What does depression do to the survival rates of breast cancer patients?

You would not immediately think that the effect of breast cancer treatment depends on your mood, but body and mind appear to be more closely connected than expected: depressed breast cancer patients have a worse chance of survival than patients who feel well psychologically.

This is shown by a new American study of women who were depressed around the time of their breast cancer diagnosis and its impact on their treatment. The conclusion in short: it makes quite a difference to the survival chances of women with breast cancer whether they suffered from depressive symptoms before or after the diagnosis.

Depressed or not
The researchers had medical records of more than 6,000 women diagnosed with breast cancer in the state of Kentucky between 2007 and 2011. They distinguished between women without depressive symptoms, women who suffered from depression only before or only after the cancer diagnosis, and a group that was chronically depressed. They also examined what percentage of the patients received the recommended treatment and what the effect was on the chance that the women were still alive four years after the diagnosis.

Of all participants, 4.1 percent had chronic depression, 3.7 percent had depression only before the cancer diagnosis, and 6.2 percent only afterwards. Overall, just over 29 percent of patients did not receive recommended medical treatment. After four years, 26.3 percent of the women had died.

Depression and survival rate
The women who were depressed before or after the diagnosis survived on average less often, compared to the women without depressive symptoms. Those who suffered from depression before the diagnosis had a 26 percent higher risk of dying. Depression after diagnosis even increased the risk of death by 50 percent.

It is striking that the chronically depressed women did not have an increased risk of death. “Patients who suffer from long-term depression do not have a lower chance of survival than women who are not depressed before or after breast cancer diagnosis. This is a surprising conclusion,” says researcher Bin Huang of the University of Kentucky Markey Cancer Center.

Missed diagnosis
It also turned out that women who did not undergo the recommended treatment had a 118 percent higher chance of dying within four years, very clear figures. Patients from the mountain region of Kentucky received the recommended treatment 18 percent less often than women who did not live in the Appalachians. However, there was no significant difference in survival rates between the two groups. What has become clear from the figures, the researchers say, is that the diagnosis and treatment of depression, from the moment breast cancer is detected, are very important for the women’s survival.

“It is a fact that the diagnosis of depression is relatively often missed in cancer patients,” continues Bin Huang. “Mental complaints are usually insufficiently addressed in this group. It could well be that chronically depressed women are treated much better for their psychological problems and that their chances of survival are therefore comparable to those of the non-depressed group. The conclusions from our research therefore show how important screening and treatment of depressive symptoms is during the treatment process of a cancer patient.”

Improved approach
But much is still unclear about this connection. “We are far from done learning”, it sounds. “Much more research is needed to get to the heart of the link between depression and the effectiveness of cancer treatments. How can we ensure that the survival chances of people who are depressed before or after the cancer diagnosis are just as high as in the control group without depressive symptoms? We hope that the conclusions from our study will be used for policies and guidelines to improve the treatment of depression in cancer care,” concludes Huang.

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