Relationship of oestrogen receptor status to depressive symptoms and quality of life in breast cancer patients.

OBJECTIVE: We investigated the relationship of oestrogen receptor (ER) status to the severity of depressive symptoms and quality of life (QOL) impairment in breast cancer patients. METHODS: Seventy-seven breast cancer patients with comorbid depression were evaluated with the Hamilton Depression Rating Scale (HAMD), the Clinical Global Impression-Severity of Illness (CGI-S) for depression, and the Functional Assessment of Cancer Therapy-Breast (FACT-B). ER status was determined using immunohistochemical analysis. RESULTS: The ER-positive group (n = 31) showed significantly higher scores compared with the ER-negative group (n = 46) on HAMD total (p = 0.04) and somatic anxiety factor (p = 0.004) scores as well as CGI-S score (p = 0.03). As for QOL measured with the FACT-B, a significantly higher score was found on the Functional Well-Being (FWB) subscale in the ER-positive group (p = 0.001). The relationships were further analysed using generalised linear models (GLM), after controlling for the influence of the current anti-oestrogen treatment. The analysis revealed that ER status was still significantly related to the FWB subscale score of the FACT-B (p = 0.04). However, the HAMD and CGI-S scores were no longer significantly related to ER status after the influence of anti-oestrogen treatment was controlled for. CONCLUSION: These results suggest that ER status, which is a well-known biological prognostic factor in breast cancer, may be related to the severity of certain aspects of depressive symptoms or QOL impairment, implying a role of the ER in affective and behavioural regulation. However, anti-oestrogen treatments significantly influence these relationships.

Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: a 12-week, open-label prospective trial.

BACKGROUND: Among patients with cancer, the management of depression is very important to improve quality of life as well as distress. Because the efficacy of escitalopram, a potent serotonin reuptake inhibitor, has not been well evaluated in cancer patients, we investigated its effects on depression and quality of life in outpatients with breast cancer. METHODS: A 12-week, open-label, prospective study with escitalopram (5-20mg/day) was performed in 79 breast cancer outpatients with depression. The primary outcome was measured using the Hamilton Depression Rating Scale (HAMD), which was administered at baseline, 1, 2, 4, 8, and 12 weeks after treatment. The Functional Assessment of Cancer Therapy-Breast (FACT-B), MD Anderson Symptoms Inventory (MDASI), Clinical Global Impression-Severity of Illness (CGI-S), and Distress Thermometer (DT) were also used to measure improvement in symptoms, distress, and quality of life. RESULTS: Compared to baseline, HAMD, DT, and CGI-S scores were significantly decreased at week 1 and onwards, and FACT-B and MDSAI were improved at week 2 and onwards. At the end point (week 12), all FACT-B subscales including the physical, emotional, social/family, functional well-being, and the breast cancer subscales were improved. Improvement in distress and quality of life was associated with a reduction in depressive symptoms. Of all participants, 45.1% met the response criterion (at least a 50% decrease in HAMD total score), and 30.6% met the remission criterion (HAMD total score ≤ 7) at week 12. CONCLUSIONS: In the present study, escitalopram improved quality of life and reduced depression in breast cancer patients. Symptoms rapidly improved within 1 week, influencing quality of life. Escitalopram may be an effective treatment of depressive symptoms in breast cancer patients.

Translation and validation of the Korean Confusion Assessment Method for the Intensive Care Unit.

BACKGROUND: Delirium is a common problem and associated with poor outcomes in intensive care unit (ICU) patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting. METHODS: Translation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). RESULTS: Twenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7%) patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, p < 0.001). CONCLUSIONS: The Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs. TRIAL REGISTRATION: ISRCTN: ISRCTN50265663.