Depression—A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer
Open accessAbstract
Context Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies.Objectives To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden.Methods A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models.Results Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 β = -0.12, P = 0.003; mGPS = 2 β = -0.09, P = 0.023), lower physical performance (β = 0.17, P < 0.001), reduced appetite (β = -0.15, P < 0.001), breathlessness (β = -0.11, P = 0.004), pain (β = -0.14, P = 0.002), and higher depression severity (β = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance.Conclusion Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.
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These factors can have negative consequences for the disease course, including increased frequency and duration of hospital stays, lower adherence to treatment recommendations, difficulties coping, reduced quality of life, and increased mortality.
“These factors can have negative consequences for the disease course, including an increase in the frequency and duration of hospital stays, lower adherence to treatment recommendations, difficulties in coping with the disease, reduced quality of life and an increase in mortality [9–14].”
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- Authors
- Grotmol, K. S., Lie, H. C., Hjermstad, M. J., Aass, N., Currow, D., Kaasa, S., Moum, T. Å., Pigni, A., & Loge, J. H.
- Affiliations
- Oslo University Hospital (NO)
- Flinders University (AU)
- University of Oslo (NO)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Corresponding author
- Grotmol, Kjersti S.
- ORCID
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 54
- Issue
- 6
- Pages
- 889-897
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W2744976423
- Cited by
- 53
- References
- 40
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 6
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (publishedVersion)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion)
- Funders
- European Commission's Sixth Framework Programme (LSHC-CT-2006-037777)
- Norwegian Cancer Society (171874 - PR-2009–0319)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- depression, quality of life, advanced cancer, depression severity, prognostic factors, systemic inflammation, Karnofsky performance status, symptom burden, pain, dyspnea, appetite loss, palliative care, patient-reported outcomes, EORTC QLQ-C30, PHQ-9, Edmonton Symptom Assessment System, Brief Pain Inventory, metastatic cancer, psychosocial factors
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Pain, Prognosis, Psychiatric Status Rating Scales, Quality of Life, Severity of Illness Index, Comorbidity, Cost of Illness, Karnofsky Performance Status, Young Adult
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