(ChemotherapyAdvisor) – In patients with newly diagnosed metastatic non–small-cell lung cancer (NSCLC), the presence of depression predicted worse survival; however, “the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from early palliative care,” investigators reported in the Journal of Clinical Oncology online March 19.
“Nonetheless, a key finding in this analysis is that depression is clearly treatable in patients with metastatic NSCLC,” Pirl et al. from Massachusetts General Hospital Cancer Center, Boston, MA, noted. Previously, they observed in a randomized trial that early palliative care integrated with standard oncology care improved survival in patients (n=77) vs. those who received standard oncology care alone (n=74).
In a secondary analysis, they explored the hypothesis that this survival benefit resulted from improving depression, assessing depression at baseline and 12 weeks with the Patient Health Questionnaire-9 (PHQ-9), which was scored using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome. Depression response was considered ≥50% reduction in PHQ-9 scores at 12 weeks.
At baseline, 21 patients (14%) met the criteria for major depression syndrome, which significantly predicted worse survival (HR, 1.82; P=0.02). Those randomized to receive early palliative care had greater improvements in PHQ-9 scores at 12 weeks (P<0.001) and, among patients with major depression syndrome, greater rates of depression response at 12 weeks (P=0.04). However, improvement in PHQ-9 scores was not associated with improved survival.
“Although survival might be considered the ultimate end point in oncology, depression is a disabling illness associated with suffering and poor quality of life that warrants intervention regardless of the potential impact on survival. Early palliative care might represent another option for its treatment,” they noted.
Future studies should include repeated assessments of depression within the first 12 weeks. “Because 18% of these newly diagnosed patients will not be alive by 12 weeks, determining the trajectory of their depressive symptoms is critical.”