Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up

Abstract

Background Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up. Methods From 1998-2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10 weeks post-surgery for nonmetastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15 year follow-up. Results A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56 years; SE=.26) than those in the mild/moderate depressed group (M=11.45 years; SE=.40), Log-rank χ2(1)=4.41, p=.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample. Conclusions Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.

The impact of psychosocial stress and stress management on immune responses in patients with cancer

“…[49][50][51][52] For instance, greater depressive symptoms relate to greater serum tumor necrosis factor α (TNF-α), IL-1β, and IL-6 levels in patients with breast cancer Cancer May 1, 2019 during the weeks after surgery. 51 In that cohort, greater postsurgical depressive symptoms also predicted shorter 11-year overall survival, 53 which is in line with prior reports on patients with breast cancer. 54,55 Greater negative affect and less positive affect in postsurgical patients with breast cancer also were related to greater leukocyte gene expression for proinflammatory cytokines (eg, TNF-α, IL-1B, and IL-6 ), inflammatory chemokines and related receptors (CCL3, CCL3L1, CCL4L2, CCL7, CCL20, C-X-C motif chemokine 10 [CXCL10], CXCR6, and CXCR7), cooxygenase-2/prostaglandin-endoperoxide synthase 2 (COX2/PTGS2), and tissue remodeling and epithelial-mesenchymal transition (EMT)-related genes (eg, lamin A/C [LMNA], MMP-9).…”

Biobehavioral modulation of the exosome transcriptome in ovarian carcinoma

“…There is a substantial literature linking biobehavioral factors such as stress, depression, and social support to disease progression in a variety of cancers, and the molecular mechanisms underlying these relationships are being elucidated in both clinical and preclinical settings . The current data extend this work in an important new direction by suggesting that longitudinal sampling of exosomes may potentially be applied to track changes in tumor biology that stem from changing biobehavioral conditions (eg, in response to a social support intervention).…”

“…Exosomal signaling enables long-range communication between cells within an organism, and this suggests that exosomal signaling may provide an additional pathway by which biobehavioral processes can influence a cancer's biology and treatment response. 19 There is a substantial literature linking biobehavioral factors such as stress, depression, and social support to disease progression in a variety of cancers, 19,49 and the molecular mechanisms underlying these relationships are being elucidated in both clinical 11,30,34 and preclinical settings. 4,50 The current data extend this work in an important new direction by suggesting that longitudinal sampling of exosomes may potentially be applied to track changes in tumor biology that stem from changing biobehavioral conditions (eg, in response to a social support intervention).…”

Emotional distress, brain functioning, and biobehavioral processes in cancer patients: a neuroimaging review and future directions

“…126 Greater depressive symptoms in the weeks after surgery in this cohort were shown to predict shorter survival over an 11-year median followup. 127 Conversely, greater decreases in leukocyte proinflammatory and increases in anti-viral gene expression over the first year of treatment predicted a longer diseasefree interval over this 11-year follow-up. 128 Thus, one way that stress factors (negative affect and depressive symptoms) can influence cancer progression is through their influence on the expression of adversity-associated genes in circulating immune cells and associated cytokines.…”