Lung cancer is the leading cause of cancer-related death in men and women in the United States, and has a five-year survival rate of only 14 percent. Lung cancer is most prevalent in the 65-and-older population, and depression is not unusual in persons who have the disease.
“As many as half of all cancer patients experience depressive symptomatology that would qualify for clinical diagnosis,” says the study’s lead author, Margot E. Kurtz of the Department of Family and Community Medicine at Michigan State University. “Physical symptoms of the disease and declining physical abilities may cause depression and anxiety, which can begin with diagnosis and continue throughout treatment,” she says in the current issue of Psycho-Oncology.
Kurtz and colleagues at Michigan State University recruited 228 lung cancer patients age 65 or older from hospital surgical units, outpatient radiation units and medical cancer units. More than half (54 percent) of the patients had late-stage lung cancer, and the remainder had early-stage lung cancer. Sixty percent of the patients were male and 40 percent were female, and the participants’ average age was 72 years.
Information was gleaned from the patients’ medical records, and the patients were interviewed four times in one year. Each patient’s symptoms of depression, physical functioning, social functioning, physical symptoms of cancer and related conditions were assessed at each time point.
The number of the patients who were severely depressed declined over the course of the study from 39 percent in the first study phase to 31 percent after one year for men, and from 42 percent to 33 percent for women.
At each interview, the best predictors of serious depression were the severity of the patients’ cancer symptoms and the patients’ social functioning, although the significance of these predictors declined over time.
In addition, not receiving radiation therapy was identified as a good predictor of depression. Patients who had not received radiation therapy within 40 days of the interviews were more depressed than patients who had received radiation therapy within 40 days.
Based on the study results, the authors suggest that health care providers pay close attention to symptom management when treating cancer in older patients.
“Since the mental health of elderly patients appears to be inextricably tied to their symptom experience, symptom management must be a foremost concern of oncologists and other health care providers,” the authors conclude.
They also suggest that clinicians try to identify any psychosocial difficulties soon after diagnosis of lung cancer and take other steps such as giving information, reassuring patients and referring patients to other resources.
The study was funded by a grant from the National Institute for Nursing Research and the National Cancer Institute.
Psycho-Oncology is a bimonthly international journal devoted to the psychological, social and behavioral dimensions of cancer. Published by John Wiley, it is the official journal of the American, British and International Psycho-Oncology Societies. Contact Jimmie Holland, M.D., Co-Editor, at (212) 739-7051 for information.
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