Depression in Breast Cancer Patients:
Effects on Survival and Receiving Guideline Recommended Treatment
A new study by Lei et al., published on April 17 in the American Cancer Society’s journal Cancer, suggests that the depression in breast cancer patients can affect receipt of guideline recommended treatment and survival.
The Kentucky population-based study included 6054 patients diagnosed with primary breast cancer in 2007-2011. Patients were classified into four categories:
No depression
Depression within 1 year before cancer diagnosis only
Depression within 1 year after cancer diagnosis only
Persistent depression (before and after cancer diagnosis)
The classification was done through ICD-9-CM code documentation at any inpatient or outpatient visit. Patients were then followed up for at least 3 years (median follow up = 47.8 months).
Guideline recommended treatment:
Multivariate logistic regression analysis showed 25% decrease (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.54–1.04) in patient’s odds to receive guideline recommended treatment among patients with depression pre-diagnosis only as compared to the other 3 groups.
Authors hypothesized this may be attributed to the fact that depression requires long-term management. Therefore, patients diagnosed with depression within a year before cancer diagnosis likely continued to have it, especially after a cancer diagnosis. Depression in this group of patients may have been undermanaged after the diagnosis with breast cancer
“Lack of depression management after cancer diagnosis may lead to less motivation and a decreased level of self‐management, and these patients may have more difficulty managing their illness and interacting effectively with their cancer care team.”
Survival:
Patients who had a history of depression only prior to cancer treatment had a 26% higher risk of death, whereas patients diagnosed with depression only after cancer diagnosis had around 50% higher risk of death.
These results were obtained in models adjusting for comorbidities, smoking status and disease characteristics.
“The mechanisms underlying depression and survival in breast cancer are not well‐defined but may include reduced health‐related quality of life, decreased function, decreased adherence to other medical care, and poorer health behaviors (e.g., sedentary activity, and poorer diet.”
In contrast with previous studies however, the study reported no significant difference between patients with persistent depression and patients with no depression with respect to survival, which the authors attributed to possible unmeasured confounders or better management of their depression.
This data goes to show that various interventions, such as screening for depression during breast cancer patient clinical visits, providing appropriate behavioral and pharmacological treatments, and collaborating with mental health providers in cancer treatment centers, are critical to the quality of life and survival of breast cancer patients. Maintaining continuity of care for patients with depression pre-diagnosis is critical for breast cancer patients following cancer diagnosis, as is depression screening, given the effect of depression undermanagement on breast cancer outcomes.
References:
Lei, F., Vanderpool, R. C., McLouth, L. E., Romond, E. H., Chen, Q., Durbin, E. B., ... & Huang, B. Influence of depression on breast cancer treatment and survival: A Kentucky population‐based study. Cancer.
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