Congress Abstracts 2004

92

THE IMPACT OF DEPRESSION ON SURVIVAL OF ESOPHAGEAL CANCER PATIENTS. Mei Ling Chen, RN, PhD, Graduate Institute of Nursing, Chang Gung University, Tao Yuan; Hsin Yi Young, RN, MS, Chang Gung Memorial Hospital, Tao Yuan; and Chang Hsien Kun, MD, Chang Gung Memorial Hospital, Lin Kou.

The prevalence of depression among cancer patients has been reported to be 20%–25%. Although the associations between depression and pain as well as low quality-of-life are well known, research regarding the long-term effect of depression on survival rate for patients with cancer has not been conclusive. The purpose of this prospective longitudinal study was to examine the effect of depression on survival in esophageal cancer patients.

Lazarus’s cognitive model of emotion was used as the conceptual framework for this study.

The sample consisted of 119 patients with newly diagnosed stage II–stage IV esophageal cancer treated in a medical center of Northern Taiwan. Hospital Anxiety and Depression Scale (HADS) and Geriatric Depression Scale (GDS) were used to measure depression. The cut-off points for determining the depression status (depressed versus non-depressed) were established by previous study with Taiwanese population with cancer. Each patient was followed for two years. Depression status was measured at entry, 2, 4, 6, 12, 18, and 24 months after enrollment.

Data were analyzed using Kaplan-Meier survival analysis and Cox regression.

Results showed that 90 of 119 patients died within the two-year period with a median survival time of 12 months. One-year and two-year cumulative survival rates were 63.4% and 51.6% respectively. After controlling for other survival predicting factors (such as degree of body weight loss and functional status), the depression status measured by either HADS or GDS at month four significantly predicted patients’ survival. Compared to non-depressed patients, the relative hazard ratios for death in depressed patients were 1.75 (HADS) and 3.31 (GDS). The depression status measured by HADS at month six was also a significant predicting factor for survival; compared to non-depressed patients, depressed patients had a relative hazard ratio for death of 2.71. This study supports the negative effect of depression on the survival of patients with cancer. Oncology nurses should treat depression as an important psychological symptom that warrants early detection, continuous assessment, and appropriate interventions.