Correlation between hormone receptor status and depressive symptoms in patients with metastatic breast cancer

Xiangyu Guo, Junnan Xu, E Ying, Zhifu Yu, Tao Sun, Xiangyu Guo, Junnan Xu, E Ying, Zhifu Yu, Tao Sun

Abstract

Individual differences in depressive symptoms correlate with morbidity and outcomes in breast cancer patients. We evaluated the effect of hormone receptor (HR) status on depressive symptoms in 176 women with metastatic breast cancer at diagnosis. To assess depression, the women completed Self-Rating Depression Scale (SDS) questionnaires at baseline examination (T1), after 4 chemotherapy cycles (T2) and after 6 months (T3). At baseline examination, 45/176 (25.6%) patients were found to be at high or medium risk for depression (SDS score ≥0.6). Among these, depression was both prevalent in HR-positive patients and in HR-negative patients (64.4% versus 51.4%, P = 0.001). In multivariate model, HR positivity and higher depression risk were associated with poorer overall survival (25.0 months versus 32.0 months, P < 0.05). Patients at high/medium risk of depression were treated with the antidepressant agent fluoxetine (N = 23) or no drug (N = 22). SDS scores in patients treated with fluoxetine were lower after 4 chemotherapy cycles and after 6 months than in the control group (mean scores: T2, 0.61 versus 0.67, P = 0.001; T3, 0.56 versus 0.65, P < 0.001). No difference on SDS scores was found between patients with positive or negative HR status during fluoxetine treatment. These findings suggest hormone receptor status is associated with depressive symptoms in patients with metastatic breast cancer. Fluoxetine relieves depressive symptoms in these patients, regardless of hormone receptor status.

Keywords: SDS; breast cancer; depression; fluoxetine; hormone receptor.

Conflict of interest statement

CONFLICTS OF INTEREST No competing financial interests exist.

Figures

Figure 1. Depression score values at 4…
Figure 1. Depression score values at 4 cycles (T2) after chemotherapy and 6 months (T3) after baseline examination (T1)
Fluoxetnine indicates fluoxetine treatment group. Control indicates control group. SDS, self-rating depression scale.
Figure 2. Survival curve showing overall survival…
Figure 2. Survival curve showing overall survival for metastatic breast cancer patients with major depression receiving fluoxetine or no drug (control)

