Patients With Breast Cancer and Depression May Have a Lower Likelihood of Survival

Patients who experienced depression before or after a breast cancer diagnosis have a lower likelihood of survival, according to Bin Huang, PhD, an associate professor at the University of Kentucky Markey Cancer Center in Lexington, and his colleagues who published their findings in Cancer, a peer-reviewed journal of the American Cancer Society.^1,2

Woman struggling with depression | Image credit: Kittiphan - stock.adobe.com

Although depression is known to be common among patients with breast cancer, the impact of depression on cancer treatment and survival remains understudied, particularly its association with diagnosis timing. According to the study investigators, neglecting to address and manage depression in patients following a breast cancer diagnosis can result in poorer cancer treatment adherence and lead to worse survival outcomes.²

In the study, Huang and colleagues analyzed data from the Kentucky Cancer Registry to identify adult women 20 years and older who received diagnoses of primary invasive breast cancer between 2007 and 2011. The investigators then classified patients into the following groups: no depression, depression precancer diagnosis only, depression postcancer diagnosis only, or persistent depression (defined as depression before and after cancer diagnosis).^1,2

Using multivariable logistic regression, the investigators assessed the impact of depression on patients who received National Comprehensive Cancer Network (NCCN) guideline–recommended breast cancer treatment; survival was examined using Cox regression.^1,2

The investigators analyzed data from 6054 eligible patients. Among these patients, 4.1% had persistent depression, 3.7% had depression prediagnosis only, and 6.2% had depression post diagnosis only. In total, 1770 (29.2%) patients did not receive NCCN guideline–recommended breast cancer treatment. Additionally, at a median follow-up of 4 years, the investigators observed that 26.3% of patients had died.²

“Utilizing linked health claims data and cancer registry data in this study demonstrated the value of data linkages across various sources for examining potential health disparities and identifying where improvements in cancer care are needed,” Huang said in a news release.¹

Based on the data, the investigators found that the likelihood of receiving NCCN guideline–recommended treatment decreased in patients with depression prediagnosis only when compared with patients with no depression (odds ratio, 0.75; 95% CI, 0.54-1.04), but this decrease did not occur in patients with only postdiagnosis depression or persistent depression. Further, patients who experienced depression post diagnosis only (HR, 1.51; 95% CI, 1.24-1.83) and depression prediagnosis only (HR, 1.26; 95% CI, 0.99-1.59) had worse survival outcomes. However, investigators found no significant survival difference between patients with persistent depression and patients with no depression (P > .05).²

“A surprising result from this study is that patients with persistent depression did not experience worse survival compared with patients with no depression,” Huang said in the news release. “Given that underdiagnosis and undertreatment of depression are common among [patients with cancer], persistent depression could be an indication that patients’ depression may have been well managed. Hence, this particular result suggests the importance of depression screening and management throughout a [patient with cancer’s] care.”¹

Based on the study data, the investigators noted that early detection and consistent management of depression in patients with cancer are important components of cancer care. Depression and other mental health concerns, although traditionally outside the scope of the oncologist and oncology pharmacist, can impact the trajectory of treatment and associated outcomes, making depression management a necessity to support improved survival outcomes.^1,2

“More rigorous studies are needed in depression management and across various cancer sites and patient populations,” Huang said. “Subsequently, results from these research studies may further shape policies and guidelines for depression management in cancer care.”¹