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Antidepressant (AD) use in ovarian cancer patients (OC) in the past 26 years at the American University of Beirut Medical Center (AUBMC)

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Abstract

Introduction: Ovarian cancer (OC) is the second most common gynecologic malignancy and the leading cause of gynecologic cancer-related deaths worldwide. Clinically depressed patients have lower treatment compliance, poorer treatment outcomes and lower 5-year survival rates. Objectives: To assess the prevalence of antidepressant (AD) use in epithelial OC patients at AUBMC between 1992 and 2018, identify important factors associated to AD use, and calculate overall survival rate. Method: Single institution, retrospective study, involving 329 patients with epithelial OC. Statistical analysis included univariate and multivariate regression analyses, calculation of correlation factors, and overall survival rate. Results: An increase in AD use is noted between 1992 and 2018 with a prevalence of 10.3% (Figure 1). This prevalence is higher in advanced FIGO stages (Figure 2). Compared to non-users, AD users have a higher rate of dyslipidemia (DL) (OR=7.3, p<0.001), are more prone to use anxiolytics (OR=6.9, p<0.001), to have a more advanced FIGO stage (OR=3.7, p<0.001), and are more likely to be gainfully employed (OR=3.66, p=0.02). Kaplan Meier projected overall survival was higher in patients not using AD (Figure 3). Moreover, using Cox-regression analysis, the following variables significantly affected the OS: interval debulking surgery with a hazard ratio (HR) of 1.51, (95% CI, 1.028 -2.29), advanced FIGO stage HR = 1.756 (95% CI, 1.301 -2.37), and advanced age with a HR = 1.016 (95% CI, 1.002-1.031). Discussion: The prevalence of AD use in patients with epithelial OC at AUBMC between 1992 and 2018 is 10.3%, but this certainly does not reflect the prevalence of depression in this population. Advanced FIGO stage, being gainfully employed, having dyslipidemia, and being on anxiolytics significantly predicted use of AD in this population. To date, few studies have examined the relationship between DL and depressive disorders, Chuang et al* found that patients with newly diagnosed DL had an increased incidence of depression (HR, 1.64; 95% CI, 1.55–1.74). This observation is similar to our findings: in our study, patients with preexisting DL had a significantly higher risk of being on AD with an OR of 7.3  p<0.001. Our results show that antidepressant use is associated with a shorter OS (p=0.132), we believe that patients with advanced FIGO stages have significant disease burden and often undergo major surgeries, those tend to use more AD and have a poorer outcome. Conclusion: Depression in cancer patients remains under-diagnosed and under-treated.  Currently we are unable to conclude on the effect of AD use on OS of patients with epithelial OC at AUBMC. Future clinical studies might be required to confirm the effects of AD use, with particular interest in effect on quality of life of patients with Epithelial OC.

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© Copyright 2020 Morressier GmbH.
All rights reserved.