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dc.contributor.advisorKoné Péfoyo, Anna
dc.contributor.advisorScharf, Deborah
dc.contributor.authorRajan, Ambili Kariaparambil
dc.date.accessioned2020-06-23T15:38:34Z
dc.date.available2020-06-23T15:38:34Z
dc.date.created2020
dc.date.issued2020
dc.identifier.urihttp://knowledgecommons.lakeheadu.ca:7070/handle/2453/4669
dc.description.abstractObjectives: The first part of this study aims to assess the impact of major depressive disorder (MDD) on cancer survival and to determine whether the impact is modified by the number of other comorbidities in a patient. The second part evaluates the impact of adequate antidepressant refill (AAR) on the survival of older cancer patients with MDD. Methods: The study used a retrospective cohort design and conducted a population-based study on all adult cancer patients diagnosed in Ontario between 2003 and 2013. The cohort was followed until 2018. Patients who had a hospital discharge diagnosis of MDD before or during the study period were identified as having depression. For the second part of the study, data on a subset of patients who were ≥ 65 years old at the time of cancer diagnosis and had MDD were analysed. Fifteen chronic conditions were included for calculating the number of comorbidities excluding MDD. Survival analysis was performed using Cox proportional hazards regression. Results: Among the 453,012 adults diagnosed with cancer, 2% had a hospital diagnosis of MDD. Those who had MDD had a higher risk of mortality (adjusted hazard ratio (aHR) 1.58; 95% confidence interval (CI) 1.54-1.63) than those without MDD. In patients with MDD, those with 0-1 comorbidities had 2.55 times (aHR 2.55; 95% CI 2.31-2.81), those with 2-3 comorbidities had 1.85 times (aHR 1.85; 95% CI 1.75-1.95), and those with ≥ 4 comorbidities had 1.44 times (aHR 1.44; 95% CI 1.40-1.49) higher risk of death compared to patients without MDD with similar levels of multimorbidity. There were 4,708 patients who were ≥ 65 years old and had MDD. Among patients whose MDD was diagnosed after cancer (N=3,183 (67.6%)), AAR was associated with a lower mortality risk (aHR 0.51; 95% CI 0.47-0.55). Conclusion: Cancer patients without MDD survive longer than those with MDD. Older patients with MDD diagnosed after cancer are likely to survive longer if they receive AAR.en_US
dc.language.isoen_USen_US
dc.subjectDepression (cancer patients)en_US
dc.subjectDepression and cancer survivalen_US
dc.subjectMultimorbidity (cancer patients)en_US
dc.subjectAntidepressant therapyen_US
dc.subjectComorbidityen_US
dc.titleImpacts of depression and its management on the survival of cancer patients with and without other chronic diseasesen_US
dc.typeThesisen_US
etd.degree.nameMaster of Health Sciencesen_US
etd.degree.levelMasteren_US
etd.degree.disciplineHealth and Behavioural Sciencesen_US
etd.degree.grantorLakehead Universityen_US
dc.contributor.committeememberGalway, Lindsay
dc.contributor.committeememberVafaei, Afshin


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