High Frequency of Depression in Advanced Cancer with Concomitant Comorbidities: A Registry Study

Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16-1.46) or having an intermediate (1.66, 1.46-1.88) or high frailty risk (2.57, 2.10-3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer.