Depression before, after diagnosis linked to higher risk for breast cancer death
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Key takeaways:
- Nearly 30% of women did not receive guideline-recommended breast cancer therapy.
- Researchers found no significant differences in survival between women with persistent depression and those with no depression.
A depression diagnosis before and after a breast cancer diagnosis appeared associated with worse survival outcomes, according to study results published in Cancer.
The findings indicate that early detection and continued management of depression are imperative to improve patient survival, researchers concluded.
Rationale and methodology
As many as 25% of patients with breast cancer experience depression, which may affect adherence to guideline‐recommended treatment, according to study background. However, data are limited on associations of the timing of depression diagnosis with cancer treatment and survival outcomes.
For this reason, researchers examined data on 6,054 women (median age, 70 years; range, 23-101) diagnosed with primary invasive breast cancer and included in the Kentucky Cancer Registry between 2007 and 2011.
Researchers used multivariable logistic regression and Cox regression to examine the impact of depression on receipt of guideline‐recommended treatment and survival.
For the purpose of this study, researchers classified women as having no depression, depression diagnosis only before cancer diagnosis, depression only after cancer diagnosis or persistent depression (depression before and after cancer diagnosis).
Findings
Overall, 3.6% of women had depression before diagnosis only, 4.1% had persistent depression, 6.2% had depression after diagnosis only and 86.1% had no depression diagnosis.
Results showed that 29.2% of women did not receive guideline-recommended cancer treatment.
Researchers found that only women with depression before diagnosis had lower odds for receiving guideline-recommended treatment than women with no depression (OR = 0.75; 95% CI, 0.54-1.04).
Odds of worse survival outcomes appeared higher among women with depression before diagnosis (HR = 1.26; 95% CI, 0.99-1.59) and after diagnosis (HR = 1.51; 95% CI, 1.24-1.83).
“A surprising result from this study is that patients with persistent depression did not experience worse survival compared with patients with no depression,” Bin Huang, DrPH, associate professor at University of Kentucky Markey Cancer Center, said in a press release. “Given that underdiagnosis and undertreatment of depression are common among [patients with cancer], persistent depression could be an indication that patients’ depression may have been well managed. Hence, this particular result suggests the importance of depression screening and management throughout a cancer patient’s care.”
Implications
The use of linked health claims data and cancer registry data demonstrated the value of data linkages across various sources for examining potential health disparities and identifying where improvements in cancer care are needed, Huang said in the release.
“More rigorous studies are needed in depression management and across various cancer sites and patient populations,” he said. “Subsequently, results from these research studies may further shape policies and guidelines for depression management in cancer care.”
References:
- Does depression affect the care and survival of patients with breast cancer? (press release). Available at: www.eurekalert.org/news-releases/985594. Published April, 17, 2023. Accessed April 18, 2023.
- Lei F, et al. Cancer. 2023;doi:10.1002/cncr.34676.
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