Postsurgical Depressive Symptoms and Proinflammatory Cytokine Elevations in Women Undergoing Primary Treatment for Breast Cancer

Abstract

Objective Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and cancer patients. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early stage BCa before beginning adjuvant treatment. Method Women with stage 0–III BCa were recruited approximately 4–8 weeks post-surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression and blood samples were collected to quantify circulating levels of IL-1β, IL-6, and TNF-α by ELISA. ANCOVAs were used to test for group differences (elevated vs. low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results Thirty-six of 89 (40%) patients showed elevated levels of depressive symptoms, and in adjusted models had marginally higher levels of IL-1β (M=14.49, 95% CI [6.11, 32.65] vs. M=4.68, 95% CI [1.96, 9.86]) and significantly higher levels of TNF-α (M=17.07, 95% CI [8.27, 34.32] vs. M=6.94, 95% CI [3.58, 12.80]) than women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β=0.06, p=0.006, R2=0.25) and TNF-α (β=0.06, p=0.003, R2=0.27). Conclusions Post-surgery and pre-adjuvant treatment for early stage BCa, depressive symptoms covary with elevated levels of multiple pro-inflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.

Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up

“…Cortisol dysregulation, frequently observed in depressed patients [29], predicts shorter overall survival in breast cancer [26], and is a potential mediating pathway [14], In breast cancer patients, inflammatory cytokines are associated with degree of depressive symptoms [30], and evidence suggests that elevated inflammation may promote pathophysiologic processes [3]. Alleviating depressive symptoms during primary treatment may help normalize neuroendocrine and inflammatory processes [31], which could provide health benefits.…”

Predictors of psychological distress in breast cancer survivors: A biopsychosocial approach

“…Although individual variables (both psychological and biological) and social variables have been analysed in relation to breast cancer experience, the biopsychosocial approach to this question is of particular importance, as it analyses the joint, interactive influence of social, psychological and biological variables. Given that low social support has been associated with psychological distress (Hughes et al, ), and that changes in CAR and TNF‐α levels have been associated with both social support and distress (Bouchard et al, ; Copertaro et al, ; Ho et al, ), we expect that social support, age, TNF‐α and CAR, independently or combined, will contribute to psychological distress in breast cancer survivors. Specifically, the present study tested the following hypotheses: Low levels of both perceived social support and CAR, and high levels of TNF‐α will predict a higher level of psychological distress in breast cancer survivors. Low social support will interact with biological variables when facilitating psychological distress. The relation between low social support and psychological distress will be stronger in younger participants. …”

Social well-being is associated with less pro-inflammatory and pro-metastatic leukocyte gene expression in women after surgery for breast cancer

“…We hypothesized that women reporting greater SWB would exhibit less expression of leukocyte genes for pro-inflammatory cytokines, chemokines and their receptors, and other pro-inflammatory and tumor-promoting factors. To explore potential pathways connecting SWB to leukocyte gene expression, we repeated the analyses controlling for depression, given prior links between depressive symptoms and inflammatory indicators [16]. Exploratory analyses assessed whether SWB mediated the relationship between depression and leukocyte gene expression.…”