Is age a risk factor for depression among the oldest old with cancer? Gil Goldzweig a, ⁎, Lea Baider b , Yakir Rottenberg c , Elisabeth Andritsch d , Jeremy M. Jacobs e a School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, Tel-aviv, Israel b Assuta Medical Center, Oncology Institute, Tel-aviv, Israel c Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel d Division of Clinical Oncology, The medical University of Graz, Graz, Austria e Department of Geriatrics and Geriatric Rehabilitation, Hadassah University Hospital, Jerusalem, Israel abstract article info Article history: Received 27 October 2017 Received in revised form 19 February 2018 Accepted 20 March 2018 Available online xxxx Introduction: Age is negatively related to depression among young and middle age patients with cancer. Never- theless the relationship between age and depression among older patients with cancer is unclear. The goal of the current study is to assess the association of depression with increasing age among older patients with cancer. Materials and methods: Participants were 243 oncology out-patients, aged ≥65, either receiving treatment for ac- tive disease or within 6 months of completing treatment for active disease, with a Karnofsky score ≥70. Partici- pants were grouped by age: “Younger-Old”– age 65–74 (N = 125); “Old” - age 75–84 (N = 49); and “Oldest- Old”–age ≥ 85 years (N = 69). Background data included: socio-demography; cancer type/staging/treatment; Charlson comorbidity index (CCI); Eastern Cooperative Oncology Group (ECOG) performance. Psychological data included: the 5-item Geri- atric Depression Scale (GDS); “Distress Thermometer” (single item); and Cancer Perceived Agents of Social Sup- port (12-item). Results: Depression levels were significantly higher among oldest-old participants in comparison to the old and younger-old groups: mean GDS scores were 0.93 ± 1.13, 1.27 ± 1.41 and 3.91 ± 1.35 respectively. After control- ling for all potential confounders in a hierarchical logistic regression model, age-group significantly predicted both depression and distress. Receiver operating characteristic (ROC) analysis determined age 86 as the optimal cutoff for both clinical depression and distress. Discussion: Depression among older patients with cancer rises with increasing age, being extremely common among the oldest old. Age independently predicted depression, irrespective of medical variables, social support, or functional status. Findings highlight the importance of addressing the potentially unmet psychological needs of this rapidly growing patient population. © 2018 Published by Elsevier Ltd. Keywords: Cancer Depression Psychological distress Old age Oldest old 1. Introduction The interaction between global aging of the world population and the developments in detection and treatment of cancer will likely result in increased numbers of older people diagnosed and treated for cancer [1,2]. According to the United States (US) National Cancer Institute, the number of people surviving after cancer diagnosis is predicted to rise in the US from 14.5 million in 2014 to almost 19 million by 2024 [1,3]. A similar rise is expected in Europe, where the incidence of cancer is already 11 times higher among people N65 years compared to adults ≤65 [4,5]. Older cancer patients with high comorbidity, functional im- pairments, and frailty, in addition to their more resilient and robust con- temporaries, are very likely to present a major challenge to oncologists, geriatricians, and associated health care professionals caring for older people. In order to achieve optimal wellbeing and higher quality of life for these patients both their physiological and psychological needs have to be addressed. Nonetheless, the specific psychological issues surrounding cancer di- agnosis among the older population, and particularly the oldest old, have yet to be clearly defined. Existing research suggests that among the adverse psychological reactions of older patients to a diagnosis of cancer, depression was found to be one of the most common disorders, frequently associated with disability, morbidity, pain, decreased social functioning, and mortality [6,7]. Diagnosing depression among older pa- tients with cancer may be challenging, and depressive symptoms may be overlooked more often than among people not suffering from malig- nant diseases of similar age [8–12]. To date, the findings concerning the relation between age and depression among older patients with cancer are conflicting. Some re- search has found that levels of depression in older adults (in comparison Journal of Geriatric Oncology xxx (2018) xxx–xxx ⁎ Corresponding author at: The Academic College of Tel-Aviv Yaffo, Rabenu-Yeruham Street 14, Tel-Aviv 6818211, Israel. E-mail address: giligold@mta.ac.il (G. Goldzweig). JGO-00530; No. of pages: 6; 4C: https://doi.org/10.1016/j.jgo.2018.03.011 1879-4068/© 2018 Published by Elsevier Ltd. Contents lists available at ScienceDirect Journal of Geriatric Oncology Please cite this article as: Goldzweig G, et al, Is age a risk factor for depression among the oldest old with cancer?, J Geriatr Oncol (2018), https:// doi.org/10.1016/j.jgo.2018.03.011