Does depression affect the care and survival of patients with breast cancer?

According to a recent study published in CANCER, a peer-reviewed journal of the American Cancer Society, individuals who experienced depression either before or after a breast cancer diagnosis had a diminished likelihood of survival. The study, conducted by Wiley online, sheds light on the negative impact of depression on breast cancer prognosis, highlighting the importance of addressing mental health in cancer care to improve patient outcomes.

In this study, led by Bin Huang, DrPH, from the University of Kentucky Markey Cancer Center, the researchers utilized data from the Kentucky Cancer Registry to investigate the association between depression and breast cancer outcomes. The study focused on adult women who were diagnosed with primary invasive breast cancer between 2007 and 2011. Using health claims-linked cancer registry data, the patients were categorized into four groups: those with no depression diagnosis, those with a depression diagnosis only before the cancer diagnosis, those with a depression diagnosis only after the cancer diagnosis, and those with persistent depression, defined as experiencing depression both before and after the cancer diagnosis. Additionally, the team examined whether patients received the first course of treatment recommended by the National Comprehensive Cancer Network breast cancer treatment guidelines.

Out of the 6,054 patients included in the study, 4.1% experienced persistent depression, 3.7% had depression only before the breast cancer diagnosis, and 6.2% had depression only after the breast cancer diagnosis. Analysis revealed that 29.2% of patients did not receive guideline-recommended treatment for breast cancer. Furthermore, over a median follow-up period of 4 years, 26.3% of the patients in the study died. These findings highlight the significant prevalence of depression among breast cancer patients and the concerning rates of suboptimal treatment, as well as the impact of depression on overall survival in this population. Further research and interventions addressing mental health in breast cancer care may be crucial for improving patient outcomes.

When compared to patients without depression, those with depression only after diagnosis or persistent depression had similar likelihoods of receiving guideline-recommended treatment. However, patients with depression only before diagnosis had 25% lower odds of receiving guideline-concordant care, although this finding was only marginally significant. Further research is needed to better understand the potential reasons for this association between pre-diagnosis depression and reduced likelihood of receiving guideline-recommended treatment for breast cancer. Identifying the underlying factors that contribute to this disparity in care could inform the development of interventions to address this issue and ensure that breast cancer patients with a history of depression receive appropriate and timely treatment in accordance with established guidelines.

The study findings revealed that both depression only before diagnosis and depression only after diagnosis (but not persistent depression) were associated with worse survival outcomes compared to patients with no depression. Specifically, depression before diagnosis was linked with a 26% higher risk of death, while depression after diagnosis was associated with a 50% higher risk of death. Moreover, patients who did not receive guideline-recommended treatment for breast cancer faced a staggering 118% higher risk of death compared to those who received recommended care. These results emphasize the significant impact of depression and suboptimal treatment on breast cancer prognosis, underscoring the need for comprehensive mental health assessments and adherence to established treatment guidelines to optimize outcomes for breast cancer patients. Further research and interventions to address these associations are warranted to improve the overall well-being and survival of breast cancer patients.

Compared with patients residing in non-Appalachian Kentucky, patients residing in Appalachia were 18% less likely to received recommended care, but investigators did not find any significant differences in survival.

The findings suggest that diagnosing and treating depression at the time of breast cancer diagnosis and beyond can be critical to patient care and survival.

Dr. Huang, the lead researcher of the study, noted that a surprising finding was that patients with persistent depression did not show worse survival outcomes compared to patients with no depression. This could potentially indicate that patients with persistent depression may have received appropriate management of their depression during their cancer care. This highlights the importance of regular depression screening and effective management of depression throughout the entire course of cancer treatment. As depression is often under-diagnosed and under-treated among cancer patients, this finding underscores the need for healthcare providers to proactively screen for depression and ensure that adequate support and interventions are in place to address the mental health needs of cancer patients. Comprehensive management of both physical and mental health aspects can contribute to improved outcomes and overall well-being for cancer patients.

Dr. Huang noted that population-based cancer registry data enhance population-based cancer outcomes research. “Utilizing linked health claims data and cancer registry data in this study demonstrated the value of data linkages across various sources for examining potential health disparities and identifying where improvements in cancer care are needed,” he said. “More rigorous studies are needed in depression management and across various cancer sites and patient populations. Subsequently, results from these research studies may further shape policies and guidelines for depression management in cancer care.”

About the Journal

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow us on Twitter @JournalCancer.

About Wiley

Wiley is one of the world’s largest publishers and a global leader in scientific research and career-connected education. Founded in 1807, Wiley enables discovery, powers education, and shapes workforces. Through its industry-leading content, digital platforms, and knowledge networks, the company delivers on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.