Incidence Of Pancreatic Cancer-related Depression And Its Relationship With The Quality Of Life Of Patients

Background and objectiveCancer-related depression adversely affects many clinical oncology outcomes. It can prolong hospital stay, augment the complication of therapy, decrease the ability to care oneself, reduce the compliance with medical treatment, lead to a poorer quality of life, and even shorten survival time. Pancreatic cancer is one of the most lethal malignancies. Despite recent advance in diagnosis and treatment, the overall survival rate remains low.Pancreatic cancer patients have not only distressing symptoms such as appetite loss, nausea, vomiting, weight loss, sleep disturbances and pain, but also psychiatric comorbidities such as adjustment disorder, depression frequently accompanying the disease process. It was reported that pancreatic cancer patients have the highest rate of major depression compared with other cancer patients. However, there is little study report about pancreatic cancer-related depression in China, although its incidence has been increasing steadily nowadays. Moreover, the report about relationship between pancreatic cancer-related depression and the quality of life has rarely been found.Therefore, we investigate and assess the patients with pancreatic cancer, liver cancer, esophageal cancer, gastric cancer, and colorectal cancer from four hospitals in Guangzhou by using HAMD-24, EORTC QLQ-C30 and EORTC QLQ-PAN26 respectively. This investigation aims to study the incidence of pancreatic cancer-related depression in China, and the relationship between symptom of pancreatic cancer-related depression and patients'quality of life, in order to enhance the recognition, diagnosis and treatment on pancreatic cancer-related depression.Methods262 inpatients with cancer of digestive system (50 patients with pancreatic cancer, 60 with liver cancer, 50 with esophageal cancer, 50 with gastric cancer, and 52 with colorectal cancer) from 4 Guangzhou hospitals between June 2007 and June 2009 were enrolled into the study. Hamilton Rating Scale for Depression-24 (HAMD-24) questionnaire was used to assess the degree of depression. Quality of Life (QoL) of all patients was evaluated by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30). EORTC QLQ-PAN-26 was used for evaluation in patients with pancreatic cancer additionally.Results(1)The incidence of depression among pancreatic cancer patients was 78.0%(39/50),which was significantly higher than that among liver cancer patients (60.0%,36/60), gastric cancer patients(36.0%, 18/50), esophageal cancer patients (24.0%, 12/50), and colorectal cancer patients(19.2%,10/52).(2)Twelve pancreatic cancer patients were reported severe depression(24.0%,12/50), which was significantly more than that with liver cancer (10.0%,6/60) and gastric cancer (4.0%,2/50). However, patients in esophageal cancer and colorectal cancer rarely suffered severe depression.(3)In pancreatic cancer patients, the incidence of depression was significantly higher by TNM stage(III+Ⅳ) than that by TNM stage (I+Ⅱ)( 94.3% vs 46.7%). More patients who were applied for chemotherapy sharply suffered depression than those were applied for operation(92.3% vs 62.5%). (4)Compared with other groups with depression, Quality of life of pancreatic cancer patients in each functioning scale was significantly worse, while the scores in symptom scales (fatigue and pain)were significantly higher. (5)The quality of life of pancreatic cancer patients with depression in role functioning,emotional functioning,social functioning, was significantly worse than that of patients without depression. The symptoms of fatigue, pain and appetite loss in cancer patients with depression were significantly more than those without depression.ConclusionsHigh incidence and severe degree of depressive symptoms can be observed in pancreatic cancer patients. Moreover, depression significantly lowers quality of life for pancreatic cancer patients.