Prognostic Impacts of Depression and Inflammatory Factors in Pancreatic Cancer Patients

Objective: This study explores the potential connections between clinical depression, inflammation, and cancer progression in pancreatic cancer patients. Methods: Conducted from May 2021 to May 2023 at the National Cheng Kung University Hospital Clinical Data Warehouse, this prospective study involved 279 pancreatic cancer patients. The nine-item self-reported Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The study focused on the correlation between clinically significant depression (PHQ-9 scores >10), levels of inflammatory factors, and patient survival rates. Results: At the time of diagnosis, 34.0% of the patients exhibited clinically significant depression. Analysis using Fixed Effects in Generalized Linear Mixed Models (GLMM) revealed a notable link between log-transformed C-reactive protein (ln CRP) levels with occurrence of depression (odds ratio [OR] = 1.274, p = .010). Furthermore, a univariate Cox proportional hazard model with time-varying covariates indicated a correlation between clinically significant depression and decreased overall survival (hazard ratio [HR] = 6.245, p < .001). A multivariate Cox model also showed significant associations of both ln CRP levels (HR = 1.966, p = .030) and clinically significant depression (HR = 3.611, p = .028) with survival outcomes. Conclusions: The findings highlight a complex interplay between inflammation, depression, and survival in pancreatic cancer patients. However, the study is limited by the lack of control over all potential confounders, such as chronic conditions, which could independently influence both depression and inflammatory biomarkers.