Association of depression with all-cause and cancer-specific mortality in older adults with cancer: Systematic review, meta-analysis, and meta-regression.

INTRODUCTION: The incidence and mortality of cancer is increasing worldwide with studies reporting that cumulative risk of cancer rises as age increases. Against the backdrop of the increasing prevalence of cancer amongst older patients, we conducted a systematic review and meta-analysis examining the depression-mortality relationship in older adults with cancer (OAC). MATERIALS AND METHODS: This PRISMA-adherent systematic review involved a systematic search of PubMed, Medline, EMBASE, and PsycINFO for prospective and retrospective cohort studies comparing the risk of all-cause and cancer-related mortality among OAC with depression. Random effects meta-analyses and meta-regressions were used for the primary analysis. RESULTS: From 5,280 citations, we included 14 cohort studies. Meta-analyses of hazard ratios (HRs) showed an increased incidence of all-cause mortality in OAC with depression (pooled HR: 1.40; 95% confidence interval [CI]: 1.25, 1.55). Subgroup analyses of other categorical study-level characteristics were insignificant. While risk of cancer-related mortality in OAC with depression was insignificantly increased with a pooled HR of 1.21 (95% CI: 0.98, 1.49), subgroup analysis indicated that risk of cancer-related mortality in OAC with depression significantly differed with cancer type. Our systematic review found that having fewer comorbidities, a higher education level, greater socioeconomic status, and positive social supportive factors lowered risk of all-cause mortality in OAC with depression. DISCUSSION: Depression in OAC significantly increases risk of all-cause mortality and cancer-related mortality among different cancer types. It is imperative for healthcare providers and policy makers to recognize vulnerable subgroups among older adults with cancer to individualize interventions.

Life stories of food agency, health, and resilience in a rapidly gentrifying urban centre: Building a multidimensional concept of food access.

Few studies examine how geographic and non-geographic elements of food access intersect. The purpose of this qualitative study is to explore the relationship between food access, food security, health, and gentrification in the rapidly gentrifying urban centre of Kitchener, Ontario, Canada. Semi-structured interviews were conducted with 20 low-income, longtime residents of Kitchener-Waterloo, and five key informants in the region. This study complicates concepts of food access that focus on density or proximity of (un)healthy food outlets and illustrates the complex decision-making processes of residents in procuring healthy, affordable, and appropriate foods. Race, equity, and food justice-based analysis also illuminate the disproportionate effects of gentrification on racialized residents, who face barriers to obtaining culturally-appropriate foods. These findings expand food access research by showing how individuals creatively cope with and adapt to changes within their food environments. To achieve a multidimensional concept of food access under conditions of gentrification, it is important to build an understanding of individuals' diverse priorities, adaptation strategies, motivations, and behaviours related to food procurement within the context of structural barriers to food security (including urban development practices and social assistance benefit levels). By supporting residents' food agency and food justice in gentrifying cities, it might be possible to develop more effective interventions to support food security and health.