J Cancer 2015; 6(11):1121-1129. doi:10.7150/jca.11239

Research Paper

Chemotherapeutic Response and Prognosis among Lung Cancer Patients with and without Depression

Jue Chen1,2*, Weichun Li2*, Lin Cui2, Yayun Qian1, Yaodong Zhu1, Hao Gu1, Gaoyang Chen2, Yi Shen3, Yanqing Liu1✉

1. Institute of Traditional Chinese Medicine and Western Medicine, School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China;
2. The Second People's Hospital of Taizhou affiliated to Yangzhou University, Taizhou, Jiangsu, China
3. Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China
*These authors contributed equally to this work

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Chen J, Li W, Cui L, Qian Y, Zhu Y, Gu H, Chen G, Shen Y, Liu Y. Chemotherapeutic Response and Prognosis among Lung Cancer Patients with and without Depression. J Cancer 2015; 6(11):1121-1129. doi:10.7150/jca.11239. Available from http://www.jcancer.org/v06p1121.htm

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Purpose: The current study examined quality of life, progression of disease, and survival rate during chemotherapy in newly diagnosed non-small cell lung cancer (NSCLC) patients with depression (n=48) and without depression (n=78). Further, the study explored the hypothesis that the survival benefit resulted from the chemotherapy of docetaxel and cisplatin (the DC regimen).

Patients and Methods: In total, 126 patients with newly diagnosed NSCLC participated in a cross-sectional study of DC chemotherapy integrated with standard oncology care in depression and non-depression groups. The health-related quality of life (HR-QOL) was assessed using the quality of life questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC). Depression was self-rated using the Zung Self-Rating Depression Scale (Z-SDS). Both HR-QOL and Z-SDS were completed before the first and after the last cycle of chemotherapy. Association between depression and quality of life, treatment responses, adverse effects and survival rate was considered positive at the significance level of p<0.05. Pearson and Spearman correlation coefficient, t-test and other statistical analysis were performed using the SPSS software version 13.0 for Windows.

Results: In total, 126 lung cancer patients were evaluated, 38% had a diagnosis of depression. The presence of depression was associated with reduced quality of life, increased progression of disease, nausea and fatigue and reduced survival rate by nearly 90 days on follow-up. Therefore, depression significantly predicted worse survival (P=0.009).In addition, the chemotherapy DC regimen did not appear to improve the quality of life in depressed patients (SDS 94.96±18.14 before chemotherapy vs. SDS 100.04±16.61 after therapy, P=0.155). In a secondary analysis, there was a positive relationship between depression and nausea and fatigue but there was no significant difference in hematologic toxicities between the depression and non-depression groups.

Conclusion: Depression was associated with worse survival in patients with newly diagnosed NSCLC. Also, the chemotherapy DC regimen did not improve quality of life in depressed patients and the data do not support the hypothesis that treatment responses of NSCLC patients with depression mediated the observed survival benefit from the DC regimen. There were more cases of progressed disease in the depressed group. Findings suggest that NSCLC patients with depression are at increased risk for decline in HR-QOL and survival rate during chemotherapy than patients without depression.

Keywords: lung cancer, chemotherapy