Evaluating depression in elderly patients with cancer

Abstract

Background: Depression is one of the most common psychiatric disorders in elderly people, especially among oncologic patients, yet it often goes unrecognized. Performing a comprehensive geriatric assessment (CGA) is recommended to identify medical, psychosocial, and functional limitations of a frail older person. The aim of the present study was to assess associations between depressive symptoms and other variables of CGA in a population of elderly oncologic patients. Patients andmethods:We considered all patients who underwent a CGA in the Geriatric Clinic of Trieste Maggiore Hospital over 2 years on request of the oncologist. We registered age, sex, cancer type and evaluated functional, cognitive, nutritional, comorbidity and affective status respectively through ADL (Activities of Daily Living), IADL (Instrumental Activities of Daily Living),MNA (Mini Nutritional Assessment), CIRS (Cumulative Illness Rating Scale), MMSE (Mini Mental State Examination) and GDS (Geriatric Depression Scale). First we identified associations between the presence of depressive symptoms (i.e. GDS>5) and CGA variables through Wilcoxon's non parametric test; then we used a generalized linear model to test independence. Finally we evaluated the ability of two screening tools that are commonly used to detect frailty among elderly oncologic patients to identify depressive symptoms (G8 screening tool and Vulnerable Elderly Survey 13). Results: 147 patients completed CGA. Of these 39 (26.5%) had significant depressive symptoms. Worse functional, nutritional, cognitive and comorbidity status was significantly associated (p<0.05) with depressed mood, but only nutritional status was an independent predictor. G8 screening tool and VES 13 had a sensitivity and specificity respectively of 92, 22% and 54, 72%. Conclusions: Our study confirmed that among elderly patients with cancer depression is associated with cognitive, nutritional and functional decline and greater comorbidity burden. The significant association with MNA highlights the vicious circle between malnutrition and depression. Given its high sensitivity, G8 screening tool could be a useful instrument to identify as soon as possible this condition with use of specific assessment scales.