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Depression and survival outcomes after emergency department cancer pain visits
  1. Cielito C Reyes1,
  2. Karen O Anderson2,
  3. Carmen E Gonzalez3,
  4. Haley Candra Ochs3,
  5. Monica Wattana3,
  6. Gyanendra Acharya3 and
  7. Knox H Todd3
  1. 1 Departments of Emergency Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Cielito C Reyes, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA; creyes{at}


Objectives Pain and depression frequently co-occur in patients with cancer. Although pain is a common reason for emergency department (ED) presentation by these patients, depression frequently goes unrecognised during an ED visit. In this study, we assessed the risk for depression in patients with cancer presenting to the ED for uncontrolled pain and assessed the extent to which the risk for depression was associated with survival in this population.

Methods Participants were consecutive patients with cancer taking Schedule II opioids (n=209) who presented to the ED of a tertiary cancer centre for uncontrolled pain. Risk for depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the somatic symptoms. Survival was calculated from date of ED visit to date of death/last follow-up.

Results The CES-D was completed by 197 of 209 participants (94.3%); of these, 81 of 197 (41.1%) had high risk for depression (CES-D ≥10). The mean survival time for the entire sample was 318 days (SD=33), with 84 deaths. Cox proportional hazards regression modeling showed that risk for depression and disease stage (CES-D ≥10: HR=1.75, 95% CI 1.11 to 2.78, p=0.016; disease stage: HR=2.52, 95% CI 1.20 to 5.30, p<0.001) were significant factors for survival.

Conclusions Risk for depression was prevalent and associated with survival outcomes in patients with cancer presenting to the ED with uncontrolled pain. Screening for risk for depression in the ED may identify patients who need referral for clinical assessment of depression. Diagnosis and adequate treatment could improve health outcomes and survival rates for these patients.

  • depression
  • emergency medicine
  • cancer
  • pain
  • survival

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  • Contributors CCR and KHT conceived and designed the study, and provided supervision for the overall project. CCR and KHT obtained research funding. CCR supervised patient recruitment and acquired and analysed the data, and CCR, KOA, CEG, HCO, MW and GA interpreted the data. CCR drafted the manuscript. KOA, CEG, MW and KHT participated in the critical revision of the manuscript for important intellectual content. All authors gave final approval of this version. CCR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work was supported by the National Institute of Dental and Craniofacial Research (grant number R01 DE022891) and the National Cancer Institute (MD Anderson Cancer Center Support grant number P30 CA016672) of the National Institutes of Health; the Emergency Medicine Foundation; and the institution’s Program in Oncologic Emergency Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board of The University of Texas MD Anderson Cancer Center approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.