Depressive Symptoms in Newly Diagnosed Lung Carcinoma: Prevalence and Associated Risk Factors

The impact of depression on the quality of life of lung cancer patients undergoing chemotherapy: mediating effects of perceived social support

Background

Quality of life (QOL) in patients undergoing chemotherapy for lung cancer has been a key research area. Numerous studies have examined the relationships among depression, perceived social support (PSS), and QOL. However, the mechanisms underlying PSS in lung cancer patients receiving chemotherapy remain underexplored.

Objective

To investigate the mediating role of PSS in the relationship between depression and QOL in lung cancer patients undergoing chemotherapy.

Methods

A convenience sample of 390 lung cancer patients undergoing chemotherapy was selected from the outpatient clinics and wards of the Department of Oncology at a tertiary hospital in Deyang City between January 2024 and June 2024. Participants completed a general information questionnaire, Self-Rating Depression Scale (SDS), Multidimensional Scale of Perceived Social Support (MPSSS), and Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L) scale. SPSS 26.0 was used to analyze correlations between depression, PSS, and QOL, while AMOS 26.0 assessed the mediating effect of PSS on the relationship between depression and QOL.

Results

The mean scores for depression, PSS, and QOL were 39.79 ± 11.63, 68.96 ± 13.09, and 66.43 ± 23.67, respectively. Pearson's correlation analysis showed that depression was negatively correlated with QOL (r = -0.319, P < 0.001) and positively correlated with PSS (r = -0.484, P < 0.001). Additionally, PSS was positively correlated with QOL (r = 0.349, P < 0.001). PSS partially mediated the relationship between depression and QOL, with a mediating effect value of -0.165, accounting for 50.3% of the total effect.

Conclusion

Depression in lung cancer patients undergoing chemotherapy directly impacts QOL and indirectly affects it through PSS. Clinically, healthcare providers should address depression in these patients and offer psychological support and interventions as needed. Additionally, medical institutions can implement targeted strategies to help patients build a strong social support system, reduce negative emotions, enhance psychological well-being, and improve overall QOL.

Quality of Life Status and Its Influencing Factors Among Lung Cancer Chemotherapy Patients in China: A Cross-Sectional Study

Background

Improving the quality of life (QOL) of lung cancer patients undergoing chemotherapy is an indispensable part of cancer treatment, as it not only pertains to their physical health but also to their psychological and social well-being. Previous research has primarily focused on investigating health-related quality of life, while studies specifically addressing the QOL of lung cancer patients remain underrepresented and under researched.

Purpose

The study aims to investigate the current status of QOL among lung cancer patients and identify the predictive factors associated with QOL.

Patients and Methods

From January 2024 to June 2024, lung cancer patients undergoing chemotherapy will be recruited from the outpatient clinics or wards of a tertiary A-level hospital in Deyang City as research subjects. They will be surveyed using the general information questionnaire, the Self-rating Depression Scale (SDS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. Multiple linear regression analysis will be employed to determine the variables associated with QOL.

Results

A total of 390 lung cancer patients undergoing chemotherapy were recruited for this study, with a male predominance accounting for 72.31%. The mean age was (59.11±11.37) years. The overall QOL score was (66.43±23.67). Age, family monthly income per capita, cancer clinical stage, depression, and perceived social support (PSS) were identified as independent factors influencing the QOL of lung cancer patients, accounting for 19.4% of the total variance.

Conclusion

There is still considerable room for improvement in the overall QOL of lung cancer patients undergoing chemotherapy. Based on the analysis of influencing factors, targeted and personalized intervention measures should be implemented to enhance the QOL for these patients.

'Beyond the blues': A case report on depression as initial presentation of lung cancer with brain metastasis

