Potential use of albumin and neutrophil‐to‐lymphocyte ratio to guide the evaluation and treatment of cancer‐related depression and anxiety

Abstract

Background: Depression and anxiety are common and associated with inflammation in patients with cancer. Inflammatory indices such as albumin and neutrophil-tolymphocyte ratio (NLR) obtained from metabolic panels and complete blood counts should be available for mental health professionals treating anxiety and depression at cancer centers. We hypothesized that albumin and NLR extrapolated from non-mental health oncology appointments would be associated with anxiety and depression and drawn close enough to psychiatry visits to be useful for the psycho-oncologist.Materials & Methods: Depression and anxiety were evaluated in patients (n = 97) referred to a cancer center psychiatric service for depression using the Patient Health Questionnaire-9 and General Anxiety Disorder-7. Albumin concentration and NLR were assessed for timing and correlation strength with anxiety and depression by setting (localized/metastatic cancer).Results: Most patients (96%) had albumin or NLR available at any time point of which 45% were drawn within one week of the psychiatric appointment. No significant correlations were noted when evaluating localized cancer or NLR exclusively. For patients with metastatic cancer, anxiety and depression were correlated with albumin at any time point (r = −0.28, p < 0.05; r = −0.40, p < 0.01, respectively) and within a week of psychiatry appointment (r = −0.40, p < 0.05; r = −0.68, p < 0.001, respectively). Albumin evaluated within a week predicted 32% of depression score variance (β = −0.63, p = 0.002). Hypoalbuminemia (<3.8 g/ul) was associated with anxiety (χ2 = 4.43, p = 0.04) and depression (χ2 = 11.06, p = 0.001). Conclusion:Hypoalbuminemia in patients with metastatic cancer may help establish the presence or persistence of anxiety, depression, treatment refractoriness, and the use of inflammation in cancer-related psychological symptom management.

Psychological adverse effects of anxiety and stress in treating patients with cancer

“…Recent studies have analysed the critical role of psychological stressors in association with protective immunity in squamous cell carcinoma (SCC), basal cell carcinoma (BCC), as well as tumours associated with human papillomavirus (HPV) [2]. Other indices of inflammation such as neutrophil-to-lymphocyte ratio and albumin could help health professionals manage successfully oncological patients that have anxiety and depression disorders at Cancer Centres with close visits to psychiatry [4]. It has been shown that a hypoalbuminemia state seen in patients with metastasis is closely correlated with incessant persistence of depression, anxiety and psychiatric treatment management [4].…”

“…Other indices of inflammation such as neutrophil-to-lymphocyte ratio and albumin could help health professionals manage successfully oncological patients that have anxiety and depression disorders at Cancer Centres with close visits to psychiatry [4]. It has been shown that a hypoalbuminemia state seen in patients with metastasis is closely correlated with incessant persistence of depression, anxiety and psychiatric treatment management [4].…”

Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: insights from NHANES

“…McFarland's research further suggests that albumin assessment can help identify the presence of inflammation in the management of depression, anxiety, and related psychological symptoms in patients with metastatic cancer (48). BMI is a fundamental measure of body fat content.…”

“…A retrospective study from Taiwan showed that serum albumin levels in the normal control group were significantly higher than those in patients with severe depression ( 45 ), and additionally, studies have found abnormally high levels of oxidative products in the peripheral blood, red blood cells, and cerebrospinal fluid of individuals with severe depression ( 46 , 47 ). Daniel McFarland’s research further suggests that albumin assessment can help identify the presence of inflammation in the management of depression, anxiety, and related psychological symptoms in patients with metastatic cancer ( 48 ). BMI is a fundamental measure of body fat content.…”

Biomarkers use in psycho-oncology practice: Are we there yet?

“…Another study reported that pro-inflammatory cytokines, such as TNF-α, have a good performance in predicting depression among patients with glioma (Li et al 2022). McFarland and colleagues studied among 97 patients with metastatic cancer demonstrating that hypoalbuminemia may help establish the presence of anxiety or depression, and treatment refractoriness (McFarland et al 2022a). The effectiveness of mind and body therapies for addressing some biomarkers of stress and immune function in people with cancer have been documented, although this evidence is limited (Deleemans et al 2023).…”