Predictors of depression in breast cancer patients treated with radiation: role of prior chemotherapy and nuclear factor kappa B
Mylin A Torres, Thaddeus W Pace, Tian Liu, Jennifer C Felger, Donna Mister, Gregory H Doho, Jordan N Kohn, Andrea M Barsevick, Qi Long, Andrew H Miller, Mylin A Torres, Thaddeus W Pace, Tian Liu, Jennifer C Felger, Donna Mister, Gregory H Doho, Jordan N Kohn, Andrea M Barsevick, Qi Long, Andrew H Miller
Abstract
Background: Depression is common during and after breast cancer treatment. However, the role of specific therapeutic modalities and related biologic mechanisms remains unclear. Radiation is an essential component of breast-conserving therapy and may contribute to depression in patients with breast cancer through the activation of inflammatory pathways.
Methods: Depressive symptoms and inflammatory mediators, including nuclear factor kappa B (NF-κB), were assessed at baseline (before radiation), during radiation, and 6 weeks after radiation in 64 women who had stage 0 through IIIA breast cancer.
Results: No significant increases in depressive symptoms occurred during or after radiation, although a number of patients exhibited moderate-to-severe depression throughout the study. Multivariate analyses of baseline factors predictive of depression revealed that educational status, perceived stress, prior chemotherapy, and peripheral blood NF-κB DNA binding all were independent predictors of persistent depressive symptoms after radiation (all P < .05). Of these factors, only prior chemotherapy was associated with inflammatory mediators, including NF-κB DNA binding, soluble tumor necrosis factor-alpha receptor 2, and interleukin-6, which, in univariate analyses predicted depressive symptoms after radiation (all P < .05). Chemotherapy-treated patients also exhibited an over-representation of gene transcripts regulated by NF-κB.
Conclusions: Radiation was not associated with increased depressive symptoms in the current study, but of disease and treatment-related factors, prior chemotherapy predicted significant depression after radiation. Longitudinal studies are warranted to investigate the relationship among prior chemotherapy, inflammation, and persistent depression after breast cancer treatment.
Copyright © 2013 American Cancer Society.
Figures
![Figure 1. Depression and fatigue before, during,…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3663885/bin/nihms442457f1.jpg)
Figure 2. NF-kB DNA binding and depression…
Figure 2. NF-kB DNA binding and depression and fatigue before radiation in breast cancer patients…
Figure 3. Over-represented biological processes and NF-kB-mediated…
Figure 3. Over-represented biological processes and NF-kB-mediated transcription factor pathways in differentially expressed genes in…
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- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Aged
- Breast Neoplasms / metabolism
- Breast Neoplasms / psychology*
- Breast Neoplasms / radiotherapy
- Breast Neoplasms / therapy*
- Chemotherapy, Adjuvant
- Depression / etiology*
- Depression / metabolism
- Female
- Humans
- Inflammation Mediators / blood
- Inflammation Mediators / metabolism
- Interleukin-1 / blood
- Interleukin-1 / metabolism
- Interleukin-6 / blood
- Interleukin-6 / metabolism
- Middle Aged
- NF-kappa B / blood
- NF-kappa B / metabolism
- Radiation Injuries / psychology*
- Tumor Necrosis Factor-alpha / blood
- Tumor Necrosis Factor-alpha / metabolism
- Inflammation Mediators
- Interleukin-1
- Interleukin-6
- NF-kappa B
- TNF protein, human
- Tumor Necrosis Factor-alpha
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 2. NF-kB DNA binding and depression…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3663885/bin/nihms442457f2.jpg)
Figure 3. Over-represented biological processes and NF-kB-mediated…
Figure 3. Over-represented biological processes and NF-kB-mediated transcription factor pathways in differentially expressed genes in…
![Figure 3. Over-represented biological processes and NF-kB-mediated…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3663885/bin/nihms442457f3.jpg)
Source: PubMed