Increased risk of depression among patients with breast cancer

1. Breast cancer patients were at an increased risk of depression resulting in hospitalization or the use of antidepressants.

2. Patients with comorbid conditions, node-positive disease, and advanced age had the highest risk for depression.

Evidence Rating Level: 2 (Good)

Study Rundown: Although previous studies have investigated depression among women with breast cancer, the trials have been primarily cross-sectional studies, or longitudinal studies with limited follow-up periods. This results in the limited ability to identify causality or specific risk factors for development of depression. The purpose of this large prospective trial was to prospectively investigate the risk of depression among women with breast cancer.

This trial prospectively followed over 44 000 women with breast cancer and over 1.9 million women as the background population through the Denmark Central Population Registry from 1998 to 2011. At the conclusion of this study, the authors found that women with breast cancer were at significantly increased risk for depression requiring hospital contact as well as use of antidepressants when compared to the background population. The effect remained significant after 8 years following breast cancer diagnosis. Medical comorbidities, older age at diagnosis, and positive axillary lymph nodes were all associated with increased risk for depression. The type of surgery and adjuvant therapy received by the patient were not risk factors. These results suggest a need for increased level of vigilance for depression for health care providers caring for breast cancer patients. The strength of the trial is the large sample size and prospective design of this study, though it should be noted that this trial focused mainly on identified and treated depression.

Click to read the study in Journal of Clinical Oncology

Relevant Reading: Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer

In-Depth [prospective cohort]: The authors identified 1 997 669 women with no diagnosis of cancer or a major psychiatric disorder from the Denmark Central Population Registry. This cohort was followed from 1998 to 2011 for the diagnosis of breast cancer. The primary outcomes were incident hospital contacts for depression and incident use of antidepressants, which were obtained from the Danish Psychiatric Central Registry and the Danish National Prescription Registry. A total of 44 494 women with breast cancer were identified during the study period. The relative risk following diagnosis of breast cancer for a hospital contact for depression and use of antidepressants was 1.7 (95% CI: 1.41-2.05) and 3.09 (95% CI: 2.95-3.22), respectively. This risk remained increased for the up to 8 years after diagnosis. Age, medical comorbidities, positive axillary lymph nodes were associated with both outcomes, while no association was found with type of surgery or adjuvant treatment.

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