C‐reactive protein and its association with depression in patients receiving treatment for metastatic lung cancer

Abstract

BACKGROUND: Depression is highly prevalent in lung cancer. Although there is a known association between inflammation and depression, this relationship has not been examined in patients with lung cancer who undergo treatment with immune and other targeted drug therapies. Peripheral blood C-reactive protein (CRP), a marker of systemic inflammation, may help identify metastatic lung cancer patients with inflammation-associated depression. METHOD: Patients with metastatic lung cancer undergoing treatment were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS). Inflammation (CRP and CRP cutoffs ≥1 and ≥3 mg/mL) and demographic and treatment variables were analyzed for association with depression. RESULTS: One hundred nine consecutive participants exhibited an average plasma CRP concentration of 1.79 mg/mL (median, 0.75 mg/mL [standard deviation, 2.5 mg/mL), and 20.7% had a CRP concentration of ≥3.0 mg/mL; 23.9% met depression screening criteria (HADS ≥8). A log transformation of CRP was significantly correlated with depression severity (r = 0.47, P < .001). CRP was the only covariate to predict depression severity (P = .008) in a multivariate model including lung cancer disease subtype and type of systemic treatment. Receiver operating characteristic analysis indicated that CRP had moderate predictive accuracy in identifying elevated depression (area under the curve = 0.74). A cutoff of CRP ≥3.0 generated high specificity (88%) but identified only 50% of those with elevated depression. CONCLUSION: Elevated CRP is associated with depression in patients with metastatic lung cancer. Thus, CRP may identify a subset of lung cancer patients with inflammation-induced depression and may be useful in predicting response to treatments that target inflammation or its downstream mediators on the brain.

Prenatal stress induced depressive‐like behavior and region dependently high CRP level in offspring rats

“…Numerous clinical studies have shown that a significantly higher circulating CRP level was involved in patients with depression (Iob et al., 2020; Osimo et al., 2019; Wang et al., 2018) and has a lower antidepressants efficacy (Li et al., 2019; Zhang, Yue, et al., 2019). Some other works have showed that heart diseases, cancer patients with depressive symptoms also had a higher CRP level (McFarland et al., 2019; Ravona‐Springer et al., 2020). However, there were also conflicting findings showed that CRP was not associated with depressive symptoms nor response to antidepressant treatment (Miller et al., 2019; Zhang et al., 2018).…”

Tumor Mutation Burden and Depression in Lung Cancer: Association With Inflammation

“…As reported previously, depression was significantly associated with CRP level and treatment type. 52,53 Depression scores were significantly higher in patients receiving chemotherapy and immunotherapy compared with those receiving targeted therapy (see Table 2). In addition, depression was significantly correlated with NLR (r 5 0.21; P5.017) and absolute neutrophil count (r 5 0.24; P5.008).…”

Inflammation and behavioral symptoms in preoperational glioma patients: Is depression, anxiety, and cognitive impairment related to markers of systemic inflammation?

“…According to recent studies, the correlation between inflammatory factors and depressive symptoms is inconsistent across different cancers. For example, in the context of lung cancer, elevated CRP levels are associated with depression in patients with metastatic lung cancer (Mcfarland, Shaffer, Breitbart, Rosenfeld, & Miller, 2018). Conversely, in the context of breast cancer, CRP was not found associated with depressive symptoms (Bower et al., 2011).…”

“…A recent meta-analysis showed a reliable association between inflammatory markers (including CRP, IL-1, and IL-6) and self-reported depressive symptoms, although studies on cancer patients remained extremely limited (Howren, Lamkin, & Suls, 2009). According to recent studies, the correlation between TA B L E 3 Univariate analyses of demographic, inflammatory markers, and physiologic related to behavioral symptoms as measured using the HAMD, HAM-A, and MMSE (Mcfarland, Shaffer, Breitbart, Rosenfeld, & Miller, 2018). Conversely, in the context of breast cancer, CRP was not found associated with depressive symptoms (Bower et al, 2011).…”