Advancing depression assessment in older adults with cancer: Development and validation of the Older Adults with Cancer-Depression Scale (OAC-D), a novel, patient-reported outcome.

Abstract

Depression in older adults with cancer (OACs) is poorly captured by patient-reported outcomes (PROs) because traditional criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) may overlook unique symptoms in OACs. By using US Food and Drug Administration Guidance for Industry on PRO development, the authors conceptualized depression in OACs and created the Older Adults with Cancer-Depression Scale (OAC-D). This study evaluates the psychometric properties of this novel measure. Based on a refined conceptual model informed by literature reviews and qualitative work with patients and experts in geriatric oncology, a 35-item draft PRO was developed. The draft was administered, alongside legacy measures, to OACs aged >70 years and older at a comprehensive cancer center and across the United States. Exploratory graph analysis was used to identify items and factors. The mean ± standard deviation age of the 155 participants was 76 ± 5 years, and 56% were women. Exploratory graph analysis yielded an 18-item measure with five domains: (1) interest and enjoyment, (2) purpose and meaning, (3) loneliness, (4) social withdrawal, and (5) regret and guilt. Internal consistency (Cronbach alpha, .85-.95) and test-retest reliability (intraclass correlation coefficient = 0.61-0.80) were strong. Convergent validity was supported by correlations with the Patient Health Questionnaire-9 (r = 0.75), the Patient-Reported Outcomes Measurement Information System anxiety score (r = 0.69), and the Patient-Reported Outcomes Measurement Information System physical score (r = -0.39). Known groups analysis demonstrated higher OAC-D scores for those with a history of depression (p < .001). The OAC-D identified five unique domains of depression, only one of which overlapped with DSM criteria. It demonstrated robust psychometric properties, providing a nuanced alternative to DSM-based measures and addressing the distinctive psychological challenges of cancer and aging.