Heterogeneity of depression trajectories and associated risk factors during radiotherapy in patients with gastrointestinal cancer: A longitudinal study

Abstract

Purpose

To identify the heterogeneity in depression trajectories and factors influencing depression during radiotherapy in patients with gastrointestinal cancer.

Methods

Between August 2023 and May 2024, we longitudinally tracked the symptoms of 146 patients with gastrointestinal cancer at T0 (pre-radiotherapy), T1 (mid-radiotherapy), and T2 (1-month post-radiotherapy). Group-based trajectory models were used to identify subgroups of depression trajectories. A fit-criteria assessment plot was used to assess the accuracy of grouping, and univariate and multivariate logistic regression models were used to analyze the potential independent factors associated with the subgroups.

Results

Patients were categorized into three subgroups: no depression (31.5 %), mild depression (54.1 %), and moderate depression (14.4 %) group. Patients aged >65 years (P < 0.05), those with a malnutrition-inflammation complex (P < 0.05), and those accompanied by children (P < 0.05) were more likely to belong to the moderate depression group. Between-group and within-group differences in psychoneurologic symptoms, such as fatigue, remained consistent with depression. Depressive symptoms were most severe mid-radiotherapy, and moderately depressed patients were at risk of developing major depression.

Conclusions

There was significant heterogeneity in depression during radiotherapy among patients with gastrointestinal cancer. Clinicians should focus on identifying high-risk patients with depression aged >65 years, those with a malnutrition-inflammation complex, and those accompanied by children. They should actively implement pharmacological and non-pharmacological treatments and refer them to specialized psychological clinics, if necessary, to prevent the occurrence of major depression.