History Of Depression Predicts Poorer Early-Stage Breast Cancer Outcomes

Women who have received treatment for depression have reduced early-stage breast cancer survival

medwireNews: Study findings from Denmark highlight an increased risk of poor survival in women with early-stage breast cancer who have previously been treated for depression.

“[W]e found that women treated for depression before the breast cancer diagnosis were at greater risk for not initiating guideline adjuvant systemic therapy, which probably partly explains the modest but significant increased risks of death and of breast cancer–specific death in this group”, write Nis Suppli, from the Danish Cancer Society Research Center in Copenhagen, and co-investigators.

 “Our findings underline the importance of identifying women with previous depression to increase initiation of adjuvant systemic breast cancer therapy and of following up such women carefully to identify depressive relapse, nonadherence to breast cancer therapy, and suicidal ideation”, they emphasise in the Journal of Clinical Oncology.

The researchers reviewed data from a nationwide cohort of 45,325 women diagnosed with early-stage breast cancer between 1998 and 2011; 2% of the patients had a history of inpatient or outpatient hospital treatment for depression and 13% had received antidepressant therapy.

Tumour stage at diagnosis was comparable in patients who had never used antidepressants, who had used antidepressants or who had hospital contact for depression, indicating that depression was not associated with a delay in breast cancer diagnosis, the authors say.

However, women who had received antidepressants before breast cancer diagnosis were significantly more likely to receive treatment that did not follow national guidelines set out by the Danish Breast Cancer Group than those who had never been prescribed antidepressants (odds ratio [OR]=1.14).

These patients also had significantly poorer overall survival and breast cancer-specific survival than nonusers with hazard ratios (HRs) of 1.21 and 1.11, respectively.

Patients who had a hospital contact for depression also had a greater risk of receiving non-guideline treatment and poorer survival, although these did not reach statistical significance.

There was also a significant HR for death by suicide for both women who used antidepressants and those with a hospital contact for depression compared with patients who had neither risk factor, at 5.38 and 19.81, respectively.

Subgroup analysis focusing on women with high-risk breast cancer who did not receive guideline-recommended adjuvant systemic therapy confirmed significantly poorer breast cancer-specific survival for patients who used antidepressants, and a trend towards poorer survival in those with a hospital contact, with HRs of 1.51 and 1.57, respectively.

But among high-risk breast cancer patients who received adjuvant systemic therapy as per guidelines, antidepressant use or having had a hospital contact for depression did not alter the risk of breast cancer-specific survival.

“Our finding that women previously treated for depression are at increased risk for not receiving guideline breast cancer treatment indicates the potential for improvement of breast cancer treatment of a large, vulnerable group of patients”, Nis Suppli et al comment.

While women with a history of antidepressant use or a hospital contact for depression were more likely to have a high burden of severe somatic comorbidity than those with no history of antidepressant use, survival remained poorer after adjusting for this factor.

“We therefore suggest that the worse survival after breast cancer of women with previously treated depression is related not only to an increased risk of death before diagnosis of breast cancer but also to the breast cancer per se”, they conclude.

Reference

Suppli NP, Johansen C, Kessing LV, et al. Survival after early-stage breast cancer of women previously treated for depression: A nationwide Danish cohort study. J Clin Oncol; Advance online publication 14 November 2016. DOI: 10.1200/JCO.2016.68.8358

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