TY  - JOUR
PY  - 2019//
TI  - Depressive symptom profiles and survival in older patients with cancer: latent class analysis of the ELCAPA Cohort Study
JO  - Oncologist, The
A1  - Gouraud, Clément
A1  - Paillaud, Elena
A1  - Martinez-Tapia, Claudia
A1  - Segaux, Lauriane
A1  - Reinald, Nicoleta
A1  - Laurent, Marie
A1  - Corsin, Lola
A1  - Hoertel, Nicolas
A1  - Gisselbrecht, Mathilde
A1  - Mercadier, Elise
A1  - Boudou-Rouquette, Pascaline
A1  - Chahwakilian, Anne
A1  - Bastuji-Garin, Sylvie
A1  - Limosin, Frederic
A1  - Lemogne, Cédric
A1  - Canouï-Poitrine, Florence
SP  - e458
EP  - e466
VL  - 24
IS  - 7
N2  - BACKGROUND: The expression of depressive symptoms in older people with cancer is heterogeneous because of specific features of age or cancer comorbidity. We aimed to identify depressive symptom profiles in this population and describe the associated features including survival. <br><br>MATERIALS AND METHODS: Patients ≥70 years who were referred to geriatric oncology clinics were prospectively included in the ELCAPA study. In this subanalysis, depressive symptoms were used as indicators in a latent class analysis. Multinomial multivariable logistic regression and Cox models examined the association of each class with baseline characteristics and mortality. <br><br>RESULTS: For the 847 complete-case patients included (median age, 79 years; interquartile range, 76-84; women, 47.9%), we identified five depressive symptom classes: "no depression/somatic only" (38.8%), "no depression/pauci-symptomatic" (26.4%), "severe depression" (20%), "mild depression" (11.8%), and "demoralization" (3%). Compared with the no depression/pauci-symptomatic class, the no depression/somatic only and severe depression classes were characterized by more frequent comorbidities with poorer functional status and higher levels of inflammation. "Severe" and "mild" depression classes also featured poorer nutritional status, more medications, and more frequent falls. Severe depression was associated with poor social support, inpatient status, and increased risk of mortality at 1 year (adjusted hazard ratio, 1.62, 95% confidence interval, 1.06-2.48) and 3 years (adjusted hazard ratio, 1.49; 95% confidence interval, 1.06-2.10). <br><br>CONCLUSION: A data-driven approach based on depressive symptoms identified five different depressive symptom profiles, including demoralization, in older patients with cancer. Severe depression was independently and substantially associated with poor survival. IMPLICATIONS FOR PRACTICE: Older patients with cancer present with distinct profiles of depressive symptomatology, including different severity levels of depression and the demoralization syndrome. Clinicians should use a systematic assessment of depressive symptoms to adequately highlight these distinct profiles. Geriatric and oncological features are differently associated with these profiles. For instance, severe depression was associated with more frequent comorbidities with poorer functional, poor nutritional status, polypharmacy, frequent falls, inpatient status and poor social support. Also, severe depression was independently and substantially associated with poor survival so that the identification and management of depression should be considered a high priority in this population.<br><br>© AlphaMed Press 2018.<p />  <p>Language: en</p>
LA  - en
SN  - 1083-7159
UR  - http://dx.doi.org/10.1634/theoncologist.2018-0322
ID  - ref1
ER  -