Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer

Andrea Vodermaier, Wolfgang Linden, Katerina Rnic, Sandra N Young, Alvina Ng, Nina Ditsch, Robert Olson, Andrea Vodermaier, Wolfgang Linden, Katerina Rnic, Sandra N Young, Alvina Ng, Nina Ditsch, Robert Olson

Abstract

Psychological factors may influence survival in breast cancer patients but results of previous research are inconclusive. This prospective population-based study tested whether depression predicts mortality in breast cancer patients. Routinely collected depression screening data were merged with electronically archived provincial cancer registry data and censored data from British Columbia Vital Statistics (extracted in December 2012). Cox proportional-hazards regression analyses were conducted to predict all-cause and breast cancer-specific mortality as a function of depression after controlling for biomedical confounders. Of 1,646 patients, 1,604 had breast cancer stages I-III and 42 had stage IV breast cancer. 176 (11.0 %) versus 28 (66.7 %) were deceased after a median follow-up of 76 months. In patients with curable breast cancer, depression predicted all-cause (HR = 1.54 (95 % CI 1.06-2.25); p = 0.024), but not breast cancer-specific mortality (HR = 1.51 (95 % CI 0.95-2.41); p = 0.084). No association was shown for metastatic disease. Stage-specific analyses demonstrated a 2-2.5-fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease, but not in patients with stage III or IV breast cancer. In stage I breast cancer patients, age moderated effects of depression such that depressed younger patients diagnosed at age 45 (i.e., mean age -1SD) showed a ninefold (HR = 9.82 (95 % CI 2.26-42.68); p = 0.002) increase in all-cause mortality and depressed patients at 57 a 3.7-fold (HR = 3.69 (95 % CI 1.44-9.48); p = 0.007) increase, while no association was evident in older patients at age 69 (mean age +1SD). Depression is strongly associated with mortality in younger patients with early stage breast cancer.

Figures

Fig. 1
Fig. 1
Depression as a predictor of overall survival in patients with curable breast cancer (stages I–III)
Fig. 2
Fig. 2
Age moderating the relationship between depression and overall survival in stage I breast cancer. Age ≤45 years are patients at least 1 SD below the mean, age 46–68 years are patients within 1 SD above or below the mean, and age ≥69 years are patients 1 SD above the mean

