Depression and Cancer Mortality: A Meta-Analysis

Department of Psychology, Philipps University, Marburg, Germany.
Psychological Medicine (Impact Factor: 5.94). 11/2010; 40(11):1797-810. DOI: 10.1017/S0033291709992285
Source: PubMed


The goal of the present study was to analyze associations between depression and mortality of cancer patients and to test whether these associations would vary by study characteristics.
Meta-analysis was used for integrating the results of 105 samples derived from 76 prospective studies.
Depression diagnosis and higher levels of depressive symptoms predicted elevated mortality. This was true in studies that assessed depression before cancer diagnosis as well as in studies that assessed depression following cancer diagnosis. Associations between depression and mortality persisted after controlling for confounding medical variables. The depression-mortality association was weaker in studies that had longer intervals between assessments of depression and mortality, in younger samples and in studies that used the Beck Depression Inventory as compared with other depression scales.
Screening for depression should be routinely conducted in the cancer treatment setting. Referrals to mental health specialists should be considered. Research is needed on whether the treatment of depression could, beyond enhancing quality of life, extend survival of depressed cancer patients.

Download full-text


Available from: Martin Pinquart,
  • Source
    • "Wassertheil-Smoller et al., 2004) or cancer (e.g. Pinquart and Duberstein, 2010). Specifically , increasing evidence suggests that the elevated risk for age-related disease in MDD may be due in part to an abnormal stress and immune response (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Leukocyte telomere length (LTL) is a marker of cellular turnover and oxidative stress. Studies suggest major depressive disorder (MDD) is associated with oxidative stress, but examinations of MDD and LTL have yielded mixed results, likely because of differences in measurement methods and unmeasured confounding. This study examined LTL and telomerase activity in 166 individuals with MDD compared to 166 age- and gender-matched matched controls free of any psychiatric disorder, using well-validated assays and clinical assessment methods, and controlling for a range of potential confounders. Subjects aged 18 to 70 were evaluated by trained raters and provided blood for LTL and telomerase activity measurement. LTL was assayed using Southern blot and replicated with qPCR, and telomerase activity was assayed with a repeat amplification protocol using a commercial kit. There was no significant difference in telomere length for individuals with MDD [mean (SD)=9.1 (3.0)kbp] compared to controls [mean(SD)=8.9(2.5)kbp] measured by Southern blot (p=0.65) or by confirmatory qPCR (p=0.91) assays. Controlling for potential confounders did not alter the results. Telomerase activity did not differ by MDD diagnosis overall (p=0.40), but the effect of MDD was significantly modified by gender (t(299)=2.67, p=0.0079) even after controlling for potential confounders, with telomerase activity significantly greater only in males with MDD versus controls. Our well-characterized, well-powered examination of concurrently assessed telomere length and telomerase activity in individuals with clinically significant, chronic MDD and matched controls failed to provide strong evidence of an association of MDD with shorter LTL, while telomerase activity was lower in men with MDD. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Psychoneuroendocrinology 04/2015; 58:9-22. DOI:10.1016/j.psyneuen.2015.04.004 · 4.94 Impact Factor
  • Source
    • "Given that bidirectional associations between biology and behavioral comorbidity likely take time to develop, it is unclear whether these associations exist in patients suffering the recent stressor of a breast cancer diagnosis, and to what extent a common group of symptoms (e.g., fatigue, poor mood, cognitive difficulty) is driven by cancer-related distress versus physiological factors. Although there is clear evidence that depression likely impacts both cancer biology and mortality (Howren et al., 2009; Pinquart and Duberstein, 2010; Spiegel and Giese-Davis, 2003), the impact of normal reactions to cancer diagnosis, such as distress, needs further exploration. Some early evidence suggests the potential relevance of persistent distress early in the cancer trajectory. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression. Developmental Cancer Research Award, awarded to authors F.S.D., S.E.S., and D.S. from the Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; University of Louisville Intramural Research Incentive Grant for Research on Women awarded to S.E.S. from the University of Louisville Office of the Vice President for Research; Carl & Elizabeth Naumann Startup Fund awarded to F.S.D. Copyright © 2015. Published by Elsevier Inc.
    Brain Behavior and Immunity 02/2015; 48. DOI:10.1016/j.bbi.2015.02.017 · 5.89 Impact Factor
  • Source
    • "Psychological distress in cancer is associated with nonadherence to treatment recommendations, poorer satisfaction with care, poorer interpersonal relationships (resulting in poorer quality of relationships with both formal and informal social support sources and healthcare professionals), utilization of ineffective coping strategies (e.g., helplessness, passive coping , and risk taking behaviours), and poorer overall quality of life (QoL) [1] [2] [3]. The impact of psychological distress on people with extremity sarcoma (ES) has not been extensively studied. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. Extremity sarcoma (ES) is a rare cancer that presents with unique challenges. This study was performed to identify the prevalence, trajectory, and determinants of distress and characterise sources of stress in this cohort. Methods. Consecutive patients with ES were prospectively recruited between May 2011 and December 2012. Questionnaires were administered during initial diagnosis and then six months and one year after surgery. Results. Distress was reported by about a third of our cohort and associated with poorer physical function, poorer quality of life, and pain. In addition to fears regarding mortality and life role changes, the most common sources of stress were centered on dissatisfaction with the healthcare system, such as frustrations with a lack of communication with the hospital regarding appointments and lack of education regarding management and outcomes. Conclusions. Psychological distress presents early in the cancer journey and persists up to one year after surgery. Distress is associated with negative outcomes. Active screening and effective interventions are necessary to improve outcomes. Sources of stress have been identified that may be amenable to targeted interventions.
    Sarcoma 02/2015; 2015:745163. DOI:10.1155/2015/745163
Show more