Risk Factors For Depression And Efficacy Of Comprehensive Care In Advanced Lung Cancer Patients With Chemotherapy

Objective: To clarify the risk factors for depression in advanced lung cancer (LC) patients who undewent chemotherapy, and to explore the effectiveness of tailored comprehensive care programs in improving depression and quality of life of such patients. Methods: In Phase I of our study, from December 2014 to November 2015, 148 patients with advanced LC who underwent chemotherapy were recruited as participants. The patients completed the questionnaires with the Zung Self-Rating Depression Scale (SDS). The enrolled patients were subdivided into the case group and the control group in terms of the presence/absence of depression. A case-control analysis was conducted for investigation of the risk factors for depression in advanced lung cancer LC patients undergoing chemotherapy. In Phase II of our study, a randomized controlled trial was designed. Between December 2015 to November 2016, 140 patients with advanced LC who underwent chemotherapy admitted to our hospital were enrolled and randomly assigned to receive comprehensive care (comprehensive care group) or usual care (usual care group) according to previously identified risk factors for depression. Subsequently, the effectiveness of comprehensive care on depression and quality of life were assessed among the patients. Results: In our study, the incidence of depression was 54.7% in patients with advanced LC who underwent chemotherapy. On the univariate analysis, age, women, education and household income levels, course of disease and pain might be associated with depression in patients with advanced LC who underwent chemotherapy. Furthermore, a multivariate logistic regression analysis revealed that an age of older than 65 years, disease course of less than 6 months, the KPS score of less than 90 and pain were independent risk factors for depression in patients with advanced lung cancer who underwent chemotherapy, with adjusted OR of 1.79 (95% CI: 1.20-2.31), 1.26 (95% CI: 1.03-1.42), 1.90 (95% CI: 1.22-2.47) and 2.14 (95% CI: 1.49-3.18). Compared with the usual care group, the comprehensive care group had greater improvements in the SDS scores and the EORTCQLQ-C scores (except for the scores for several components of the quality of life, all P<0.05). Conclusion: Older age, shorter course of disease, a lower KPS score and pain were independent risk factors for depression in advanced LC patients undergoing chemotherapy. Compared with conventional care, comprehensive psychological care improved the depressive symptoms of the patients and enhanced their quality of life.