Depressive symptoms and health-related quality of life in older women with gynecologic Cancers

Objectives: This study aims to assess factors associated with depressive symptoms in older women with gynecologic cancers and to examine the association of depression with health-related quality of life (HRQOL). Materials and methods: Women aged 65 and older previously diagnosed with cervical, ovarian, or uterine cancer (n=1977) were identified from the Surveillance, Epidemiology, and End Results – Medicare Health Outcomes Survey database and compared to propensity-matched cancer-free controls (n=9885). Women with and without depressive symptoms were compared by cancer status. Logistic regression was used to identify factors associated with depressive symptoms, and linear regression was used to determine the association of depressive symptoms with HRQOL measures. Results: The prevalence of depressive symptoms was higher among older women with gynecologic cancer (31.9%, 32.2%, and 25.3% for cervical, ovarian, and uterine cancer, respectively) than cancer-free older women (24.9%) (p=0.05). Adjusting for demographic and clinical factors, older women with ovarian cancer were significantly more likely to have depressive symptoms than controls (Prevalence Odds Ratio = 1.74, 95% CI: 1.31, 2.32, p < 0.01). Among older women with gynecologic cancer, comorbid conditions and functional limitations were strongly associated with depressive symptoms. Women with depressive symptoms showed significant decrements in both physical and mental measures of HRQOL. Conclusion: This study gives insight into correlates of depressive symptoms that may be used to better identify women with gynecologic cancers who are at risk of depression. The relatively high prevalence of depressive symptoms and significant deficits in HRQOL underscore the need for effective screening and treatment of depression in older women with gynecologic cancers.