Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1941–1948 | Cite as

Association of Depression and Anxiety on Quality of Life, Treatment Adherence, and Prognosis in Patients with Advanced Non-small Cell Lung Cancer

  • Óscar ArrietaEmail author
  • Laura P. Angulo
  • Carolina Núñez-Valencia
  • Yuzmiren Dorantes-Gallareta
  • Eleazar O. Macedo
  • Dulce Martínez-López
  • Salvador Alvarado
  • José-Francisco Corona-Cruz
  • Luis F. Oñate-Ocaña
Thoracic Oncology



Symptoms of depression and anxiety are common in patients with lung cancer and may produce an impact on both health-related quality of life (HRQL) and survival. The aim of the present study was to evaluate the association of depression and anxiety on HRQL, treatment adherence, and prognosis in patients with non-small cell lung cancer (NSCLC).


This is a prospective study of patients with stage IIIB or IV NSCLC. Depression and anxiety were measured using the hospital anxiety and depression scale, the International Neuropsychiatric Interview, and the HRQL with the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Instruments were applied before treatment and repeated at 3 and 6 months. Lack of treatment adherence was considered as patients who stopped going to their consultation appointments.


A total of 82 patients were included. At the initial evaluation, depression and anxiety were found in 32.9 and 34.1 % of patients, respectively. Depression was associated with feminine gender (p = 0.034) and poor performance status (p = 0.048). Depression and anxiety showed an association with HRQL. Patients with depression showed median overall survival of 6.8 months, whereas that for nondepressed patients was 14 months (hazard ratio [HR], 1.9; 95 % confidence interval (95 % CI), 1.03–3.7; p = 0.042). The 58 % of patients with depression had poor treatment adherence versus 42 % of patients without depression (p = 0.004).


Depression and anxiety were present in one-third of patients with recently diagnosed NSCLC. Depression and anxiety were associated with decreased HRQL scales, and depression was independently associated with treatment adherence and with poor prognosis.


Depression Overall Survival Treatment Adherence Advanced NSCLC Karnofsky Performance Status 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This project was supported partially by Instituto Nacional de Cancerología (INCan) and CONACYT (115574).

Conflict of interest

The authors have nothing to disclose.


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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Óscar Arrieta
    • 1
    • 2
    Email author
  • Laura P. Angulo
    • 1
    • 3
  • Carolina Núñez-Valencia
    • 1
    • 4
  • Yuzmiren Dorantes-Gallareta
    • 1
  • Eleazar O. Macedo
    • 1
  • Dulce Martínez-López
    • 3
  • Salvador Alvarado
    • 4
  • José-Francisco Corona-Cruz
    • 5
  • Luis F. Oñate-Ocaña
    • 6
  1. 1.Thoracic Oncology ClinicInstituto Nacional de Cancerología (INCan)Mexico CityMexico
  2. 2.Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM)Mexico CityMexico
  3. 3.Psychiatry DepartmentInstituto Nacional de Cancerología (INCan)Mexico CityMexico
  4. 4.Psycho-Oncology DepartmentInstituto Nacional de Cancerología (INCan)Mexico CityMexico
  5. 5.Thoracic Surgery DepartmentInstituto Nacional de Cancerología (INCan)Mexico CityMexico
  6. 6.Clinical Research DivisionInstituto Nacional de Cancerología (INCan)Mexico CityMexico

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