References

    1. Derogatis LR, Abeloff MD, Melisaratos N. Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA. 1979;242:1504–1508. doi: 10.1001/jama.1979.03300140020016.
    1. Bardwell WA, Natarajan L, Dimsdale JE, Rock CL, Mortimer JE, Hollenbach K, Pierce JP. Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol. 2006;24:2420–2427. doi: 10.1200/JCO.2005.02.0081.
    1. van’t Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med. 1997;59:280–293.
    1. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients. Cancer. 2009;115:5349–5361. doi: 10.1002/cncr.24561.
    1. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40:1797–1810. doi: 10.1017/S0033291709992285.
    1. Hislop TG, Waxler NE, Coldman AJ, Elwood JM, Kan L. The prognostic significance of psychosocial factors in women with breast cancer. J Chronic Dis. 1987;40:729–735. doi: 10.1016/0021-9681(87)90110-X.
    1. Tross S, Herndon J, 2nd, Korzun A, Kornblith AB, Cella DF, Holland JF, Raich P, Johnson A, Kiang DT, Perloff M, Norton L, Wood W, Holland JC. Psychological symptoms and disease-free and overall survival in women with stage II breast cancer. Cancer and Leukemia Group B. J Natl Cancer Inst. 1996;88:661–667. doi: 10.1093/jnci/88.10.661.
    1. Goodwin PJ, Ennis M, Bordeleau LJ, Pritchard KI, Trudeau ME, Koo J, Hood N. Health-related quality of life and psychosocial status in breast cancer prognosis: analysis of multiple variables. J Clin Oncol. 2004;22:4184–4192. doi: 10.1200/JCO.2004.12.091.
    1. Watson M, Homewood J, Haviland J, Bliss JM. Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort. Eur J Cancer. 2005;41:1710–1714. doi: 10.1016/j.ejca.2005.01.012.
    1. Phillips KA, Osborne RH, Giles GG, Dite GS, Apicella C, Hopper JL, Milne RL. Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol. 2008;26:4666–4671. doi: 10.1200/JCO.2007.14.8718.
    1. Saquib N, Pierce JP, Saquib J, Flatt SW, Natarajan L, Bardwell WA, Patterson RE, Stefanick ML, Thomson CA, Rock CL, Jones LA, Gold EB, Karanja N, Parker BA. Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors. Psychooncology. 2011;20:252–259. doi: 10.1002/pon.1742.
    1. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet. 1999;16:1331–1336. doi: 10.1016/S0140-6736(98)11392-2.
    1. Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006;28:396–402. doi: 10.1016/j.genhosppsych.2006.05.006.
    1. Vodermaier A, Linden W, Siu C. Screening for emotional distress in cancer care. A systematic review of assessment instruments. J Natl Cancer Inst. 2009;101:1464–1488. doi: 10.1093/jnci/djp336.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. doi: 10.1177/014662167700100306.
    1. Hjerl K, Andersen EW, Keiding N, Mouridsenm HT, Mortensen PB, Jørgensen T. Depression as a prognostic factor for breast cancer mortality. Psychosomatics. 2003;44:24–30. doi: 10.1176/appi.psy.44.1.24.
    1. Goodwin JS, Zhang DD, Ostir GV. Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geriatr Soc. 2004;52:106–111. doi: 10.1111/j.1532-5415.2004.52018.x.
    1. Cao J, Olson R, Tyldesley S (Accepted 2013) Comparison of recurrence and survival rates between breast-conserving therapy and mastectomy in young women with breast cancer. Curr Oncol 20. doi:10.3747/co.20.1543
    1. de Bock GH, van der Hage JA, Putter H, Bonnema J, Bartelink H, van de Velde CJ. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies. Eur J Cancer. 2006;42:351–356. doi: 10.1016/j.ejca.2005.10.006.
    1. Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol. 1994;12:888–894.
    1. Henderson AS, Jorm AF, Korten AE, Jacomb P, Christensen H, Rodgers B. Symptoms of depression and anxiety during adult life: evidence for a decline in prevalence with age. Psychol Med. 1998;28:1321–1328. doi: 10.1017/S0033291798007570.
    1. Vodermaier A, Linden W, MacKenzie R, Greig D, Marshall C. Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer. Br J Cancer. 2011;12:1814–1817. doi: 10.1038/bjc.2011.503.
    1. Linden W, Vodermaier A, McKenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord. 2012;141:343–351. doi: 10.1016/j.jad.2012.03.025.
    1. Linden W, Yi D, Barroetavena MC, MacKenzie R, Doll R. Development and validation of a psychosocial screening instrument for cancer. Health Qual Life Outcomes. 2005;3:54. doi: 10.1186/1477-7525-3-54.
    1. Linden W, Vodermaier A, MacKenzie R, Barroetavena M, Yi D, Doll R. The Psychosocial Screen for Cancer (PSSCAN): further validation and normative data. Health Qual Life Outcomes. 2009;7:16. doi: 10.1186/1477-7525-7-16.
    1. Bewick V, Cheek L, Ball J. Statistics review 12: survival analysis. Crit Care. 2004;8:389–394. doi: 10.1186/cc2955.
    1. The surveillance and outcomes unit population oncology (2010) BC Cancer Agency Survival Statistics 2007. . Accessed 25 May 2012
    1. Lopresti AL, Hood SD, Drummond PD. A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord. 2013;148:12–27. doi: 10.1016/j.jad.2013.01.014.
    1. Berk M, Sarris J, Coulson CE, Jacka FN. Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl. 2013;443:38–54. doi: 10.1111/acps.12124.
    1. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134:459–478. doi: 10.1007/s10549-012-2114-5.
    1. Güth U, Myrick ME, Kilic N, Eppenberger-Castori S, Schmid SM. Compliance and persistence of endocrine adjuvant breast cancer therapy. Breast Cancer Res Treat. 2012;131:491–499. doi: 10.1007/s10549-011-1801-y.
    1. Avis NE, Crawford S, Manuel J. Quality of life among younger women with breast cancer. J Clin Oncol. 2005;23:3322–3330. doi: 10.1200/JCO.2005.05.130.
    1. Schover LR. Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr. 1994;16:177–182.
    1. Wong-Kim EC, Bloom JR. Depression experienced by young women newly diagnosed with breast cancer. Psychooncology. 2005;7:564–573. doi: 10.1002/pon.873.
    1. Cluze C, Rey D, Huiart L, BenDiane MK, Bouhnik AD, Berenger C, Carrieri MP, Giorgi R. Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol. 2012;23:882–890. doi: 10.1093/annonc/mdr330.
    1. Armaiz-Pena GN, Lutgendorf SK, Cole SW, Sood AK. Neuroendocrine modulation of cancer progression. Brain Behav Immun. 2009;23:10–15. doi: 10.1016/j.bbi.2008.06.007.
    1. McEwen BS, Seeman T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Ann NY Acad Sci. 1999;896:30–47. doi: 10.1111/j.1749-6632.1999.tb08103.x.
    1. Olson R, Parkinson M, McKenzie M. Selection bias introduced by neuropsychological assessments. Can J Neurol Sci. 2010;37:264–268.
    1. Hinz A, Krauss O, Hauss JP, Höckel M, Kortmann RD, Stolzenburg JU, Schwarz R. Anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care (Engl) 2010;19:522–529. doi: 10.1111/j.1365-2354.2009.01088.x.
    1. Hopwood P, Sumo G, Mills J, Haviland J, Bliss JM. The course of anxiety and depression over 5 years of follow-up and risk factors in women with early breast cancer: results from the UK Standardisation of Radiotherapy Trials (START) Breast. 2010;19:84–91. doi: 10.1016/j.breast.2009.11.007.
    1. Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol. 2011;29:413–420. doi: 10.1200/JCO.2010.28.4455.
    1. Duijts SF, Faber MM, Oldenburg HS, van Beurden M, Aaronson NK. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors–a meta-analysis. Psychooncology. 2011;20:115–126. doi: 10.1002/pon.1728.
    1. Jacobsen PB, Phillips KM, Jim HS, Small BJ, Faul LA, Meade CD, Thompson L, Williams CC, Jr, Loftus LS, Fishman M, Wilson RW. Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology. 2013;22:1229–1235. doi: 10.1002/pon.3122.

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