Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up

Abstract

Background: Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up.

Methods: From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up.

Results: A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56years; SE=0.26) than those in the mild/moderate depressed group (M=11.45years; SE=0.40), Log-rank χ2(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample.

Conclusions: Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.

Keywords: Breast neoplasms; Depressive symptoms; Follow-up study; Recurrence; Survival.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Full sample: KM survival function for women classified as High (HDRS >7) vs. Low (HDRS ≤7) at study entry Note: HDRS = Hamilton Depression Rating Scale

Figure 2

Full Sample: Cox PH model for overall survival (using 0.6 – 1.0 scaling) for women classified as no/low (0-7), mild (8-16), or moderate (17-23) depressive symptoms at study entry Note: HDRS = Hamilton Depression Rating Scale