OBJECTIVES The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.

中文翻译：

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新诊断的晚期非小细胞肺癌患者：中度至重度抑郁症状患者的临床描述。

目标 本观察性研究的目的是 1) 收集等待一线治疗开始的新诊断晚期非小细胞肺癌 (NSCLC) 患者，并识别出中度至重度抑郁症状的患者，以及 2) 提供对可能加剧和维持抑郁症状的多种同时发生的心理和行为困难以及身体症状的临床描述。材料和方法 IV 期 NSCLC 患者（N = 186）参加了一项观察性研究（ClinicalTrials.gov 标识符：NCT03199651）并完成了美国临床肿瘤学会推荐的抑郁症筛查措施（Patient Health Questionnaire-9 [PHQ- 9]）。无/轻度 (n = 119; 64 %)、中度 (n = 52; 28 %) 和重度 (n = 15; 8 %) 的抑郁症状被发现。患者还完成了绝望、广泛性焦虑症 (GAD) 症状、压力、疾病感知、功能状态和症状的测量。结果 患有严重抑郁症状的患者报告了伴随的绝望感（增加自杀行为的风险）、暗示 GAD 的焦虑症状以及创伤性、癌症特异性压力。他们认为肺癌对他们的生活产生重大影响，并且无法通过治疗来控制。存在疼痛和多种严重症状以及严重的功能障碍。具有中度抑郁症状的患者的干扰水平通常较低，但仍然很严重。最显着的差异是 GAD 症状严重程度低，中度症状患者的功能障碍较少。结论 中度至重度抑郁症状同时出现在焦虑症状、创伤性压力、功能状态受损以及疼痛和其他身体症状的临床水平矩阵中。所有后一种因素已被证明，单独和集体，有助于抑郁症状的维持或恶化。随着延长生命的靶向治疗和免疫治疗使用的扩大，及时识别中度至重度抑郁症状的患者、转诊进行评估以及心理/行为治疗是最大限度地提高晚期 NSCLC 患者的治疗结果和生活质量的关键。所有后一种因素已被证明，单独和集体，有助于抑郁症状的维持或恶化。随着延长生命的靶向治疗和免疫治疗使用的扩大，及时识别中度至重度抑郁症状的患者、转诊进行评估以及心理/行为治疗是最大限度地提高晚期 NSCLC 患者的治疗结果和生活质量的关键。所有后一种因素已被证明，单独和集体，有助于抑郁症状的维持或恶化。随着延长生命的靶向治疗和免疫治疗使用的扩大，及时识别中度至重度抑郁症状的患者、转诊进行评估以及心理/行为治疗是最大限度地提高晚期 NSCLC 患者的治疗结果和生活质量的关键。