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Depression linked to shorter survival among those with prostate cancer
Men with moderate- to high-risk prostate cancer and a recent diagnosis of depression were less likely to undergo definitive treatment, and they also demonstrated shorter OS, according to recent findings.
“Whereas depression has been associated with an increased likelihood of receipt of noncurative treatment, as well as lower overall survival for other cancers, including breast cancer and hepatobiliary carcinoma, little is known about the relationship between depression and diagnosis, treatment and outcomes in prostate cancer,” Jim Hu, MD, director of robotic and minimally invasive surgery at the David Geffen School of Medicine at UCLA, and colleagues wrote.
Jim Hu
In the population-based, observational cohort study, Hu and colleagues utilized SEER Medicare-linked data to identify 41,275 men with clinically localized prostate cancer from 2004 to 2007, observed through 2009. Eligible participants were aged at least 67 years.
The researchers stratified patients into National Comprehensive Cancer Network risk groups, and history of depressive disorder was determined based on diagnostic codes. Based on this information, the researchers determined that 1,894 men had been diagnosed with a depressive disorder during the 2 years before prostate cancer diagnosis. They evaluated the relationship between prior depression diagnosis and treatment/survival outcomes.
Demographic characteristics associated with depressed men included: older age, white or Hispanic race, unmarried status, residence in nonmetropolitan areas, lower median income, and more comorbid conditions (P<.05). However, there was no difference noted in pretreatment disease characteristics between men who were depressed and those who were not.
Adjusted analyses revealed that men with depressive disorder were more likely to undergo watchful waiting for low-, intermediate- and high-risk disease (P≤.05). Depressed men were less likely to undergo definitive interventions such as surgery or radiation across all risk levels (P<.01).
In addition, researchers observed an overall worse mortality incidence among depressed men at all risk levels (low: RR=1.86; 95% CI, 1.48-2.33; intermediate: RR=1.25; 95% CI, 1.06-1.49; high: RR=1.16; 95% CI, 1.03-1.32).
“Although [expectant management] may be appropriate for elderly men with low-risk disease, depression may blunt the aggressiveness of treatment for intermediate- and high-risk disease,” Hu and colleagues wrote. “Considering the marked prevalence of both prostate cancer and depression, additional efforts are needed to better understand and ameliorate the decreased survival following prostate cancer diagnosis in the depressed male patient.”
Disclosure: The researchers report no relevant financial disclosures.