Depression Can Impact Breast Cancer Treatment and Survival

Women with a history of depression were less likely to receive recommended breast cancer care, according to recent research.

Patients with breast cancer who have depression were found to be less likely to receive recommended courses of treatment and saw lower rates of survival, according to a recent study. Experts told CURE® that these findings are consistent with the need for attention to mental health to be part of cancer care.

“There's no question that there is a high degree of depression in patients with cancer, and I do think that depression affects the course of cancer care, delivered and outcomes,” Dr. David Silver, a gynecologic psychiatrist with UPMC with 15 years’ experience as a gynecologic oncologist, said in an interview with CURE®.

A study of more than 6,000 patients diagnosed with primary invasive breast cancer age 20 or older (median age of 70) between 2007 and 2011, published in the journal, Cancer, found that 4.1% (246), 3.7% (221) and 6.2% (375) of patients had persistent depression, depression pre-diagnosis only, and depression post-diagnosis only, respectively.

Nearly a third (1,770, or 29.2%) of patients did not receive guideline-recommended cancer treatment, and the odds of receiving recommend treatment were 75% lower for patients with depression pre-diagnosis. There was no change in likelihood of treatment for patients with post-diagnosis or persistent depression.

Patients with depression pre- or post-cancer diagnosis were significantly more likely to see worse survival rates than patients with no depression, according to the study.

There was no significant difference in survival found between patients with persistent depression and those without depression. Those findings surprised the study’s authors.

“After further investigation, we understand it's because the depression condition is often under-reported, under-diagnosed and under-managed,” said co-author Bin Huang of the division of cancer biostatistics, department of internal medicine, at the University of Kentucky.

The survivorship rate, Huang said, “is actually a strong indicator that a patient's depression condition was well-managed. And because they are well-managed, that's why we do not see a clear difference between those patients with consistent depression and those are patients without depression at all.”

While the study was focused on patients with breast cancer in Kentucky, Huang said he would like to see similar studies regarding mental health conducted among other patient populations.

“As we all know, one study is not (comprehensive) — you cannot be provided your conclusive answer just based on one population-based study,” he said. “Maybe this study (would) only work for this segment of (the) population, maybe just this breast cancer. We certainly need to look at more studies in a much bigger scale and for a wider population.”

Depression, Silver said, is a “sorely underrated part of the cancer patient’s care, not unlike mental health care in general.”

“When we're talking about patients with cancer, I think there's such a high likelihood for distress, depression, anxiety and other disorders that, if attended to during a patient's cancer care, will make their cancer care that much more palatable, that much more feasible,” he said. “Because sometimes it's not even possible to get a patient through their cancer care.

Symptoms of depression include inability to motivate oneself as well as difficulty focusing, concentrating and completing tasks, Silver explained.

“When you think about what a cancer patient is up against, you realize that there are so many steps that a patient is put through in such a short period of time,” he said. “There is so much pressure to be to the hospital at a certain time, to be at the infusion room at a certain time, to tolerate toxic treatments that will benefit their cancer (that are) at the same time giving them side effects that are uncomfortable.

“If a person has depression, they may have trouble getting to things on time, they may not want to leave their house. And first that can get in the way of them getting breast cancer care. … And then conversely, having cancer is a huge stressor, and a huge stressor like that will bring out more symptoms in people who have underlying diagnoses of depression and anxiety or other mental health issues.”

For patients with a history of depression or mental health concerns, Huang urged discussion with care providers.

“The best approach is just to talk to their primary care physicians and work with mental health providers to come up with a plan to get better management for their depression conditions,” he said. “And also, (they should) talk to their oncologist as well, because sometimes this helps the oncologist understand the patient's decision making. Because sometimes for oncologists, their mindset is 'provide the best care for the patient.' But in the patient's mind, the best of care may not be just survival.”

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