Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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The Effects of Depression on the Survival of Terminal Cancer Patients in a Palliative Care Unit

완화병동에 입원한 말기 암 환자에서 우울증이 생존기간에 미치는 영향

  • Son, Ji-Sung (Department of Psychiatry, Inha University College of Medicine) ;
  • Kim, Won-Hyoung (Department of Psychiatry, Inha University College of Medicine) ;
  • Lee, Jeong-Seop (Department of Psychiatry, Inha University College of Medicine) ;
  • Kim, Hye-Young (Department of Psychiatry, Inha University College of Medicine) ;
  • Kang, Sang-Gu (Department of Psychiatry, Inha University College of Medicine) ;
  • Choi, Seo-Hyeon (Department of Psychiatry, Inha University College of Medicine) ;
  • Bae, Jae-Nam (Department of Psychiatry, Inha University College of Medicine)
  • 손지성 (인하대학교 의과대학 정신건강의학교실) ;
  • 김원형 (인하대학교 의과대학 정신건강의학교실) ;
  • 이정섭 (인하대학교 의과대학 정신건강의학교실) ;
  • 김혜영 (인하대학교 의과대학 정신건강의학교실) ;
  • 강상구 (인하대학교 의과대학 정신건강의학교실) ;
  • 최서현 (인하대학교 의과대학 정신건강의학교실) ;
  • 배재남 (인하대학교 의과대학 정신건강의학교실)
  • Received : 2019.08.16
  • Accepted : 2019.08.29
  • Published : 2019.12.31
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Abstract

Objectives : This study examined the association between depression and survival time in terminal cancer patients admitted to the palliative care unit. Emotional problems are important for terminal cancer patients in the palliative care unit, and evaluation of patients' depression plays an important role in treatment planning. Methods : From October 2015 to August 2018, we conducted a retrospective study of 291 terminal cancer patients admitted to a palliative care unit at a university hospital and evaluated depression with PHQ-9 at admission. Of the 291 patients, 146 (50.2%) completed PHQ-9 but 145 (49.8%) were not evaluated due to loss of consciousness or rejection. Results : 4-week survival rate in the Kaplan-Meier survival analysis were 45.4% in the non-depressed group (PHQ-9<10) and 18.7% in the depressed group (PHQ-9≥10). According to the severity of depression, in the Cox proportional hazard model, the risk of mortality in moderate, moderately sever and severe group was 2.778, 1.882 and 3.423 times higher than minimal group, respectively. Conclusions : Of the patients with terminal cancer who were admitted to the palliative care unit, the survival time was shorter in the depressed group than in the non-depressed group. Further research is needed to determine if treatment of depression increase the survival in terminal cancer patients.

연구목적 말기 암 환자에서 우울증이 암의 경과 및 예후와 관련성이 있다고 알려져 있으며, 암 환자의 생존율과도 부적 관련성이 보고된 바 있으나 국내에서는 연구가 부족한 실정이다. 본 연구에서는 완화 병동에 입원한 말기 암 환자에서 우울 증상과 생존율의 관련성을 분석하였다. 방 법 2015년 10월부터 2018년 8월까지 한 대학병원의 완화 병동에 입원한 291명을 대상으로 후향적 연구를 진행하였으며, 대상자는 혈액종양내과 전문의가 최종적으로 진단 확정한 2개월 미만의 예상 생존 기간을 가진 말기 암 환자로 하였다. 생존기간은 완화 병동에 입원 후부터 완화 병동에서 임종 시까지의 기간으로 하였으며, 3일 이내 사망하거나 일반 병실로 전실 및 다른 병원으로 전원을 간 환자는 제외하였다. 입원 시 Patient Health Questionnaire-9 (PHQ-9)으로 우울증을 평가했으며, 291명의 환자 중 146명(50.2 %)이 PHQ-9를 완료했으며, 145명(49.8 %)은 의식 저하 또는 환자의 거부로 인해 평가되지 않았다. 결 과 Kaplan-meier 생존 분석에서, 4주 생존율은 우울하지 않은 군(PHQ-9<10)에서 45.4%, 우울증 군(PHQ-9≥10)에서 18.7%였다. 우울증의 중증도에 따라 Cox 비례위험 모델에서, 중등도(moderate), 중증(moderately sever) 및 고도(severe)의 우울증 군의 사망 위험은 최소(minimal) 우울증 군보다 각각 2.778, 1.882 및 3.423배 높았다. 결 론 완화 병동에 입원한 말기 암 환자 중, 우울증이 있는 군에서 우울증이 없는 군보다 생존기간이 짧았다. 우울증 치료가 말기 암 환자의 생존율을 증가시키는지를 알기 위해 추가 연구가 필요하다

Keywords

References

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