Lung cancer usually presents with pulmonary symptoms such as cough, dyspnoea, and extrapulmonary symptoms with metastatic involvement of the brain may present as delirium or neurological deficits. However, in rare cases, psychiatric symptoms such as depression may be the only initial manifestation of lung cancer with brain metastasis, which may mislead the clinical picture. We describe a case of a middle-aged female with no past or family history of medical and psychiatric illness who was brought with low mood, decreased social interaction, fatigue, and decreased appetite in the past 2 weeks. She also had poor concentration and memory disturbances with difficulty in performing household chores. Interpersonal relationship issues in the family were attributed as precipitating factors. She was diagnosed with major depressive disorder and initiated on antidepressants but with no improvement. Later course of the illness, she developed a bilateral diffuse headache associated with vomiting. On mental status examination, she had decreased psychomotor activity. Her speech was minimal with decreased response rate and little variability in the tone. She was not able to describe her mood and her affect was restricted. No abnormal beliefs or psychotic symptoms were elicited. On general physical examination, mild deviation of the angle of mouth was noted. Because of the suspicion of organic etiology, a magnetic resonance imaging brain scan with contrast was suggested and an intracranial space-occupying lesion involving the left frontal lobe with significant perilesional edema causing mass effect was noted. Further, a positron emission tomography scan revealed hypermetabolic soft tissue mass over the supra-hilar region of the right lung likely indicating the primary site with brain metastasis. Here in this case, the initial presentation of psychiatric symptoms in lung cancer with brain metastasis obscured the underlying central nervous system pathology. This case illustrates the need for a holistic approach with prompt and detailed assessment including neuroimaging in patients with a high index of suspicion of organicity.

Trajectories of depression and predictors in lung cancer patients undergoing chemotherapy: growth mixture model

BACKGROUND

Depression is prevalent among lung cancer patients undergoing chemotherapy, and the symptom cluster of fatigue-pain-insomnia may influence their depression. Identifying characteristics of patients with different depression trajectories can aid in developing more targeted interventions. This study aimed to identify the trajectories of depression and the fatigue-pain-insomnia symptom cluster, and to explore the predictive factors associated with the categories of depression trajectories.

METHODS

In this longitudinal study, 187 lung cancer patients who were undergoing chemotherapy were recruited and assessed at the first (T1), second(T2), and fourth(T3) months using the Patient Health Questionnaire-9 (PHQ-9), the Brief Pain Inventory (BPI), the Brief Fatigue Inventory (BFI), and the Athens Insomnia Scale (AIS). Growth Mixture Model (GMM) and Latent Class Analysis (LCA) were used to identify the different trajectories of the fatigue-pain-insomnia symptom cluster and depression. Binary logistic regression was utilized to analyze the predictive factors of different depressive trajectories.

RESULTS

GMM identified two depressive trajectories: a high decreasing depression trajectory (40.64%) and a low increasing depression trajectory (59.36%). LCA showed that 48.66% of patients were likely members of the high symptom cluster trajectory. Binary logistic regression analysis indicated that having a history of alcohol consumption, a higher symptom cluster burden, unemployed, and a lower monthly income predicted a high decreasing depression trajectory.

CONCLUSIONS

Depression and fatigue-pain-insomnia symptom cluster in lung cancer chemotherapy patients exhibited two distinct trajectories. When managing depression in these patients, it is recommended to strengthen symptom management and pay particular attention to individuals with a history of alcohol consumption, unemployed, and a lower monthly income.

Enhancing the revelation of key genes and interaction networks in non-small cell lung cancer with major depressive disorder: A bioinformatics analysis

Background and Aims

Lung cancer is ranked as the second most prevalent form of cancer worldwide. Nonsmall cell lung cancer (NSCLC) represents the predominant histological subtype. Research suggests that one-third of lung cancer patients also experiencing depression. Antidepressants play an indispensable role in the management of NSCLC. Despite significant advancements in treatment, lung cancer patients still face a high mortality rate. Major depressive disorder (MDD) and related antidepressants involved in treatment efficacy and prognosis of NSCLC. However, there has been a lack of screening and analysis regarding genes and networks associated with both NSCLC and MDD.

Methods

To investigate the correlation between MDD and NSCLC, our discovery and validation analysis included four datasets from the Gene Expression Omnibus database from NSCLC or MDD. Differential gene expression (DEGs) analysis, GO and KEGG Pathway, and protein-protein interaction network analyzes to identify hub genes, networks, and associated observations link between MDD and NSCLC.

Results

The analysis of two datasets yielded a total of 84 downregulated and 52 upregulated DEGs. Pathway enrichment analyzes indicated that co-upregulated genes were enriched in the regulation of positive regulation of cellular development, collagen-containing extracellular matrix (ECM), cytokine binding, and axon guidance. We identified 20 key genes, which were further analyzed using the MCODE plugin to identify two core subnetworks. The integration of functionally similar genes provided valuable insights into the potential involvement of these hub genes in diverse biological processes including angiogenesis humoral immune response regulation inflammatory response organization ECM network.

Conclusion

We have identified a total of 136 DEGs that participate in multiple biological signaling pathways. A total of 20 hub genes have demonstrated robust associations, potentially indicating novel diagnostic and therapeutic targets for both diseases.

Factors associated with depressive symptoms among cancer patients: a nationwide cross-sectional study

OBJECTIVE

Research on factors contributing to depressive symptoms in cancer patients at a national level, encompassing a comprehensive set of variables was limited. This study aimed to address this gap by identifying the factors associated with depressive symptoms among cancer patients through a nationwide cross-sectional analysis.

METHODS

Various factors, including demographic, socioeconomic, behavioral patterns, general and self-rated health status, chronic conditions, dietary habits, and cancer-related factors, were examined. Data was from the National Health and Nutrition Examination Survey. Univariate and multivariate logistic regression analyses were performed to identify associated factors. The receiver-operating characteristic (ROC) curve was used to evaluate the performance of the logistic model.

RESULTS

The findings showed that five sociodemographic factors, two behavioral styles, self-rated health status, comorbid arthritis, two dietary factors and two cancer-related factors were strongly associated with depressive symptoms. Compared with those aged 20-39 years, cancer individuals aged 40-59 years (OR = 0.48, P < 0.05) and those 60 years or older (OR = 0.18, P < 0.05) had lower odds of depression. Positive factors included being never married (OR = 1.98, P < 0.05), widowed, divorced or separated (OR = 1.75, P < 0.05), unemployment (OR = 1.87, P < 0.05), current smoking (OR = 1.84, P < 0.05), inadequate sleep (OR = 1.96, P < 0.05), comorbid arthritis (OR = 1.79, P < 0.05), and poor self-rated health status (OR = 3.53, P < 0.05). No significant association was identified between the Healthy Eating Index 2015 and the Dietary Inflammatory Index with depression (P > 0.05). Shorter cancer diagnosis duration was associated with reduced odds of depression (P < 0.05). The logistic model had an area under the curve of 0.870 (95% CI: 0.846-0.894, P < 0.05).

CONCLUSIONS

Cancer patients should receive enhanced family and social support while cultivating a healthy lifestyle and diet. Incorporating plenty of fruits, greens, and beans is highly recommended, along with establishing a comprehensive health management framework.

Depression and anxiety in cancer patient enrolled in clinical trials with serious adverse events

OBJECTIVE

Drug-induced side effects, particularly serious adverse events (SAEs), often affect cancer patients enrolled in clinical trials. However, little is known about anxiety and depression in cancer patients who experienced SAEs. This study evaluated the prevalence of anxiety and depression in cancer patients enrolled in clinical trials who experienced SAEs and explored the risk factors.

METHODS

A multi-center, cross-sectional survey was conducted in hospitals affiliated with the University of Science and Technology of China from December 2021 to November 2022. A total of 112 cancer patients who experienced SAEs while enrolled in clinical trials, and who completed the informed consent process and study questionnaires, were included in the final analysis.

RESULTS

The rate of moderate-severe depression in cancer patients was 38.4% and that of moderate-severe anxiety was 13.4%. Among the patients who had moderate-severe anxiety, 93.3% had concurrent moderate-severe depression. Lower cognitive function and lower global quality of life were risk factors for depression in cancer patients who experienced SAEs. Pain, low emotional function, low global quality of life, and a high Impact of Events Scale score were risk factors for anxiety.

CONCLUSIONS

Cancer patients enrolled in a clinical trial who experienced SAEs tended to be anxious and depressed, particularly the latter. These results indicate the need to evaluate anxiety and depression, and mental health treatment among cancer patients with SAEs in clinical trials.

Factors associated with and risk factors for depression in cancer patients - A systematic literature review

Objective

The prevalence of depression in oncological patients is 3, 4-fold compared to the general population. However, the specific risk factors for these prevalence rates are not fully understood.

Methods

A systematic literature review was conducted in nine electronic databases between 2005 and 2020. The quality of the eligible studies was appraised by two persons using the adapted 11-items Downs and Black checklist.

Results

Among 2010 potentially relevant articles, 40 studies were eligible, with 27 studies of high quality and 13 studies of moderate quality. A total of 156 factors associated with depression were identified which were clustered into somatic, psychological, social and sociodemographic factors. Pre-existing depression and personality factors were the most consistent associated factors with depression in cancer patients, while for most somatic and treatment-related factors only modest associations were found.

Conclusions

Grouped as bio-psycho-social associated factors, somatic factors showed a modest influence, whereas social relationship (support) and previous depression are unequivocally significantly associated with depression.

