Depressive Symptom Profiles and Survival in Older Patients with Cancer: Latent Class Analysis of the ELCAPA Cohort Study

Abstract

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.

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.

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).

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.

Keywords: Cancer; Cluster; Depression; Epidemiology; Old age; Psycho‐oncology.

Figure 1.

Flow of participants in the study. Describes the flow of participants and the sample size for each step included in the study, classification sample, and analysis sample.

Figure 2.

Symptom profiles for the 5 classes: conditional probabilities of presenting each indicator for a specific class (n = 847). Presents the conditional probabilities of presenting each indicator for the 5 identified classes: Class 1 no depression/somatic only, class 2 no depression/pauci‐symptomatic, class 3 severe depression, class 4 mild depression, and class 5 demoralization.Abbreviation: Cl, class.

Figure 3.

Kaplan‐Meier plots of overall 3‐year survival for each of the 5 classes. Presents the Kaplan‐Meier survival curves of overall 3‐year survival for each of the 5 classes and the numbers at risk for each class. The severe depression class shows lower survival. *p value for unadjusted log‐rank test.