Prevalence of Depression and Cancer - A systematic review.

Objective: While comorbidity of different forms of cancer and clinical depression is reported for many single studies, representative and global overviews are scarce. Methods: A systematic review was carried out (mainly based on Medline, Embase, Cochrane, PsychLit, and Psyndex) to identify studies in adult cancer patients from 2007 to 2019. Studies with noncancer populations and cancer survivors were excluded. Assessment methods of depression were chart-based diagnoses, interview-based and self-report questionnaires. Quality and plausibility were checked using the adapted Downs & Black checklist. Results: For all 210 included studies the prevalence rate of clinical depression varied from 7.9 % to 32.4 %, with a mean of 21.2 % depression for different (mixed) cancer entities. The different methods of assessment have led to under- (especially charts-based diagnoses) as well as overreporting for some forms of cancer. In general, the different assessment forms show an acceptable variation in prevalence. Conclusions: The risk for a cancer patient to suffer a clinical depression during the first year after diagnoses is 15 % to 20 %, meaning every fifth or sixth patients. Different cancer entities, stage of cancer and treatments as well as different cultural and medical backgrounds show only slight variation in prevalence rates.

Effects of 24 h working on-call on psychoneuroendocrine and oculomotor function: a randomized cross-over trial.

OBJECTIVES: On-call duty (OCD) is frequently associated with health and safety risks for both physicians and patients. The lack of studies conducted in clinical care environments and the ongoing public dialogue concerning OCD led to a detailed investigation of a working schedule including sleep fragmentation and extended work hours. DESIGN: Within-person randomized cross-over trial. SETTING: Comparison of a 24h on-call shift (OCD) compared to a routine working-day (non on call, NOC) in hospital. PARTICIPANTS: 30 residents and senior physicians of the Department of Internal Medicine, Neurology and Otorhinolaryngology at the University Hospital Innsbruck. MAIN OUTCOME MEASURES: Sleep variables, cognitive performance (Concentration-Endurance d2 test), emotional status (Eigenschaftswoerterliste 60S), serum-cortisol, urinary cortisol and noradrenaline, heart-rate variability, and saccadic eye movements were determined before and after OCD and NOC respectively. RESULTS: Concentration-endurance performance was significantly reduced after OCD as compared to NOC by 16.4% (p<0.001). Changes in emotional status consisted in a reduction of subjective concentration and performance related activation after OCD by 17.4% (p<0.001) and 16.0% (p<0.001) respectively together with a 21.8% increase of general deactivation (p<0.001) and a 29.2% rise of fatigue (p<0.001). On the contrary, subjective activation and raised mood showed an 18.3% and 21.7% increase after OCD (p<0.01). Urinary noradrenaline excretion (46 µg/24 h, 19-97) was greater during OCD when compared to NOC (36 µg/24 h, 10-54, p<0.01). Sympathetic activity measured by heart rate variability was significantly higher during OCD in contrast to NOC (p<0.05). Serum-cortisol was lower in the morning after (132 ng/l, 60-273) than the morning before OCD (p<0.01). Finally, the number of short saccadic latencies was reduced after OCD (p<0.05) compared to NOC. CONCLUSIONS: 24 h OCD alters both, the sympathetic-adrenomedullary system as well as the hypothalamic pituitary-adrenocortical axis. Moreover, physicians' emotional state, cognitive and oculomotor performance seems to be influenced independently from sleep interruptions. The discrepancy between subjective feeling and objective cognitive impairments pose a risk for performing complex manual and cognitive tasks. Hence, our findings argue against an oversimplified interpretation of alterations in the physicians' psychoneuroendocrine structure in terms of impaired mood and neurocognitive deterioration combined with up-/dysregulated stress axes associated with OCD as a consequence of sleep deprivation.