Worsening symptoms of depression linked to shorter survival for patients with lung cancer
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Patients with lung cancer whose depression symptoms became more severe after diagnosis had significantly shorter survival than patients with stagnant or improved symptoms, according to study results published in Psychosomatic Medicine.
The study is the first to examine how the trajectory of depressive symptoms affects survival of patients with lung cancer, according to a press release from The Ohio State University.
“Data show post-diagnosis trajectories of psychological symptoms predicted risk for premature mortality from advanced non-small cell lung cancer, even controlling for the survival benefits of immune and targeted therapies,” Barbara L. Andersen, PhD, distinguished university professor in the department of psychology at The Ohio State University, told Healio. “Substantial evidence underscores the need for psychological therapies to address the common comorbidities of stress, depression and anxiety with advanced NSCLC.”
Andersen added that improvement of patients’ psychological status may help prolong quality of life and, potentially, OS. Meanwhile, if depressive symptoms go untreated, patients may have a suboptimal understanding of their disease and treatment, impaired decision-making or engagement in treatment, lower tolerance for symptoms and treatment adverse events, and low motivation to maintain functional status, she said.
“Lung patients have received so little attention in psychosocial research. They are in the midst of a treatment revolution, but the significant problems with depression remain,” Andersen said. “We are trying to send an alarm about their psychological needs.”
The analysis included 157 patients (mean age, 63.76 years; standard deviation, 10.74 years; 56.7% men; 93% white) with stage IV non-small cell lung cancer at The Ohio State University Comprehensive Cancer Center from June 2017 to October 2019.
Andersen and colleagues collected completed questionnaires on validated measures for depressive and anxiety symptoms at the time of diagnosis and assessed patients regularly — monthly through 8 months and then bimonthly through death or 24 months (80% average completion rate).
Approximately 28% of patients had moderate depression levels at diagnosis, whereas 8% had moderate to severe levels and the remainder had lower levels. In addition, 6% had moderate anxiety levels and 18% had moderate to severe levels.
Researchers used joint statistical models for simultaneous modeling of longitudinal (psychological) and time-to-event (survival) processes. They also accounted for age, race, employment status, income level and smoking status — other factors that can influence survival — in their analyses.
Median follow-up was 8.7 months (range, 1.1-31.4).
Results showed depression and anxiety symptoms significantly decreased with time since diagnosis, but the trajectory of depressive symptoms appeared significantly associated with cancer survival after adjustment for covariates (HR per unit increase in patient health questionnaire score = 1.09; 95% CI, 1.03-1.15). Additionally, researchers reported marginally significant anxiety in the unadjusted model but not in the adjusted model.
Patients with no depression or only mild levels 3 months after diagnosis had more than a 50% chance of surviving 15 months, compared with closer to a 30% chance for those with moderate to severe depression levels, according to a press release.
“Depression is a toxic psychosocial and behavioral symptom relevant to predicting overall mortality, regardless of whether or not chronic illness is present,” Andersen told Healio.
Patients who received newer treatments that have dramatically improved survival for many patients with lung cancer also saw their lives shortened if they had worsening depression, the press release stated.
“Even as impressive new treatments are coming online, their efficacy may be constrained for those patients also struggling with depression,” Andersen said in the release. “These data are novel in suggesting continuing depression as a significant limiting factor, even when the best therapies we have for lung cancer are being used.”
She added that the study’s results were “incredibly persuasive evidence” for the need to help these patients, beyond diagnosis, with depressive symptoms.
“Our research shows that psychological interventions delivered during this period — the early months following diagnosis — have shown robust biobehavioral effects and reduced risk for recurrence in other [patients with cancer],” Andersen told Healio. “Our intention is to conduct a randomized trial with these patients to test the efficacy of depression treatment for improving survivorship and reducing risk for premature death.”
References:
Andersen BL, et al. Psychosom Med. 2021;doi:10.1097/PSY.000000000000102710.1097.
Worsening depression cuts survival in lung cancer patients. https://news.osu.edu/worsening-depression-cuts-survival-in-lung-cancer-patients/. Published Oct. 12, 2021. Accessed Dec. 15, 2021.
For more information:
Barbara L. Andersen, PhD, can be reached at Department of Psychology at The Ohio State University, 1835 Neil Ave., Columbus, OH 43210-1222; email: andersen.1@osu.edu.
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