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      Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

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          Abstract

          Objective

          The objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).

          Methods

          Data from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12‐month follow‐up. Also, socio‐demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS‐depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12‐month follow‐up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.

          Results

          In total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33‐2.05), but this decreased after correcting for socio‐demographic, clinical, and lifestyle‐related factors (HR = 1.21; 95% CI 0.97‐1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36‐3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66‐1.90) as the reference group who never experienced DS. After correcting for socio‐demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09‐2.53).

          Conclusions

          Pretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.

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          Most cited references19

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          Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses.

          Several hundred studies have shown that depression is associated with an elevated risk of dying at follow-up. It is not clear, however, whether the mechanisms for this association are disease specific, leading to higher mortality in specific patient groups, or generic, resulting in comparable mortality rates in all patient groups as well as in community samples. The authors conducted a comprehensive meta-analysis of prospective studies of community as well as patient samples associating depression at baseline with excess mortality at follow-up.
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            Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis.

            The Hospital Anxiety and Depression Scale (HADS) is the most extensively validated scale for screening emotional distress in cancer patients. However, thresholds for clinical decision making vary widely across studies. A meta-analysis was conducted with the aim of identifying optimal, empirically derived cut-offs. PubMed, Embase, and PsycINFO databases were searched for studies that compared the HADS total and its subscale scores against a semi-structured or structured clinical interview as a reference standard with regard to its screening efficacy for any mental disorders and depressive disorders alone. Separate pooled analyses were conducted for single or two adjacent thresholds. A total of 28 studies (inter-rater agreement, κ = 0.86) were included. The best thresholds for screening for mental disorders were 10 or 11 on the HADS total (sensitivity 0.80; specificity 0.74), 5 on the HADS depression subscale (sensitivity 0.84; specificity 0.50), and 7 or 8 on the HADS anxiety subscale (sensitivity 0.73; specificity 0.65). Respective thresholds for depression screening were 15 for the HADS total (sensitivity 0.87; specificity 0.88), 7 for the HADS depression subscale (sensitivity 0.86; specificity 0.81), and 10 or 11 for the HADS anxiety subscale (sensitivity 0.63; specificity 0.83). The HADS anxiety subscale performed worse than the total and the depression subscales for both indicators. Diagnostic accuracy varied widely by threshold but was consistently superior for depression screening than for screening of any mental disorder.
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              Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment.

              Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months' follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.
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                Author and article information

                Contributors
                f.jansen1@vumc.nl
                Journal
                Psychooncology
                Psychooncology
                10.1002/(ISSN)1099-1611
                PON
                Psycho-Oncology
                John Wiley and Sons Inc. (Hoboken )
                1057-9249
                1099-1611
                23 July 2018
                September 2018
                : 27
                : 9 ( doiID: 10.1002/pon.v27.9 )
                : 2245-2256
                Affiliations
                [ 1 ] Department of Otolaryngology‐Head and Neck Surgery, Cancer Center Amsterdam (CCA) VU University Medical Center Amsterdam The Netherlands
                [ 2 ] Department of Clinical, Neuro and Development Psychology, Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
                [ 3 ] Molecular Diagnostics of Oncogenic Infections Division German Cancer Research Center (DFKZ) Heidelberg Germany
                [ 4 ] National Institute for Health Research (NIHR) Bristol Biomedical Research Centre the University Hospitals Bristol NHS Foundation Trust and the University of Bristol Bristol UK
                [ 5 ] School of Oral and Dental Sciences University of Bristol Bristol UK
                Author notes
                [*] [* ] Correspondence

                Femke Jansen, Department of Otolaryngology‐Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands.

                Email: f.jansen1@ 123456vumc.nl

                Author information
                http://orcid.org/0000-0002-0111-0557
                Article
                PON4816 PON-18-0214.R2
                10.1002/pon.4816
                6231089
                29927013
                ffab5be0-c229-49b2-bdca-44451269f532
                © 2018 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/3.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 March 2018
                : 06 June 2018
                : 11 June 2018
                Page count
                Figures: 0, Tables: 3, Pages: 12, Words: 3231
                Funding
                Funded by: KWF Kankerbestrijding
                Award ID: VU 2013‐5930
                Funded by: National Institute for Health Research (NIHR) under its Programme Grants for Applied Research
                Award ID: RP‐PG‐0707‐10034
                Funded by: Cancer Research UK Programme
                Award ID: C18281/A19169
                Categories
                Paper
                Papers
                Custom metadata
                2.0
                pon4816
                September 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.1 mode:remove_FC converted:12.11.2018

                cancer,depression,depressive symptoms,head and neck cancer,mortality,oncology,survival

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