Major Depression and Survival in People With Cancer

Abstract

Objective: The question of whether depression is associated with worse survival in people with cancer remains unanswered because of methodological criticism of the published research on the topic. We aimed to study the association in a large methodologically robust study. Methods: We analyzed data on 20,582 patients with breast, colorectal, gynecological, lung, and prostate cancers who had attended cancer outpatient clinics in Scotland, United Kingdom. Patients had completed two-stage screening for major depression as part of their cancer care. These data on depression status were linked to demographic, cancer, and subsequent mortality data from national databases. We estimated the association of major depression with survival for each cancer using Cox regression. We adjusted for potential confounders and interactions between potentially time-varying confounders and the interval between cancer diagnosis and depression screening, and used multiple imputation for missing depression and confounder data. We pooled the cancer-specific results using fixed-effects meta-analysis. Results: Major depression was associated with worse survival for all cancers, with similar adjusted hazard ratios (HRs): breast cancer (

Psychological Symptom Trajectories and Non–Small Cell Lung Cancer Survival: A Joint Model Analysis

“…HRs for the anxiety (GAD7) trajectory (HR = 1.06, To aid in the understanding and contribution of these new findings, Cox model results are provided in Table S2, Supplemental Digital Content, http://links.lww.com/PSYMED/A796, for the reader to compare with those of the JM analyses. Cox models have been the biostatistical "gold standard" for testing the relationship between psychological variables measured at baseline and survival (6,8). Cox models identified significant associations between baseline depressive symptoms and mortality, but for anxiety scores also, for both unadjusted and adjusted models.…”

“…New data show postdiagnosis trajectories of psychological symptoms predicted the risk of premature mortality from advanced NSCLC, even adjusting for the survival benefits of immune and targeted therapies. Substantial evidence underscores the need for psychological therapies to address the common comorbidities of stress, depression, and anxiety with advanced NSCLC (2,8,21). Without interventions, worries will remain regarding patients having suboptimal understanding of their disease and its treatment (36), impaired decision making and engagement in treatment (37,38), lowered tolerance of symptoms and treatment adverse effects (39,40), and poor motivation to maintain functional status (41,42).…”

“…Prior studies have found negative emotions, particularly depression, to be associated with mortality in cancer patients. Using Kaplan-Meyer estimates and Cox models (2,6,7), meta-analyses find that baseline assessments are associated with shortened survival across cancer types (6), including those with depression and lung cancer (n = 4476; hazard ratio [HR] = 1.39; 95% confidence interval [CI] = 1.24-1.56) (8). It may be that psychological symptoms after diagnosis add to mortality risk, but this possibility has not been examined, nor have patients been studied since the advent of immunotherapy and targeted therapies.…”

Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study

“…Previous studies have also shown that gynecological cancer survivors had the highest level of anxiety compared to survivors of other cancers [ 4 ], and breast cancer survivors had the highest depression score compared to those who experienced other cancers [ 5 ]. Psychological pain such as depression and anxiety in female cancer survivors can lead to reduced quality of life [ 2 ], lower treatment compliance [ 6 ], and lower survival rates [ 7 , 8 ]; therefore, it must be monitored and managed promptly.…”

Longitudinal Association of Universal Screening and Treatment for Major Depressive Disorder with Survival in Cancer Patients

“…Similarly, in two other follow-up studies, depression was correlated with the worse survival prognosis of colorectal cancer [ 9 , 11 ]. In a large-scale follow-up study, major depressive disorder (MDD) was associated with worse survival in patients with several common cancers, with a similarly increased hazard value [ 16 ]. In two similar studies, both depression and inflammation independently predicted inferior survival in patients with advanced lung cancer.…”