Depression and anxiety by decade in older adults with cancer

Abstract

Background: Depression and anxiety are common psychological sequelae of cancer, resulting in decreased adherence to treatment regimens and longer hospital stays. In men with prostate cancer, aging is associated with reduced anxiety and increased depression. The overall goal of this study was to examine the association among age, anxiety, and depression in a cohort of older adults receiving chemotherapy (chemo). Methods: This is a secondary analysis of a prospective longitudinal study investigating chemotherapy toxicity in older adults with cancer. Eligibility included: age > 65, diagnosis of cancer, and scheduled to receive a new chemo regimen. Data (pre-chemotherapy) included: age, sociodemographics, tumor and treatment factors (including tumor type and stage), geriatric assessment parameters (functional status, comorbidities, psychological state, nutritional status, social support). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Univariate and multiple regression analyses were conducted to test the relationship between age, anxiety, and depression. Results: The average age of the 500 patients (56% females) was 73.1 (range 65-91, SD+6.18) with 5% Stage I, 12% Stage II, 22% Stage III and 61% stage IV. Mean depression and anxiety scores were: 3.6+3.17; 4.7+3.60. Clinically significant depression was reported in 12.6% (n=62). Clinically significant anxiety was reported in 20.9% (n=103). In univariate analyses, there was no association between anxiety and age, or depression and age. In multivariable analyses, older age (beta= -0.07, p = 0.05) was associated with decreased anxiety, as well as lack of social support (p < 0.01) and increased number of comorbidities (p < 0.01). In multivariable analysis, depression was associated with lack of social support (p < 0.01), increased number of comorbidities (p < 0.01), and advanced stage (p < 0.01). Conclusions: This study supports previous research that anxiety decreases with age in older adults with cancer. However, depression remained constant with increasing age. Greater resources and attention to identifying and treating the psychological sequelae of cancer in older adults are warranted.