医学
萧条(经济学)
内科学
癌症
荟萃分析
相对风险
心理信息
置信区间
疾病
奇纳
肿瘤科
梅德林
精神科
心理干预
政治学
法学
经济
宏观经济学
作者
Jillian R. Satin,Wolfgang Linden,Melanie Laverdiere
出处
期刊:Cancer
[Wiley]
日期:2009-09-14
卷期号:115 (22): 5349-5361
被引量:849
摘要
Abstract BACKGROUND: Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta‐analysis assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients. METHODS: Using the MEDLINE, PsycINFO, CINAHL, and EMBASE online databases, the authors identified prospective studies that examined the association between depressive symptoms or major/minor depression and risk of disease progression or mortality in cancer patients. Two raters independently extracted effect sizes using a random effects model. RESULTS: Based on 3 available studies, depressive symptoms were not shown to significantly predict cancer progression (risk ratio [RR] unadjusted = 1.23; 95% confidence interval [CI], 0.85‐1.77; P = .28). Based on data from 25 independent studies, mortality rates were up to 25% higher in patients experiencing depressive symptoms (RR unadjusted = 1.25; 95% CI, 1.12‐1.40; P < .001), and up to 39% higher in patients diagnosed with major or minor depression (RR unadjusted = 1.39; 95% CI, 1.10‐1.89; P = .03). In support of a causal interpretation of results, there was no evidence that adjusting for known clinical prognostic factors diminished the effect of depression on mortality in cancer patients. CONCLUSIONS: This meta‐analysis presented reasonable evidence that depression predicts mortality, but not progression, in cancer patients. The associated risk was statistically significant but relatively small. The effect of depression remains after adjustment for clinical prognosticators, suggesting that depression may play a causal role. Recommendations were made for future research to more clearly examine the effect of depression on cancer outcomes. Cancer 2009. © 2009 American Cancer Society.
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