Increased Depressive Symptoms Linked to Worse Survival in Lung Cancer Patients

As symptoms of depression worsen, so too does the length of survival in lung cancer patients, according to a study published in the Journal of Clinical Oncology.

This association between mental and physical health was seen particularly in patients who were in the early stages of the disease. While these worsening symptoms were associated with shorter survival, conversely, when depression symptoms were lifted, survival tended to improve.

“Surprisingly, depression remission was associated with a mortality benefit as they had the same mortality as never-depressed patients,” said lead study author Donald R. Sullivan. “This study cannot prove causation — but it lends support to the idea that surveillance for depression symptoms and treatment for depression could provide significant impact on patient outcomes, perhaps even a mortality benefit.”

In the study, researchers followed more than 1700 patients newly diagnosed with lung cancer between 2003 and 2005. Each participant had completed an 8-item depression assessment at diagnosis, and again 1 year later.

The results of the study showed that 40% of patients had depressive symptoms at diagnosis, and 14% developed new-onset symptoms during treatment. Overall findings revealed that those who were depressed at the start of the study were 17% more likely to die during follow-up compared with those who did not have depressive symptoms.

When researchers compared the 640 participants who never developed depressive symptoms, 105 with new on-set symptoms were 50% more likely to die. Furthermore, another 254 patients whose depression symptoms persisted throughout the study were 42% more likely to die.

Interestingly, the participants who had depressive symptoms at diagnosis, but did not have them a year later, had a similar risk of death to those who were never depressed. However, researchers did not have any available data on how or why these particular patients expressed depression remission.

“We have known since the 1970’s that a cancer diagnosis sets off a period of existential plight, a period that lasts about 100 days during which people ask questions of life and death and worry about their health and the meaning of their physical symptoms,” said Mark Lazenby, associate professor at Yale School of Nursing and a member of Yale Cancer Center, who was not involved in the study. “Although for this study we cannot say that treating depression would extend survival, other studies have shown that care aimed at improving the psychosocial well-being, which includes but is not limited to detecting and treating depression, does have a survival benefit.”

Sullivan noted that depression does have an impact on quality-of-life, and has been associated with lower adherence to treatments and missed appointments, which in the end could impact morality.

“Most of all, I believe a positive attitude, fighting spirit, and coping ability significantly impact a patient’s ability to persevere in the face of a life-threatening illness,” Sullivan said. “This is likely why married patients and those with strong social support networks have better cancer outcomes — having a ‘community’ to help share the emotional burden is essential. Clinicians have to do a better job of treating the whole person and not focusing on the disease only. From the patients’ perspective, hopefully some of them will take a look at this study and realize the feelings they are experiencing are common and they will feel empowered to advocate for themselves and ask their clinicians for help or resources when they need it.”