• J Pain Symptom Manage · Aug 2017

    Depression - a major contributor to poor quality of life in patients with advanced cancer.

    • K S Grotmol, H C Lie, M J Hjermstad, N Aass, D Currow, S Kaasa, T Å Moum, A Pigni, J H Loge, and European Palliative Care Research Collaborative (EPCRC).
    • Regional Advisory Unit for Palliative Care, Dept. of Oncology, Oslo University Hospital. Electronic address: k.s.grotmol@medisin.uio.no.
    • J Pain Symptom Manage. 2017 Aug 9.

    ContextQuality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear due to few methodologically sound studies.ObjectivesTo examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.Methods563 patients were included from the European Palliative Care Research Collaborative Study (EPCRC-CSA), an international, multi-centre, cross-sectional study. The relative importance of prognostic factors (systemic inflammation (mGPS), co-morbidities and physical performance (KPS), symptom burden (loss of appetite, breathlessness, nausea (ESAS) and pain (BPI)) and depression severity (PHQ-9) in predicting Global Health/QoL (EORTC-QLQ-C30) were assessed using hierarchical multiple regression models.Results55% were females, median age 64 years, 87% had metastatic disease, median KPS was 70 and mean global QoL 50.5 (SD=23.3). Worse QoL was associated with increased systemic inflammation (mGPS=1 β=-0.12, p=0.003, mGPS=2 β=-0.09, p=0.023), lower physical performance (β=0.17, p<0.001), reduced appetite (β=-0.15, p<0.001), breathlessness (β=-0.11, p=0.004), pain (β=-0.14, p=0.002), and higher depression severity (β=-0.27, p<0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance.ConclusionDepression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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