Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

Abstract

Background Ovarian function suppression (OFS) is indicated in premenopausal women with early or metastasis breast cancer, which may be achieved with similar effect by gonadotropin-releasing hormone agonists (GnRHa) or ovarian ablation (OA). We examined whether there were differences in major depressive symptoms outcomes and its associated factors between gonadotropin-releasing hormone agonists (GnRHa) and ovarian ablation (OA) in premenopausal breast cancer patients. Methods Premenopausal breast cancer patients from seven hospitals who received OFS participated in the study between June 2019 and June 2020. The correlated variable was the type of ovarian suppression, categorized as either OA (n = 174) or GnRHa (n = 389). Major depressive symptoms was evaluated using the Patient Health Questionnaire (PHQ-9), and the Female Sexual Function Index questionnaire was used to assess sexual function. Results A total of 563 patients completed the surveys. The mean PHQ-9 sum score was slightly lower in the GnRHa cohort than in the OA cohort (11.4 ± 5.7 vs. 12.8 ± 5.8, P = 0.079). There were significantly fewer patients with major depressive symptoms (PHQ-9 ≥ 15) in the GnRHa cohort (31.1% vs. 40.2%, Exp (B)=1.805, P=0.004). Further, breast-conserving surgery and sexual dysfunction were negatively correlated with major depressive symptoms [mastectomy vs. breast-conserving: Exp (B) = 0.461, P <0.001;[sexual dysfunction vs. normal: Exp (B) = 0.512, P = 0.001]. Conclusions This is the first study to demonstrate that GnRHa results in more favorable depressive symptoms outcomes than OA. Moreover, most patients preferred alternatives to their OFS treatment. These findings can contribute to improving and alleviating the adverse effects of OFS.

Empowerment-Led Guided Self-Help Intervention for Symptom Burden in Breast Cancer Women Treated With Ovarian Function Suppression: A Randomized Trial Protocol

“…However, OFS treatment causes their estrogen to fall rapidly and remain at postmenopausal levels [ 7 ]. Patients are prone to premature ovarian failure, which affects their fertility and poses a significant challenge to the patient’s physical and mental health [ 8 ].…”

Ovarian Suppression: Early Menopause and Late Effects

“…In the SOFT trial, the incidence of any-grade depression increased from 46.6% to 51.9% with the addition of OFS to endocrine therapy [ 45 ]. Interestingly, recent evidence suggests that the incidence of major depressive symptoms may vary according to the suppression method used, with GnRHa being more commonly associated with depression than ovarian ablation [ 81 ]. The development of anxiety represents an important psychosocial issue in adult cancer survivors, with some data suggesting that it is even more frequent than depression in the long-term [ 82 ].…”

Distress Tolerance in Patients with Metastatic and Non-metastatic Breast Cancer: A Single-center Experience

“…Breast cancer has several negative results such as worse body image and disturbances in sexual life as a result of treatment including mastectomy or breast-conserving surgery (2). Menopause caused by the treatments like chemotherapy, hormonal therapies that cause ovarian function suppression or surgery can be an obstacle in front pregnancy since this cancer is common in women of reproductive age (3). The outcomes of treatment and the process of the disease have been found to be related to depressive symptoms (3).…”

“…Menopause caused by the treatments like chemotherapy, hormonal therapies that cause ovarian function suppression or surgery can be an obstacle in front pregnancy since this cancer is common in women of reproductive age (3). The outcomes of treatment and the process of the disease have been found to be related to depressive symptoms (3). In addition, psychosocial distress has long been identified as a significant issue for breast cancer patients who come up against difficulties in many different areas.…”