Longitudinal Study of Depressive Symptoms in Patients With Metastatic Gastrointestinal and Lung Cancer
Abstract
Purpose: Although early intervention is increasingly advocated to prevent and relieve distress in patients with metastatic cancer, the risk factors for such symptoms and their trajectory are not well established. We therefore conducted a longitudinal study to determine the course and predictors of depressive symptoms. Patients and Methods: Patients (N = 365) with metastatic gastrointestinal or lung cancer completed measures of physical distress, self-esteem, attachment security, spiritual well-being, social support, hopelessness, and depression at baseline; physical distress, social support, hopelessness, and depression were subsequently assessed at 2-month intervals. Results: Of the sample, 35% reported at least mild depressive symptoms, with 16% reporting moderate to severe depressive symptoms that persisted in at least one third of such individuals. Moderate to severe depressive symptoms were almost three times more common in the final 3 months of life than ≥ 1 year before death. Predictors of depressive symptoms included younger age, antidepressant use at baseline, lower self-esteem and spiritual well-being, and greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. The combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression. Conclusion: Depressive symptoms in advanced cancer patients are relatively common and may arise as a final common pathway of distress in response to psychosocial vulnerabilities, physical suffering, and proximity to death. These findings support the need for an integrated approach to address emotional and physical distress in this population and to determine whether early intervention may prevent depression at the end of life.
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Emotional disturbances are common in patients with advanced or metastatic cancer, with anxiety peaking at diagnosis and recurrence and depression becoming more common with disease progression and proximity to death.
“Emotional disturbances are common in patients with advanced or metastatic cancer, with anxiety peaking at the time of diagnosis and again at recurrence and with depression becoming more common with disease progression and proximity to death. 1,2”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [2]
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“4 INTRODUCTION Emotional disturbances are common in patients with advanced or metastatic cancer, with anxiety peaking at the time of diagnosis and again at recurrence and with depression becoming more common with disease progression and proximity to death.(1,2) Depression in this context may be considered a final comm…”
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- Authors
- Lo, C., Zimmermann, C., Rydall, A., Walsh, A., Jones, J. M., Moore, M. J., Shepherd, F. A., Gagliese, L., & Rodin, G.
- Affiliations
- University Health Network (CA)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2010-06-20
- Volume
- 28
- Issue
- 18
- Pages
- 3084-3089
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2127896588
- Cited by
- 228
- References
- 48
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 15 · 2021: 24 · 2020: 16 · 2019: 15 · 2018: 17 · 2017: 13 · 2016: 12 · 2015: 13 · 2014: 18 · 2013: 18 · 2012: 20
- FWCI
- 9.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (/MOP-62861)
- 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
- depressive symptoms, metastatic cancer, gastrointestinal cancer, lung cancer, end-of-life care, physical distress, hopelessness, attachment security, self-esteem, spiritual well-being, social support, antidepressant use, proximity to death, psychosocial vulnerability, predictors of depression
- MeSH terms
- Adult, Aged, Aged, 80 and over, Attitude to Death, Attitude to Health, Cross-Sectional Studies, Depressive Disorder, Female, Gastrointestinal Neoplasms, Humans, Longitudinal Studies, Lung Neoplasms, Male, Middle Aged, Neoplasm Metastasis, Quality of Life, Risk Factors, Self Concept, Social Support, Survival Rate, Spirituality, Young Adult
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