associated with increased age, female sex, white race, single or widowed status, and advanced stage disease (P <.0001). In an adjusted model, patients with locoregional disease and depression had 37{\%} lower odds of undergoing surgical resection (odds ratio, 0.63; 95{\%} confidence interval, 0.52-0.76). In patients with locoregional disease, depression was associated with lower 2-year survival (hazard ratio, 1.20; 95{\%} confidence interval, 1.09-1.32). After adjusting for surgical resection, this association was attenuated (hazard ratio, 1.14; 95{\%} confidence interval, 1.04-1.26). In patients who underwent surgical resection, depression was a significant predictor of survival (hazard ratio, 1.34; 95{\%} confidence interval, 1.04-1.73). Patients with distant disease and depression had 21{\%} lower odds of receiving chemotherapy (odds ratio, 0.79; 95{\%} confidence interval, 0.70-0.90). After adjusting for chemotherapy for distant disease, depression was no longer a significant predictor of survival (hazard ratio, 1.03; 95{\%} confidence interval, 0.97-1.09). Conclusion: The decreased survival associated with depression appears to be mediated by a lower likelihood of appropriate treatment in depressed patients. Accurate recognition and treatment of pancreatic cancer patients with depression may improve treatment rates and survival.",
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T1 - The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma

AU - Boyd, Casey A.

AU - Benarroch-Gampel, Jaime

AU - Sheffield, Kristin M.

AU - Han, Yimei

AU - Kuo, Yong Fang

AU - Riall, Taylor S.

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N2 - Background: Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. Methods: Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International Classification of Diseases, 9th edition, Clinical Modification codes were used to evaluate depression during the 3 to 27 months before the diagnosis of cancer. The effect of depression on receipt of therapy and survival was evaluated in univariate and multivariate models. Results: Of patients with pancreatic cancer in our study, 7.9% had a diagnosis of depression (N = 1,868). Depression was associated with increased age, female sex, white race, single or widowed status, and advanced stage disease (P <.0001). In an adjusted model, patients with locoregional disease and depression had 37% lower odds of undergoing surgical resection (odds ratio, 0.63; 95% confidence interval, 0.52-0.76). In patients with locoregional disease, depression was associated with lower 2-year survival (hazard ratio, 1.20; 95% confidence interval, 1.09-1.32). After adjusting for surgical resection, this association was attenuated (hazard ratio, 1.14; 95% confidence interval, 1.04-1.26). In patients who underwent surgical resection, depression was a significant predictor of survival (hazard ratio, 1.34; 95% confidence interval, 1.04-1.73). Patients with distant disease and depression had 21% lower odds of receiving chemotherapy (odds ratio, 0.79; 95% confidence interval, 0.70-0.90). After adjusting for chemotherapy for distant disease, depression was no longer a significant predictor of survival (hazard ratio, 1.03; 95% confidence interval, 0.97-1.09). Conclusion: The decreased survival associated with depression appears to be mediated by a lower likelihood of appropriate treatment in depressed patients. Accurate recognition and treatment of pancreatic cancer patients with depression may improve treatment rates and survival.

AB - Background: Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. Methods: Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International Classification of Diseases, 9th edition, Clinical Modification codes were used to evaluate depression during the 3 to 27 months before the diagnosis of cancer. The effect of depression on receipt of therapy and survival was evaluated in univariate and multivariate models. Results: Of patients with pancreatic cancer in our study, 7.9% had a diagnosis of depression (N = 1,868). Depression was associated with increased age, female sex, white race, single or widowed status, and advanced stage disease (P <.0001). In an adjusted model, patients with locoregional disease and depression had 37% lower odds of undergoing surgical resection (odds ratio, 0.63; 95% confidence interval, 0.52-0.76). In patients with locoregional disease, depression was associated with lower 2-year survival (hazard ratio, 1.20; 95% confidence interval, 1.09-1.32). After adjusting for surgical resection, this association was attenuated (hazard ratio, 1.14; 95% confidence interval, 1.04-1.26). In patients who underwent surgical resection, depression was a significant predictor of survival (hazard ratio, 1.34; 95% confidence interval, 1.04-1.73). Patients with distant disease and depression had 21% lower odds of receiving chemotherapy (odds ratio, 0.79; 95% confidence interval, 0.70-0.90). After adjusting for chemotherapy for distant disease, depression was no longer a significant predictor of survival (hazard ratio, 1.03; 95% confidence interval, 0.97-1.09). Conclusion: The decreased survival associated with depression appears to be mediated by a lower likelihood of appropriate treatment in depressed patients. Accurate recognition and treatment of pancreatic cancer patients with depression may improve treatment rates and survival.

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