Depression in patients with lung cancer: Prevalence and risk factors derived from quality-of-life data

purpose: To evaluate self-reported depression rates in patients with inoper able lung cancer and to explore demographic, clinical, and quality-of-life (QOL) factors associated with depression and thus identify patients at risk . patients and Methods: Nine hundred eighty-seven patients from three palliat ive treatment trials conducted by the Medical Research Council Lung Cancer Working Party formed the study sample. 526 patients (53%) had poor prognosi s small-cell lung cancer (SCLC) and 461 patients (47%) held good prognosis non-small-cell lung cancer (NSCLC), Hospital Anxiety and Depression Scale d ata and QOL items from the Rotterdam Symptom Checklist were analyzed, toget her with relevant demographic and clinical factors. Results: Depression was self-rated in 322 patients (33%) before treatment a nd persisted in more than 50% of patients, SCLC patients had a three-fold g reater prevalence of case depression than those with NSCLC (25% v 9%; P < . 0001). An increased rate for women was found for good performance status (9 5) patients (PS of 0 or 1) but the sex difference reduced for poor PS patie nts (PS of 3 or 4) because of increased depression rates for men (chi(2) fo r trend, P < .0001). Multivariate analysis showed that functional impairmen t was the most important risk factor; depression increased by 41% for each increment on the impairment scale. Pretreatment physical symptom burden, fa tigue, and clinician-rated PS were also independent predictors, but cell ty pe wets not. Conclusion: Depression is common and persistent in lung cancer patients, es pecially those with more severe symptoms or functional limitations. Psychol ogic screening and appropriate intervention is an essential part of palliat ive care. (C) 2000 by American Society of Clinical Oncology.