Past depression tied to worse breast cancer survival chances


Women with a history of depression may have lower survival chances with breast cancer than patients without past mental health problems, research in Denmark suggests.

In the study of more than 45,000 women with early stage breast cancer malignancies, 13 percent of the patients previously treated with antidepressants died within five years after the cancer diagnosis, compared with 11 percent of the women who have never medications for depression.

“We did not find that women with depression were diagnosed at a later stage,” said lead study author Dr. Nis Palm Suppli, of the Danish Cancer Society Research Center in Copenhagen.

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Instead, women with depression may be less likely to start or continue recommended treatments, based on individual factors, such as patient age, tumor size, the type of cancer and how far it has spread in the body, Suppli added by e-mail.

Many people develop depression as a result of a cancer diagnosis, but to identify the potential impact of depression on cancer prognosis, rather than the other way around, researchers focused on women with a history of depression before the diagnosis of cancer, the study team writes in the Journal of Clinical Oncology.

They analysed the data on the Danish women diagnosed with breast cancer from 1998 to 2011.

Overall, 6,068 women, or 13 percent, had been treated with antidepressants and other 744, or 2 percent, had previously been hospitalized for depression.

The women had a history of depression, they were 14 percent more likely to receive breast cancer care that do not follow the recommended guidelines for the treatment, the study found.

With a depression history, women were also 21 percent more likely to die of any cause during the study, and 11 percent more likely to die from breast cancer.

The study doesn’t prove depression causes worse outcomes for women with breast cancer.

Even so, the findings suggest that doctors need to be extra careful with women with a history of depression or patients begin any recommended treatment and to continue with therapy may sometimes be necessary for a number of years, Suppli said.

That is because the depression could lead some women to miss treatments or not taking daily medication as prescribed. In the worst cases, depression can also lead to suicidal thoughts that make women stop with the treatment of cancer.

Previous research also suggests certain antidepressants may cause some breast-cancer drugs less effective when they are taken at the same time.

A limitation of the study is that the researchers lacked data about depression that can mean that some women will be counted if the absence of a history of mental illness might actually have one, the authors note. They also lacked the data needed to identify women with undiagnosed or untreated depression, or women who receive psychotherapy without medication for the condition.

Still, the findings show the potential for depression to have an effect on the care women, said Dr. Harold Burstein, a researcher at the Harvard Medical School in Boston and a breast cancer expert for the American Society of Clinical Oncology.

“It remains unclear why a history of depression may be linked to less favourable results,” Burstein, who was not involved in the study, said by e-mail.

“The concern is that depression may represent a risk for standard care,” Burstein added. “For example, maybe women who are depressed are less likely to get mammography, or to receive timely evaluations and treatment for breast cancer, but this is just speculation.”

SOURCE: Journal of Clinical Oncology, online November 14, 2016.

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