Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer

Abstract

Background

Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC).

Methods

This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard.

Results

Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=−0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively).

Conclusion

The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.

Keywords:

• depression
• elderly
• cancer
• screening
• geriatric assessment

Acknowledgments

The authors acknowledge Douglas Micheau-Bonnier, Nicolas Gane, and Bénédicte Votan from the GINECO study office, the Délégation à la Recherche Clinique et à l’Innovation of the Hospices Civils de Lyon and Raymonde Maraval-Gaget. We also thank the following investigators and psychologists who participated in the trial: Drs B Weber, MC Kaminsky, and E Luporsi (Centre Alexis Vautrin-Brabois, Vandoeuvre-lès-Nancy), Prof H Curé, Drs AM Savoye and G Yazbek (Institut Jean Godinot, Reims), Drs I Ray-Coquard, JP Guastalla, and O Tredan (Centre Léon Bérard, Lyon), Dr E Sevin (Centre François Baclesse, Caen), Drs L Stefani and J Provençal (Centre Hospitalier de la région d’Annecy, Pringy), Drs S Kalla, F Savinelli, and G Deplanque (Groupe Hospitalier Saint-Joseph, Paris), Drs M Combe and M Atlassi (Centre Hospitalier du Mans, Le Mans), Dr J Salvat (Hôpitaux du Léman, Thonon-les-Bains), Profs E Pujade-Lauraine and J Alexandre, and Drs L Chauvenet and JM Tigaud (Hôpital Hôtel-Dieu, Paris), Dr J Meunier and D Bosquet (Centre Hospitalier Régional d’Orléans, Orléans), Dr J Cretin and E Roux (Clinique Bonnefon, Alès), Dr M Fabbro and P Champoiral (Institut du Cancer de Montpellier, Montpellier), Dr MN Certain and M Gillon (Centre Hospitalier d’Auxerre, Auxerre), Drs E Legouffe and M Armand (Clinique de Valdegour, Nîmes), Mrs I Gourmoud (Hôpital d’Instruction des Armées Sainte-Anne, Toulon), Drs C Ligeza-Poisson and P Deguiral, A Harel (Clinique Mutualiste de l’Estuaire, Saint-Nazaire), Dr C Tep and K Pietrain (Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon), Dr F Rousseau and P Bensoussan (Institut Paoli Calmettes, Marseille), N Darchy (Hôpital Perpétuel Secours, Levallois-Perret), and G Marini (Centre Azuréen de Cancérologie, Mougins).

This work was supported by research grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2006, 27–39) and La Fondation de France (grant #2006010589).

This work was presented as a poster at the 48th Annual Meeting of the American Society of Clinical Oncology, June 1–5, 2012.

Disclosure

The authors report no conflicts of interest in this work.

Supplementary material

Figure S1 Kaplan–Meier estimates of overall survival according to the presence or the absence of depression using DSM criteria.

Abbreviation: DSM, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised.