정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
권호 표지
DOI QR코드

DOI QR Code

완화병동에 입원한 말기 암 환자에서 우울증이 생존기간에 미치는 영향

The Effects of Depression on the Survival of Terminal Cancer Patients in a Palliative Care Unit

  • 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)
  • 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)
  • 투고 : 2019.08.16
  • 심사 : 2019.08.29
  • 발행 : 2019.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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

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.

키워드

참고문헌

  1. McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry 1995;52:89-99. https://doi.org/10.1001/archpsyc.1995.03950140007002
  2. Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding. Palliat Med 2002;16:81-97. https://doi.org/10.1191/02169216302pm507oa
  3. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004;32:57-71. https://doi.org/10.1093/jncimonographs/lgh014
  4. Harrison J, Maguire P. Influence of age on psychological adjustment to cancer. Psycho-Oncology 1995;4:33-38. https://doi.org/10.1002/pon.2960040104
  5. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 2011;12:160-174. https://doi.org/10.1016/S1470-2045(11)70002-X
  6. Butler LD, Koopman C, Cordova MJ, Garlan RW, DiMiceli S, Spiegel D. Psychological distress and pain significantly increase before death in metastatic breast cancer patients. Psychosom Med 2003;65:416-426. https://doi.org/10.1097/01.PSY.0000041472.77692.C6
  7. Yun YH, Heo DS. Problems of terminal cancer patient's admission to a university hospital. J Korean Acad Fam Med 1996;17:294-304.
  8. Chaturvedi SK. Exploration of concerns and role of psychosocial intervention in palliative care--a study from India. Ann Acad Med Singapore 1994;23:256-260.
  9. Rabkin JG, McElhiney M, Moran P, Acree M, Folkman S. Depression, distress and positive mood in late-stage cancer: a longitudinal study. Psychooncology 2009;18:79-86. https://doi.org/10.1002/pon.1386
  10. Ha HK. Anxiety and depression of the hospitalized cancer patients. J Korean Neuropsychiatr Assoc 1982;21:665-674.
  11. Oh BH, Cho DY, Kim NK. The comparison of anxiety and depression between cancer patients and non-cancer medical patients. J Korean Neuropsychiatr Assoc 1986;25:121-131.
  12. Lee CY, Oh DW. Levels of anxiety and depression of the hospitalized cancer patients. J Korean Neuropsy chiatr Assoc 1990;29:178-187.
  13. Lee YJ, Kim CM, In YH, Lee DC, Seo SY, Seo AR. Association between spiritual well-being and pain, anxiety and depression in terminal cancer patients: a pilot study. Korean J Hosp Palliat Care. 2013;16:175-182. https://doi.org/10.14475/kjhpc.2013.16.3.175
  14. Kim SW, Lee SY, Kim JM. Depression in cancer patients. J Korean Soc Biol Psychiatry 2006;13:59-69.
  15. Johansen C. Psychosocial factors. In: Holland JC, Breitbart WS, Butow PN, Jacobsen PB, Loscalzo MJ, McCorkle R, editors. Psycho-oncology. New York: Oxford University Press; 2015. p.35-39.
  16. Meyer HA, Sinnott C, Seed PT. Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional. Palliat Med 2003;17:604-607. https://doi.org/10.1191/0269216303pm813oa
  17. Rieke K, Schmid KK, Lydiatt W, Houfek J, Boilesen E, Watanabe-Galloway S. Depression and survival in head and neck cancer patients. Oral Oncol 2017;65:76-82. https://doi.org/10.1016/j.oraloncology.2016.12.014
  18. Bortolato B, Hyphantis TN, Valpione S, Perini G, Maes M, Morris G, Kubera M, Kohler CA, Fernandes BS, Stubbs B, Pavlidis N, Carvalho AF. Depression in cancer: the many biobehavioral pathways driving tumor progression. Cancer Treat. Rev 2017;52:58-70 https://doi.org/10.1016/j.ctrv.2016.11.004
  19. Lawrie I, Lloyd-Williams M, Taylor F. How do palliative medicine physicians assess and manage depression. Palliative Medicine 2004;18:234-238. https://doi.org/10.1191/0269216304pm865oa
  20. Kim SY, Kim SW, Kim JM, Shin IS, Bae KY, Shim HJ, Bae WK, Cho SH, Chung IJ, Yoon JS. Differential Associations Between Delirium and Mortality According to Delirium Subtype and Age: A Prospective Cohort Study. Psychosom Med 2015;77:903-10. https://doi.org/10.1097/PSY.0000000000000239
  21. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  22. Park SJ, Choi HR, Choi JH, Kim KW, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety and Mood 2010;6:119-122.
  23. Moriarty AS, Gilbody S, McMillan D, Manea L. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. General Hospital Psychiatry 2015;37:567-576. https://doi.org/10.1016/j.genhosppsych.2015.06.012
  24. Anonymous. Obesity: preventing and managing the global epidemic. Report on a WHO Consultation on Obesity. Geneva: World Health Organization;2000.
  25. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  26. Huang YQ, Gou R, Diao YS, Yin QH, Fan WX, Liang YP, Chen Y, Wu M, Zang L, Li L, Zang J, Cheng L, Fu P, Liu F. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2014;15:58-66. https://doi.org/10.1631/jzus.B1300109
  27. Jung KW, Won YJ, Kong HJ, Lee ES. Prediction of cancer incidence and mortality in Korea, 2019. Journal of Korean Cancer Association 2019;51:431-437.
  28. Cook MB, McGlynn KA, Devesa SS, Freedman ND, Anderson WF. Sex disparities in cancer mortality and survival. Cancer Epidemiol Biomarkers Prev 2011;20:1629-1637. https://doi.org/10.1158/1055-9965.EPI-11-0246
  29. Machin D, Campbell MJ, Tan SB, Tan SH. Sample size tables for clinical studies. 3rd ed, Chichester: Wiley-Blackwell; 2009.