Effects of depression on parameters of cell-mediated immunity in patients with digestive tract cancers

AIM:To evaluate the effects of depression on parameters of cell-mediated immunity in patients with cancers of the digestive tract.METHODS:One hundred and eight adult patients of both sexes with cancers of the digestive tract admitted between March 2001 and February 2002 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. The Zung self-rating depression scale (SDS),Zung self-rating anxiety scale(SAS),numeric rating scale (NRS) and social support rating scale (SSRS) were employed to evaluate the degree of depression and their contributing factors.In terms of their SDS index scores,the patients were categorized into depression group (SDS≥50) and non-depression group(SDS<50).Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared between the two groups of patients.RESULTS:The SDS index was from 33.8 to 66.2 in the 108 cases,50% of these patients had a SDS index more than 50.Similarly,the SAS index of all the patients ranged from 35.0 to 62.0 and 46.3% of the cases had a SAS index above 50.Cubic curve estimation showed that the depression was positively correlated with anxiety and negatively with social support.Furthermore,the depression correlated with the tumor type,which manifested in a descending order as stomach,gallbladder, pancreas,intestine， esophagus,duodenum and rectum,according to their correlativity. Stepwise regression analysis suggested that hyposexuality,dispiritment,agitation,palpitation, low CD56 and anxiety were the significant factors contributing to depression.More severe anxiety (49.7±7.5 vs 45.3±6.9,P<0.05), pain (6.5±2.8 vs 4.6±3.2,P<0.05), poor social support (6.8±2.0vs 7.6±2.1,P<0.05),as well as decline of lymphocyte count (0.33±0.09vs 0.39±0.87, P<0.05) and CD56 (0.26±0.11 vs 0.29±0.11,P<0.05) were noted in the depression group compared with those of the non-depression patients. However,fewer obvious changes in CD4/CD8 ratio and other immunological parameters were found between the two groups.CONCLUSION:Depression occurs with a high incidence in patients with cancers of the digestive tract,which probably is not bhe sole factor leading to bhe impairment of immunological functions in these cases. However, comprehensive measures including psychological support should be taken in order to improve the immunological function,quality of life and clinical prognosis of these patients.

Impact of comorbid anxiety and depression on quality of life and cellular immunity changes in patients with digestive tract cancers

AIM: A study was performed to investigate the impact of comorbid anxiety and depression (CAD) on quality of life (QOL) and cellular immunity changes in patients with digestive tract cancers.METHODS: One hundred and fifty-six cases of both sexes with cancers of the digestive tract admitted between March 2001 and February 2004 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-Ⅳ. All adult patients were evaluated with the Hamilton depressive scale (HAMD, the 24-item version), the Hamilton anxiety scale (HAMA, a modified 14-item version), quality of life questionnaire-core 30 (QLQ-C30), social support rating scale (SSRS), simple coping style questionnaire (SCSQ), and other questionnaires, respectively. In terms of HAMD ≥ 20 and HAMA ≥ 14, the patients were categorized, including CAD (n = 31) in group A, anxiety disorder (n = 23) in group B,depressive disorder (n = 37) in group C, and non-disorder (n = 65) in group D. Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared among the four groups.RESULTS: The incidence of CAD was 21.15% in patients with digestive tract cancers. The average scores of social support was 43.67±7.05 for 156 cases, active coping 20.34±7.33, and passive coping 9.55±5.51. Compared with group D, subjective support was enhanced slightly in group A, but social support, objective support, and utilization of support reduced, especially utilization of support with significance (6.16 vs 7.80, P＜0.05); total scores of active coping decreased, while passive coping reversed; granulocytes proliferated, monocytes declined,and lymphocytes declined significantly (32.87 vs 34.00,P＜0.05); moreover, the percentage of CD3, CD4, CD8and CD56 in T lymphocyte subsets was in lower level,respectively, and CD56 showed a significant decline in group A (26.02 vs 32.20, P＜0.05), however, CD4/CD8ratio increased. Physical function, role function, fatigue,sleeplessness and constipation had significant changes among different groups by one-way ANOVA, and group A was in poor QOL. It revealed that global health-related quality of life (QL) were positively correlated with active coping and CD56; CAD was negatively correlated with QL, active coping and CD56. Furthermore, the step-wise regression analysis suggested that utilization of support,CD56, active coping, fatigue, sleeplessness and depression were significant factors contributing to QOL.CONCLUSION: CAD, which can impair QOL and cellular immunity, occurs with a higher incidence in patients with digestive tract cancers. Hence, it is essential to improve mental health for them with specifically tailored interventions.