Treatment Receipt and Outcomes among Lung Cancer Patients with Depression

Donald Sullivan, Linda Ganzini, J. P. Duckart, A. Lopez-Chavez, M. E. Deffebach, S. M. Thielke, C. G. Slatore

Research output: Contribution to journalArticle

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Abstract

Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95% confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95% confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95% confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95% confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95% confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalClinical Oncology
Volume26
Issue number1
DOIs
StatePublished - Jan 2014

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Lung Neoplasms
Confidence Intervals
Mortality
Non-Small Cell Lung Carcinoma
Odds Ratio
Veterans
International Classification of Diseases
Health Services
Cohort Studies
Retrospective Studies
Logistic Models
Radiation
Drug Therapy
Survival
Health
Therapeutics

Keywords

  • Depression
  • Epidemiology
  • Lung cancer
  • Lung cancer treatment
  • Patient outcomes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Sullivan, D., Ganzini, L., Duckart, J. P., Lopez-Chavez, A., Deffebach, M. E., Thielke, S. M., & Slatore, C. G. (2014). Treatment Receipt and Outcomes among Lung Cancer Patients with Depression. Clinical Oncology, 26(1), 25-31. https://doi.org/10.1016/j.clon.2013.09.001

Treatment Receipt and Outcomes among Lung Cancer Patients with Depression. / Sullivan, Donald; Ganzini, Linda; Duckart, J. P.; Lopez-Chavez, A.; Deffebach, M. E.; Thielke, S. M.; Slatore, C. G.

In: Clinical Oncology, Vol. 26, No. 1, 01.2014, p. 25-31.

Research output: Contribution to journalArticle

Sullivan, D, Ganzini, L, Duckart, JP, Lopez-Chavez, A, Deffebach, ME, Thielke, SM & Slatore, CG 2014, 'Treatment Receipt and Outcomes among Lung Cancer Patients with Depression', Clinical Oncology, vol. 26, no. 1, pp. 25-31. https://doi.org/10.1016/j.clon.2013.09.001
Sullivan, Donald ; Ganzini, Linda ; Duckart, J. P. ; Lopez-Chavez, A. ; Deffebach, M. E. ; Thielke, S. M. ; Slatore, C. G. / Treatment Receipt and Outcomes among Lung Cancer Patients with Depression. In: Clinical Oncology. 2014 ; Vol. 26, No. 1. pp. 25-31.
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abstract = "Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14{\%} had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95{\%} confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95{\%} confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95{\%} confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95{\%} confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95{\%} confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95{\%} confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.",
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AU - Sullivan, Donald

AU - Ganzini, Linda

AU - Duckart, J. P.

AU - Lopez-Chavez, A.

AU - Deffebach, M. E.

AU - Thielke, S. M.

AU - Slatore, C. G.

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N2 - Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95% confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95% confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95% confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95% confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95% confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.

AB - Aims: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. Materials and methods: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. Results: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio=1.14, 95% confidence interval: 1.03-1.27, P=0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P=0.003). There was no association of depression diagnosis with surgery (odds ratio=0.83, 95% confidence interval: 0.56-1.22, P=0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio=1.02, 95% confidence interval: 0.89-1.16, P=0.78) or chemotherapy (odds ratio=1.07, 95% confidence interval: 0.83-1.39, P=0.59) or radiation (odds ratio=1.04, 95% confidence interval: 0.81-1.34, P=0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Conclusions: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.

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KW - Epidemiology

KW - Lung cancer

KW - Lung cancer treatment

KW - Patient outcomes

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