Addressing depression can improve quality of life, treatment outlook among patients with lung cancer
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Lung cancer remains the No. 1 cause of cancer-related death worldwide.
Non-small cell lung cancer comprises 85% of all cases, and many patients present with stage IV disease.
Such a diagnosis often triggers anxiety and a sense of hopelessness. A study published in the journal Lung Cancer showed roughly one-third of patients newly diagnosed with NSCLC experience moderate to severe symptoms of depression.
“If you mention lung cancer to someone on the street, they’ll likely have a very negative reaction,” Barbara L. Andersen, PhD, lead author of the study and professor of psychology at The Ohio State University, said in an interview with Healio. “People walking in the door for a diagnosis also have that view. What they don’t realize is that lung cancer treatment or those with advanced disease is being revolutionized with the advent of new immunotherapies and targeted therapies.”
The study by Andersen and colleagues evaluated data on 186 patients with newly diagnosed stage IV NSCLC at one cancer center. The patients completed a telephone survey that assessed psychological and physical symptoms, stress, and daily functioning. The study showed 8% of the patients had severe depressive symptoms, 28% had moderate depressive symptoms, and 64% had mild or no depressive symptoms.
Andersen spoke with Healio about the study and its implications, and the need for more psychological interventions for patients with lung cancer.
Question: What prompted you to study depression among patients with NSCLC?
Answer: There’s very little data for this important patient group. More data come from larger, population-based studies that have looked at depression, anxiety or stress for patients with cancer. When you look at those studies, across patients with cancer, those with lung cancer have the highest levels of distress. The other unique thing about our study is that all patients were recently diagnosed. Diagnosis is a very difficult time for all patients with cancer, but those newly diagnosed with lung cancer are at high risk for symptoms of depression. Most being unfamiliar with the world of cancer, few know about the progress that has been made in treatment. They just know that this is an exceedingly difficult disease, and in many cases, they are learning that they are at a late stage. Not surprising but unfortunate, some people may decide not to even pursue treatment.
Q: Do patients usually stick with that decision? Or is it just an initial reaction?
A: We have follow-up data on a subset of these participants; about 6% of the sample decided not to have treatment. Indeed, without treatment, most declined sharply at about 4 months or sooner. Those who decided to receive treatment had a very different course. They are living well beyond 4 months, and some much longer — as long as 18 months.
Q: What impact did social factors have on the extent of depression among these individuals?
A: Variables like marital status predict survival for every disease. People who have a partner survive longer than those without. Over the years, the same has been found for people who have broader social networks — more friends and family. In our study, people who had the most severe symptoms had a smaller social network. Those with moderate or severe depression also were more likely to have comorbid anxiety, traumatic stress, impaired functional status, pain and other physical symptoms.
Q: Should more psychological resources be offered to patients with lung cancer at diagnosis?
A: Absolutely. Psychological treatments seldom are available to patients with cancer; it’s the unique center that has those resources. It’s been only recently mandated that patients be screened for psychological symptoms. Beyond screening, it’s important to provide resources to these patients once you identify them. A study we did years ago included patients with stage II and stage III breast cancer who were randomly assigned to receive a psychological intervention delivered in small groups vs. no treatment. We found that the intervention arm had significantly reduced risk of recurrence, our primary endpoint. Among those who did recur, those in the intervention arm lived longer — approximately 18 months. So, referring or providing patients with resources is very important. Patients can improve their adjustment and quality of life by having access to psychological resources.
Another important message of this paper is that depressive symptoms do not occur in isolation. They come with all sorts of other problems that make life difficult, aside from the physical symptoms. These patients had poor functional status and a very pessimistic view of their disease and treatment. Depression can be a driver of many difficulties, and treatment for these patients needs to be multifocal. They’re not only depressed; in many cases, they’re debilitated.
Q: Do you think oncologists need to become more aware of psychological symptoms among their patients?
A: Yes. Some physicians who aren’t very familiar with depression might look at a study like ours and think, “Of course they’re depressed. They have lung cancer.” However, moderate to severe symptoms — or major depressive disorder — is much more than low mood but pervasive disruption of emotions, thoughts, and behaviors . Another common misconception is that when a person starts treatment, they will “get better.” That can occur for some people, but major depressive disorder doesn’t go away just because you’ve started treatment. This manner of thinking is not intentionally dismissive. It just may be a product of less familiarity with the other symptoms of depressive disorder, and/or less appreciation of the long duration and severity of the trajectory of symptoms that will follow during treatment and beyond. – by Jennifer Byrne
Reference:
Andersen BL, et al. Lung Cancer. 2020;doi:10.1016/j.lungcan.2019.11.015.
For more information:
Barbara L. Andersen, PhD, can be reached at 149 Psychology Building, 1835 Neil Ave., Columbus, OH 43210; email: andersen.1@osu.edu.
Disclosure: Andersen reports no relevant financial disclosures.
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