Prevalence and correlation of anxiety and depression on the prognosis of postoperative non-small-cell lung cancer patients in North China

Abstract

Identify the prevalence of postoperative anxiety and depression as well as their correlations with clinical features and survival profiles in non-small-cell lung cancer (NSCLC) patients who underwent resection.Four hundred NSCLC patients who underwent resection were recruited, and their anxiety and depression were assessed by hospital anxiety and depression scale (HADS) at discharge after surgery. Besides, 480 healthy controls (HCs) were also enrolled and assessed by HADS.The HADS-Anxiety score of NSCLC patients (7.8 ± 3.9) was greatly higher than that of HCs (4.8 ± 2.7), and the anxiety prevalence of NSCLC patients (49.6%) were dramatically increased compared with HCs (13.8%). Furthermore, the HADS-Depression score (7.2 ± 3.6) of NSCLC patients was considerably increased compared with HCs (4.2 ± 2.6), and the depression prevalence of NSCLC patients (38.3%) was significantly raised compared with HCs (10.0%). Besides, anxiety correlated with gender, marital status, hypertension, diabetes, pathological differentiation, tumor size, lymph node metastasis, TNM stage and carcinoembryonic antigen level, meanwhile, depression correlated with marital status, employment status before surgery, diabetes, pathological differentiation, and TNM stage in NSCLC patients. Additionally, the anxiety and depression predicted shorter disease-free survival in NSCLC patients. And the anxiety predicted worse overall survival (OS), while no association of depression with OS was observed in NSCLC patients.Post-operative anxiety and depression are highly prevalent and implicated in the ongoing care and prognosis prediction in NSCLC patients who underwent resection.

Figure 1

Study flow. NSCLC, non-small-cell lung cancer.

Figure 2

HADS-A score, anxiety rate and severity in NSCLC patients and HCs. Comparisons of HADS-A score (A), anxiety rate (B) and anxiety severity (C) between NSCLC patients and HCs. Comparison of HADS-A score between NSCLC patients and HCs was assessed by Student t test, and comparison of anxiety rate between NSCLC patients and HCs was performed by Chi-Squared test. Furthermore, comparison of anxiety severity was evaluated by Wilcoxon rank sum test. P value < .05 was considered significant. HADS-A, hospital anxiety and depression scale-anxiety; NSCLC, non-small-cell lung cancer; HC, healthy controls.

Figure 3

HADS-D score, depression rate and severity in NSCLC patients and HCs. Comparisons of HADS-D score (A), depression rate (B) and depression severity (C) between NSCLC patients and HCs. Comparison of HADS-D score between NSCLC patients and HCs was assessed by Student t test. As for depression rate, its comparison between NSCLC patients and HCs was conducted by Chi-Squared test. Besides, comparison of depression severity was analyzed by Wilcoxon rank sum test. P value < .05 was considered significant. HADS-D, hospital anxiety and depression scale-depression; NSCLC, non-small-cell lung cancer; HC, healthy controls.

Figure 4

Differences of DFS between anxiety vs non-anxiety, depression vs nondepression NSCLC patients. Comparison of DFS between NSCLC patients with and without anxiety (A). Comparison of DFS between NSCLC patients with and without depression (B). DFS was displayed with Kaplan–Meier curve, and comparisons of DFS between anxiety vs nonanxiety, depression vs nondepression NSCLC patients were determined by log-rank test. P value < .05 was considered significant. DFS, disease-free survival; NSCLC, non-small-cell lung cancer.

Figure 5

Differences of OS between anxiety vs non-anxiety, depression vs nondepression NSCLC patients. Comparison of OS between NSCLC patients with and without anxiety (A). Comparison of OS between NSCLC patients with and without depression (B). OS was shown by Kaplan–Meier curve, and comparisons of OS between anxiety vs non-anxiety, depression vs nondepression NSCLC patients were examined by log-rank test. P value < .05 was considered significant. OS, overall survival; NSCLC, non-small-cell lung cancer.