References

    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132.
    1. Beith J, Burslem K, Bell R, Woodward N, McCarthy N, De Boer R, Loi S, Redfern A. Hormone receptor positive, HER2 negative metastatic breast cancer: a systematic review of the current treatment landscape. Asia Pac J Clin Oncol. 2016;12:3–18.
    1. Jerusalem G, Bachelot T, Barrios C, Neven P, Di Leo A, Janni W, de Boer R. A new era of improving progression-free survival with dual blockade in postmenopausal HR(+), HER2(-) advanced breast cancer. Cancer Treat Rev. 2015;41:94–104.
    1. Ristevska-Dimitrovska G, Stefanovski P, Smichkoska S, Raleva M, Dejanova B. Depression and resilience in breast cancer patients. Open Access Maced J Med Sci. 2015;3:661–665.
    1. Belmaker RH, Agam G. Major depressive disorder. N Engl J Med. 2008;358:55–68.
    1. Chen VC, Liao YT, Yeh DC, Tseng HC, Stewart R, Lee CT. Relationship between antidepressant prescription and breast cancer: a population based study in Taiwan. Psychooncology. 2016;25:803–807.
    1. Shabbir F, Patel A, Mattison C, Bose S, Krishnamohan R, Sweeney E, Sandhu S, Nel W, Rais A, Sandhu R, Ngu N, Sharma S. Effect of diet on serotonergic neurotransmission in depression. Neurochem Int. 2013;62:324–329.
    1. Pan A, Lucas M, Sun Q, van Dam RM, Franco OH, Willett WC, Manson JE, Rexrode KM, Ascherio A, Hu FB. Increased mortality risk in women with depression and diabetes mellitus. Arch Gen Psychiatry. 2011;68:42–50.
    1. Campayo A, de Jonge P, Roy JF, Saz P, de la Cámara C, Quintanilla MA, Marcos G, Santabárbara J, Lobo A, ZARADEMP Project Depressive disorder and incident diabetes mellitus: the effect of characteristics of depression. Am J Psychiatry. 2010;167:580–588.
    1. Oerlemans ME, van den Akker M, Schuurman AG, Kellen E, Buntinx F. A meta-analysis on depression and subsequent cancer risk. Clin Pract Epidemiol Ment Health. 2007;3:29.
    1. Ahn HK, Bae JH, Ahn HY, Hwang IC. Risk of cancer among patients with depressive disorder: a meta-analysis and implications. Psychooncology. 2016;25:1393–1399.
    1. Oerlemans ME, van den Akker M, Schuurman AG, Kellen E, Buntinx F. A meta-analysis on depression and subsequent cancer risk. Clin Pract Epidemiol Ment Health. 2007;3:29.
    1. Jacob L, Bleicher L, Kostev K, Kalder M. Prevalence of depression, anxiety and their risk factors in German women with breast cancer in general and gynecological practices. J Cancer Res Clin Oncol. 2016(142):447–452.
    1. Hamelinck VC, Bastiaannet E, Pieterse AH, de Glas NA, Portielje JE, Merkus JW, den Hoed ID, van de Velde CJ, Liefers GJ, Stiggelbout AM. A prospective comparison of younger and older patients' preferences for adjuvant chemotherapy and hormonal therapy in early breast cancer. Clin Breast Cancer. 2016;16:379–388.
    1. Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2015;152:239–246.
    1. Jacob L, Hadji P, Albert US, Kalder M, Kostev K. Impact of disease management programs on women with breast cancer in Germany. Breast Cancer Res Treat. 2015;153:391–395.
    1. Ates O, Soylu C, Babacan T, Sarici F, Kertmen N, Allen D, Sever AR, Altundag K. Assessment of psychosocial factors and distress in women having adjuvant endocrine therapy for breast cancer: the relationship among emotional distress and patient and treatment-related factors. Springerplus. 2016;5:486.
    1. Miura K, Ando S, Imai T. The association of cognitive fatigue with menopause, depressive symptoms, and quality of life in ambulatory breast cancer patients. Breast Cancer. 2016;23:407–414.
    1. Khan F, Amatya B. Factors associated with long-term functional outcomes, psychological sequelae and quality of life in persons after primary brain tumour. J Neurooncol. 2013;111:355–366.
    1. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS, National Comorbidity Survey Replication The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R) JAMA. 2003;289:3095–3105.
    1. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN, Kaur J, Kostyuchenko S, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90.
    1. Chang SM, Hahm BJ, Lee JY, Shin MS, Jeon HJ, Hong JP, Lee HB, Lee DW, Cho MJ. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affect Disord. 2008;106:159–167.
    1. Cho MJ, Lee JY, Kim BS, Lee HW, Sohn JH. Prevalence of the major mental disorders among the Korean elderly. J Korean Med Sci. 2011;26:1–10.
    1. Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biol Psychiatry. 2003;54:269–282.
    1. Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 2013;38:1310–1317.
    1. Kishan AU, Wang PC, Sharif J, Kupelian PA, Steinberg ML, McCloskey SA. Clinical indicators of psychosocial distress predict for acute radiation-induced fatigue in patients receiving adjuvant radiation therapy for breast cancer: an analysis of patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2016;95:946–955.
    1. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330:702.
    1. Breitbart W. Do antidepressants reduce the effectiveness of tamoxifen? Psychooncology. 2011;20:1–4.
    1. Ramaswami R, Villarreal MD, Pitta DM, Carpenter JS, Stebbing J, Kalesan B. Venlafaxine in management of hot flashes in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2015;152:231–237.
    1. Lee KC, Ray GT, Hunkeler EM, Finley PR. Tamoxifen treatment and new-onset depression in breast cancer patients. Psychosomatics. 2007;48:205–210.
    1. Day R, Ganz PA, Costantino JP. Tamoxifen and depression: more evidence from The National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention (P-1) Randomized Study. J Natl Cancer Inst. 2001;93:1615–1623.
    1. Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, et al. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387:857–865.
    1. Laird BJ, Scott AC, Colvin LA, McKeon AL, Murray GD, Fearon KC, Fallon MT. Pain, depression, and fatigue as a symptom cluster in advanced cancer. J Pain Symptom Manage. 2011;42:1–11.
    1. Thornton LM, Andersen BL, Blakely WP. The pain, depression, and fatigue symptom cluster in advanced breast cancer: covariation with the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Health Psychol. 2010;29:333–337.
    1. Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet. 2004;363:1341–1345.

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