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 language | English (US) |
|---|---|
| Pages (from-to) | 403-413 |
| Number of pages | 11 |
| Journal | Surgery (United States) |
| Volume | 152 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2012 |
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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 journal › Article
}
TY - JOUR
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.
PY - 2012/9
Y1 - 2012/9
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.
UR - http://www.scopus.com/inward/record.url?scp=84865741604&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865741604&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2012.06.010
DO - 10.1016/j.surg.2012.06.010
M3 - Article
C2 - 22938900
AN - SCOPUS:84865741604
VL - 152
SP - 403
EP - 413
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 3
ER -