(P 211) AN ANALYSIS OF SELF-REPORTED DEPRESSION IN SARCOMA PATIENTS

Objective: Sarcomas are a rare heterogeneous group of malignancies, with varied but often intensive treatment among different subtypes, including surgery, radiation, and systemic therapy. Such therapy is intended to improve survival but may also lead to adverse psychological and social outcomes. Scarce data exists correlating patient demographic and lifestyle characteristics to symptoms of depression in the contemporary treatment era. In a cohort of sarcoma patients treated with contemporary therapy, we evaluated prevalence rate and associated factors for self-reported symptoms of depression.

Methods: The “Cohort to Augment the Understanding of Sarcoma Survivorship Across the Lifespan” (CAUSAL) is designed to build a retrospective-prospective cohort of sarcoma patients to assess the impact of sarcoma, its treatment, and patient characteristics on health outcomes. Sarcoma patients treated at Vanderbilt University Medical Center from 2012-present are being identified and recruited to the study. Self-reported depression symptoms are assessed via the PROMIS-57, which encompasses seven domains across physical, mental, and social health in adults. We report on responses from CAUSAL participants to the PROMIS-57 depression survey, collected at the time of enrollment into CAUSAL. Scores from each completed survey are calculated into a raw score and translated into a T-score, allowing for standardization. The general population mean T-score is 50, with a standard deviation (SD) of 10. Higher scores are more associated with symptoms of depression. Patient demographic and lifestyle characteristics are collected via patient surveys. Clinical characteristics and sarcoma treatment data were abstracted from the electronic medical record. Associations between participant characteristics and treatment with T-scores, per SD increase, were evaluated using multivariable linear regression analysis. Mean differences (β coefficients) and 95% confidence intervals (CIs) were derived from linear regression models.

Results: Our analysis includes 429 participants who completed the PROMIS-57 survey. There are more female (54.1%) than male participants. The median age is 55 (range 18-86). Among participants, 147 are receiving therapy, and 282 have completed treatment. Mean depression T-score was 48.1 (SD 9.7) in our study population; 48.3% of participants had a T-Score of 41-59 (within one SD of the mean of the general population). 39.4% had a T-score ≤40 (greater than one SD below the mean of the general population), while 12.3% scored ≥60 (greater than one SD above the mean of the general population). Multivariable linear regression showed that age, income and smoking were significantly associated with the depression score. Compared with participants >60 years, participants 18-39 and 40-59 years of age had significantly higher depression scores (β = 0.38, 95% CI: 0.12, 0.64, p = 0.005) and (β = 0.27, 95% CI: 0.07, 0.48, p = 0.010), respectively. Compared to participants with household incomes under $45,000, participants with higher household incomes had significantly lower depression scores: income $45,000-$70,000 (β = -0.34, 95% CI: -0.62, -0.06, p = 0.017), income $70,000-$120,000 (β = -0.50, 95% CI: -0.77, -0.23, p< 0.001) and income >$120,000 (β = -0.51, 95% CI: -0.81, -0.22, p< 0.001). Additionally, participants who identified as previous or current smokers had significantly higher depression (β = 0.21, 95% CI: 0.01, 0.40, p = 0.039), compared to those who did not. Participants’ current treatment status and tumor characteristics, such as diagnosis and primary tumor site, were not independently associated with the depression score.

Conclusion: Our study is thus far the largest analysis evaluating depression symptoms among sarcoma patients. We found that younger sarcoma patients, previous or current smokers, and those with low income have a high prevalence of depression symptoms. These findings provide important information for developing personalized supportive care strategies.