Depression Before and After a Diagnosis of Pancreatic Cancer

Abstract

Objectives The aim of this study was to evaluate depression in pancreatic cancer (PC) patients before and after a cancer diagnosis using a US-based healthcare database. We also sought to study the impact of treatment of depression in PC patients on all-cause mortality. Methods Pancreatic cancer patients with comorbid depression in Explorys (1999–2019) were compared with controls using odds ratios with 95% confidence intervals. Rates of depression diagnosed within 6 months, 1 year, and 3 years before and after a PC diagnosis were recorded. Patients who developed depression after a PC diagnosis were further categorized into those treated for depression using mental health professionals (MHPs), pharmacologic treatment, or both (2015–2019). Results Of the 62,450 PC patients, 10,220 (16.4%) were diagnosed with depression before PC and 8130 (13%) were diagnosed with depression after PC. Patients diagnosed with depression after PC had a significantly higher all-cause mortality than patients with PC alone (P < 0.0001). Involvement of MHP significantly improved all-cause mortality (P = 0.0041). Conclusions Most post-PC depression is diagnosed in the first 6 months after a PC diagnosis. Although depression significantly increases PC mortality, integrating MHP in the care of PC patients with depression improves outcomes.

Prodromal depression and anxiety are associated with worse treatment compliance and survival among patients with pancreatic cancer

“…Of note, a recent report demonstrated that over 90% of patients diagnosed with depression in the year preceding diagnosis of PC were diagnosed in the 6-month period immediately preceding identification of PC. 12 Prediagnosis depression and anxiety were not recorded when documentation stated that these conditions were secondary to the diagnostic work-up or knowledge of PC.…”

“…[5][6][7][8] Patients with PCassociated depression or anxiety suffer worse outcomes, including a poor quality of life, reduced compliance with treatment, 3,[9][10][11] and reduced survival. 11,12 Thus, effective mental health screening and treatment of psychiatric symptoms may have important oncologic ramifications. 12 Physicians may underappreciate that PC is frequently foreshadowed by depression or anxiety, similar to presenting signs like unintentional weight loss or new-onset or worsening diabetes.…”

“…11,12 Thus, effective mental health screening and treatment of psychiatric symptoms may have important oncologic ramifications. 12 Physicians may underappreciate that PC is frequently foreshadowed by depression or anxiety, similar to presenting signs like unintentional weight loss or new-onset or worsening diabetes. 4,13 The first reported observation of prodromal psychiatric symptoms was published in 1931.…”

“…Four patients developed diverse psychiatric symptoms (e.g., anxiety, depression, restlessness, anorexia, fatigue, insomnia, or nervousness) prior to diagnosis of PC. 14 Subsequent reports validated depression [10][11][12][15][16][17][18][19][20][21][22] or anxiety 20,23,24 as a common presentation of PC. The prodromal nature of these symptoms suggests there may be an underlying biologic mechanism.…”

Artificial Intelligence and Early Detection of Pancreatic Cancer

“…Several forums were subsequently presented by Kenner Family Research Fund, including the 2015 Early Detection of Pancreatic Cancer: Lessons Learned from Other Cancers 6 and the 2016 The Role of Industry in the Development of Biomarkers . 7 In 2018, the Role of Depression and Anxiety as a Precursor for Disease 8 , 9 was the core presentation in a symposium at the American Pancreatic Association. After these initiatives and the publication of several articles for dissemination to the broader community, significant additional funding was invested in early detection research.…”