Depression among older adults with gastrointestinal (GI) malignancies: Results from the Cancer and Aging Resilience Evaluation (CARE) registry.

Abstract

92 Background: Depression among older adults with cancer is often under recognized and under treated. This study characterizes the burden of depression in older adults with GI malignancies and its relationship with geriatric assessment (GA) impairments, health-related quality of life (HRQOL), and healthcare utilization. Methods: Since September 2017, patients ≥60 years in GI oncology clinics at UAB were asked to complete a CARE GA questionnaire. We examined depression using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression 4 item short form; moderate/severe (mod/sev) depression was defined by a T-score ≥60. GA impairments, HRQOL (PROMIS Global-10), and healthcare utilization were compared between those with and without mod/sev depression using a Chi-squared or t-test. Results: A total of 462 enrolled; mean age was 69 (range 60-96), majority white (72%), males (52%), and with advanced stage (III/IV, 69.1%). Most common cancers were colorectal (36%), pancreatic (23%), or hepatobiliary (15%). Overall, 55 patients reported mild depressive symptoms (12%) and 60 (13%) were found to have mod/sev depression. Depressed participants did not differ in demographics or GI cancer type/stage. Those reporting mod/sev depression were more likely to report falls (44 v 19%, p<.001), impaired performance status (63 v 27%, p<.001), dependence in activities of daily living (ADL; 45 v 14%, p<.001), dependence in instrumental ADL (84 v 45%, p<.001), cognitive dysfunction (40 v 5%, p<.001), financial distress (37 v 23%, p=.03), anxiety (76 v 10%, p<.001), fatigue (88 v 54%, p<.001), and pain (70 v 32%, p<.001). Depressed patients reported lower physical (32 v 45%, p<.001) and mental (36 v 50%, p<.001) HRQOL sub-scores, as well as more emergency room visits (67 v 49%, p=.009), but no difference in hospitalizations. Conclusions: More than one out of eight older adults with a GI malignancy reported mod/sev depression, which was associated with impairment in several geriatric domains and overall quality of life. As depression is a pleiotropic yet treatable comorbidity, oncologists should prioritize its screening and treatment.