Depression, immunity, and survival in patients with hepatobiliary carcinoma. J Clin Oncol 2007 Jun 10;25(17):2397-405
Date
06/15/2007Pubmed ID
17557953DOI
10.1200/JCO.2006.06.4592Scopus ID
2-s2.0-34347239328 (requires institutional sign-in at Scopus site) 131 CitationsAbstract
PURPOSE: The aims of the present study were to assess the prevalence of depressive symptoms at diagnosis, test the association between depressive symptoms and survival, and preliminarily test a mediational model of depression, immunity, and survival in patients with hepatobiliary carcinoma (HBC).
PATIENTS AND METHODS: One hundred one patients diagnosed with HBC were prospectively studied. Depressive symptoms were measured at diagnosis using the Center for Epidemiological Studies Depression Scale (CES-D). Sociodemographic and disease-specific data were gathered from the patients' charts. In a subsample of patients, stress; alcohol, tobacco, and drug use; sleep quality; physical activity; social support; natural killer (NK) cell number and cytotoxicity; and plasma levels of interleukin (IL) -4, IL-5, tumor necrosis factor alpha, and interferon gamma were measured. Survival was measured from date of diagnosis to death.
RESULTS: At diagnosis, 37% of patients reported a CES-D score of > or = 16 (clinical range). Using Cox regression analysis, sociodemographic and disease-specific variables and CES-D score significantly predicted survival (Breslow chi2 = 32.4, P = .006). Only vascular invasion (P = .001) and CES-D score > or = 16 (P = .03) were significant predictors. In a subsample of 23 patients, patients who reported a CES-D score of > or = 16 were found to have significantly lower NK cell numbers than patients who reported a CES-D score of less than 16 (F1,21 = 9.39, P = .003). A robust trend was found in which NK cell number was associated with survival. A mediational model linking depressive symptoms and survival, with NK cell number as a mediator, was preliminarily supported.
CONCLUSION: Secondary to the high prevalence of depressive symptoms and impact on survival, psychological and pharmacologic interventions should be designed and implemented in patients diagnosed with HBC.
Author List
Steel JL, Geller DA, Gamblin TC, Olek MC, Carr BIAuthor
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Biliary Tract Neoplasms
Cytokines
Depression
Enzyme-Linked Immunosorbent Assay
Female
Humans
Killer Cells, Natural
Liver Neoplasms
Male
Middle Aged
Prevalence
Survival Analysis