Risk factors of inability to live independently in the course of lung cancer

Introduction

A number of articles focus on functioning with lung cancer. However, there are no articles on factors which result in the inability to live independently in the course of this disease. This study assesses risk factors regarding the inability to live independently among individuals with lung cancer.

Materials and Methods

This study included 134 patients who displayed interest in obtaining a certificate of the inability to live independently.

Results

Over the study period, 75% of the patients obtained the certificate of inability to live independently (group A) and 25% of them did not obtain the certificate (group B). In group A, 56.4% of individuals were men, and in group B, 42.4% of them were men. In group A, 11.8% of patients were diagnosed with small cell lung cancer; no such case was found in group B. Metastases were revealed in 83.2% of patients from group A and in 57.6% from group B. Patients from group A had a significantly lower score in the Barthel Index for Activities of Daily Living and lower body mass index compared with those from group B.

Conclusions

Information on body mass index, histopathological diagnosis, and the presence of metastases is useful in assessing the risk of being unable to live independently in patients with lung cancer. The Barthel Index for Activities of Daily Living is helpful in assessing the inability to live independently.

Functional Disability Among Older Versus Younger Adults With Advanced Non-Small-Cell Lung Cancer

PURPOSE

To determine patient and disease characteristics associated with functional disability among adults with advanced non-small-cell lung cancer (NSCLC).

METHODS

In a prospective cohort of participants newly diagnosed with advanced NSCLC and beginning systemic treatment, functional disability in usual activities, mobility, and self-care was measured using the EuroQol-5D-5L at baseline. Demographics, comorbidities, brain metastases, Eastern Cooperative Oncology Group performance status (ECOG PS), and psychologic variables (depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder 7-item scale]) were captured. Patients were classified into two disability groups (none-slight or moderate-severe) on the basis of total functional status scores. Differences between disability groups were determined (chi-square and t tests). Associations between patient characteristics and baseline disability were assessed using logistic regression.

RESULTS

Among 173 participants, mean age was 63.3 years, 56% were male, 83% had ECOG PS 0-1, and 41% had brain metastases. Baseline disability was present in 39% of participants, with patients having moderate to severe disability in usual activities (37.6%), mobility (26.6%), and self-care (5.2%). Depressive and/or anxiety symptoms ranged from none to severe (Patient Health Questionnaire 9-item scale M = 6.5, SD = 5.3). Depressive symptoms were the only characteristic associated with a higher odds of baseline disability (adjusted odds ratio [aOR]: 1.26; 95% CI, 1.15 to 1.38; P < .001). Participants with poorer ECOG PS (aOR: 4.64; 95% CI, 1.84 to 11.68; P = .001) and depressive symptoms (aOR: 1.15; 95% CI, 1.07 to 1.24; P < .001) had higher odds of moderate-severe mobility disability compared with the none-slight disability group.

CONCLUSION

More than one third of all adults with advanced NSCLC have moderate-severe functional disability at baseline. Psychologic symptoms were significantly associated with moderate-severe baseline disability.

Identifying risk factors for depression and anxiety symptoms in patients with chronic lymphocytic leukemia

PURPOSE

This study assessed whether empirically supported risk factors can identify future depression and anxiety symptoms in a specific cancer type, chronic lymphocytic leukemia (CLL).

METHODS

Patients enrolled in a CLL treatment clinical trial (N = 106) participated at baseline following informed consent and prior to treatment initiation. Risk factors with empirical support (personal or family psychiatric history, recurrent, advanced or progressive disease, low socioeconomic status, gender, medical comorbidities, and single marital status) and additional risk factors (cancer-specific stress, social contacts, negative life events, absolute lymphocyte counts, treatment group, and fatigue) were measured at baseline to predict depression and anxiety symptoms at 12 months.

RESULTS

Data show 14% (n = 15) and 12% (n = 13) of patients experienced moderate-severe depression and anxiety symptoms, respectively. Multiple linear regression analyses found medical comorbidities predicted 12-month anxiety symptoms (p < 0.05). Also, negative life events predicted depression and anxiety symptoms and fatigue predicted depression symptoms (p < 0.05).

CONCLUSION

Empirically supported risk factors associated with depression and anxiety symptoms are limited in predicting future depression and anxiety symptoms beyond initial screening in patients with CLL. In addition to levels of depression and anxiety symptoms at baseline, negative life events, higher levels of fatigue, and greater medical comorbidities were associated with future depression or anxiety symptoms in patients with CLL.