Worsening symptoms of depression linked to shorter survival in lung cancer patients

January 03, 2022

3 minutes to read

Source / Disclosures

Disclosures: Andersen does not report any relevant financial disclosure. Please see the study for relevant financial information from all other authors.

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According to the results of a study published in Psychosomatic medicine.

The study is the first to examine how the trajectory of depressive symptoms affects the survival of patients with lung cancer, according to a press release from Ohio State University.

Quote from Barbara L. Anderson, PhD.

“Data show that post-diagnostic trajectories of psychological symptoms predict the risk of premature mortality from advanced non-small cell lung cancer, even controlling for the survival benefits of immune and targeted therapies.” Barbara L. Andersen, PhD, eminent college professor in the Department of Psychology at Ohio State University, Healio said. “Substantial evidence points to the need for psychological therapies to treat the common comorbidities of stress, depression and anxiety with advanced NSCLC.”

Andersen added that improving the psychological state of patients can help prolong quality of life and, potentially, OS. Meanwhile, if depressive symptoms are left untreated, patients may have suboptimal understanding of their disease and treatment, impaired decision making or commitment to treatment, lower tolerance symptoms and adverse events of treatment, and low motivation to maintain functional status, she said.

“Lung patients have received so little attention in psychosocial research. They are in the midst of a therapeutic revolution, but the significant problems of depression remain, ”said Andersen. “We are trying to send an alarm on their psychological needs.”

The analysis included 157 patients (mean age, 63.76 years; standard deviation, 10.74 years; 56.7% male; 93% white) with stage non-small cell lung cancer. IV at the Ohio State University Comprehensive Cancer Center from June 2017 to October 2019.

Andersen and colleagues collected completed questionnaires on validated measures of depressive and anxiety symptoms at diagnosis and assessed patients regularly – monthly for up to 8 months, then bimonthly until death or 24 months (average completion rate 80%).

About 28% of the patients had moderate levels of depression at the time of diagnosis, while 8% had moderate to severe levels and the rest had lower levels. Additionally, 6% had moderate anxiety levels and 18% had moderate to severe levels.

The researchers used joint statistical models for the simultaneous modeling of longitudinal (psychological) and time-to-event (survival) processes. They also considered age, race, employment status, income level, and smoking – other factors that can influence survival – in their analyzes.

The median follow-up was 8.7 months (range: 1.1-31.4).

The results showed that symptoms of depression and anxiety decreased significantly with time from diagnosis, but the trajectory of depressive symptoms appeared to be significantly associated with cancer survival after adjusting for covariates (HR per unit increase in Patient Health Questionnaire score = 1.09; 95% CI: 1.03-1.15). Additionally, the researchers reported marginally significant anxiety in the unadjusted model, but not in the fitted model.

According to a press release, patients without depression or with only mild levels 3 months after diagnosis had a more than 50% chance of surviving 15 months, compared to more than 30% for those with moderate to severe levels of depression.

“Depression is a toxic psychosocial and behavioral symptom relevant to predicting overall mortality, regardless of the presence or absence of chronic disease,” Andersen told Healio.

Patients who received newer treatments that dramatically improved survival for many lung cancer patients also saw their lives shortened if they suffered from worsening depression, the press release said.

“Even as impressive new treatments come online, their effectiveness may be limited for patients who also have depression,” Andersen said in the release. “These data are new in suggesting that depression continues as a major limiting factor even when the best therapies available to us for lung cancer are used.”

She added that the study results were “incredibly compelling evidence” of the need to help these patients, beyond diagnosis, with depressive symptoms.

“Our research shows that psychological interventions performed during this period – the first few months after diagnosis – have shown robust biobehavioral effects and a reduced risk of recurrence in others. [patients with cancer]”Andersen told Healio.” Our intention is to conduct a randomized trial with these patients to test the effectiveness of treatment for depression in improving survival and reducing the risk of premature death. “

The references:

Andersen BL, et al. J Clin Oncol. 2021; doi: 10.1200 / JCO.2004.06.030.
The worsening of depression reduces the survival of patients with lung cancer. https://news.osu.edu/worsening-depression-cuts-survival-in-lung-cancer-patients/. Posted October 12, 2021. Accessed December 15, 2021.

For more information:

Barbara L. Andersen, PhD, can be contacted at the Department of Psychology, Ohio State University, 1835 Neil Ave., Columbus, OH 43210-1222; email: [email protected]

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