Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The goal of this large prospective population-based study was to examine the association between depressive symptoms and all-cause mortality among cancer survivors up to 10 years post-diagnosis.
All currently alive individuals diagnosed with endometrial or colorectal cancer (CRC) between 1998 and 2007 or with lymphoma or multiple myeloma between 1999 and 2008, as registered in the Eindhoven Cancer Registry, received a questionnaire on depressive symptoms (Hospital Anxiety and Depression Scale (HADS)) in 2008 or 2009, respectively; 69 % (n = 3,080) responded. Survival status was obtained from the Central Bureau for Genealogy.
Clinically elevated levels of depressive symptoms (HADS cutoff value ≥8) were more prevalent in those who died compared to those who survived (38 vs. 19 %, respectively; p < 0.0001). This was also evident across different types of cancer. After adjustment for independent predictors of all-cause mortality, 1–10-year survivors with depressive symptoms had an increased risk of death (hazard ratio (HR) 2.07; 95 % confidence interval (CI) 1.56–2.74; p < 0.0001), and this was also found among 1–2-year survivors (HR, 2.20; 95 % CI, 1.41–3.43; p < 0.001). Sub-analyses among CRC survivors gave the opportunity to adjust for metastasis and showed that depressive symptoms among 1–10-year CRC survivors and 1–2-year CRC survivors increased the risk of death (HR, 1.88; 95 % CI, 1.24–2.83; p < 0.01 and HR, 2.55; 95 % CI, 1.44–4.51; p < 0.001, respectively).
This study showed that patients with depressive symptoms had twofold risk for all-cause mortality, even after adjustment for major clinical predictors.
Implications for Cancer Survivors
Paying more attention to the recognition and treatment of depressive symptoms seems warranted since depressive symptoms are often underdiagnosed and undertreated in cancer patients.
- Signaleringscommissie-Kanker, Kanker in Nederland. Trends, prognoses en implicaties voor zorgvraag. [Cancer in the Netherlands. Trends, prognosis and implications for health care.] 2004, KWF Kankerbestrijding: Amsterdam.
- Ganz PA. Why and how to study the fate of cancer survivors: observations from the clinic and the research laboratory. Eur J Cancer. 2003;39(15):2136–41. CrossRef
- Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71. CrossRef
- Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349–61. CrossRef
- Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797–810. CrossRef
- Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol. 2011;29(4):413–20. CrossRef
- Edelman S, Lemon J, Bell DR, Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psychooncology. 1999;8(6):474–81. CrossRef
- Cunningham AJ, Edmonds CV, Jenkins GP, Pollack H, Lockwood GA, Warr D. A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psychooncology. 1998;7(6):508–17. CrossRef
- Goodwin PJ, Leszcz M, Ennis M, Koopmans J, Vincent L, Guther H, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med. 2001;345(24):1719–26. CrossRef
- Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol. 2004;22(21):4255–60. CrossRef
- Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biol Psychiatry. 2003;54(3):269–82. CrossRef
- Faller H, Schmidt M. Prognostic value of depressive coping and depression in survival of lung cancer patients. Psychooncology. 2004;13(5):359–63. CrossRef
- Spiegel D. Mind matters in cancer survival. Psycho-Oncology. 2012;21(6):588–93. CrossRef
- Arrieta, O., L.P. Angulo, C. Nunez-Valencia, Y. Dorantes-Gallareta, E.O. Macedo, D. Martinez-Lopez, S. Alvarado, J.F. Corona-Cruz, and L.F. Onate-Ocana. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. 2013. Ann Surg Oncol. doi:10.1245/s10434-012-2793-5
- Garssen B. Letter to the editor: depression linked to cancer mortality not convincingly demonstrated. Psychol Med. 2011;41(6):1338–42. CrossRef
- van de Poll-Franse LV, Horevoorts N, Eenbergen MV, Denollet J, Roukema JA, Aaronson NK, et al. The Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer. 2011;47(14):2188–94. CrossRef
- Janssen-Heijnen MLG, Louwman WJ, Van de Poll-Franse LV, Coebergh JWW. Results of 50 years cancer registry in the South of the Netherlands: 1955–2004 (in Dutch). Eindhoven: Eindhoven Cancer Registry; 2005.
- Nicolaije KA, Husson O, Ezendam NP, Vos MC, Kruitwagen RF, Lybeert ML, et al. Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry. Patient Educ Couns. 2012;88(3):427–35. CrossRef
- Thong MS, Mols F, Lemmens VE, Rutten HJ, Roukema JA, Martijn H, et al. Impact of preoperative radiotherapy on general and disease-specific health status of rectal cancer survivors: a population-based study. Int J Radiat Oncol Biol Phys. 2011;81(3):e49–58. CrossRef
- Thong MS, Mols F, Lemmens VE, Creemers GJ, Slooter GD, van de Poll-Franse LV. Impact of chemotherapy on health status and symptom burden of colon cancer survivors: a population-based study. Eur J Cancer. 2011;47(12):1798–807. CrossRef
- Oerlemans S, Mols F, Issa DE, Pruijt JH, Peters WG, Lybeert M, et al. A high level of fatigue among long-term survivors of non-Hodgkin’s lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica. 2013;98(3):479–86. CrossRef
- Mols F, Oerlemans S, Vos AH, Koster A, Verelst S, Sonneveld P, et al. Health-related quality of life and disease-specific complaints among multiple myeloma patients up to 10 yr after diagnosis: results from a population-based study using the PROFILES registry. Eur J Haematol. 2012;89(4):311–9. CrossRef
- UICC. TNM atlas illustrated guide to the TNM/pTNM classification of malignant tumors. 4th ed. Berlin: Springer; 1992. p. 141–4. 2nd Revision ed.
- van Duijn C, Keij I. Sociaal-economische status indicator op postcode niveau. Maandstatistiek van de bevolking. 2002;50:32–5.
- Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. CrossRef
- Olsson I, Mykletun A, Dahl AA. The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry. 2005;5:46. CrossRef
- Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003;49(2):156–63. CrossRef
- Mols F, Oerlemans S, Denollet J, Roukema JA, van de Poll-Franse LV. Type D personality is associated with increased comorbidity burden and health care utilization among 3080 cancer survivors. Gen Hosp Psychiatry. 2012;34(4):352–9. doi:10.1016/j.genhosppsych.2012.01.014. CrossRef
- Coyne JC, Palmer SC, Shapiro PJ, Thompson R, DeMichele A. Distress, psychiatric morbidity, and prescriptions for psychotropic medication in a breast cancer waiting room sample. Gen Hosp Psychiatry. 2004;26(2):121–8. CrossRef
- Fechner-Bates S, Coyne JC, Schwenk TL. The relationship of self-reported distress to depressive disorders and other psychopathology. J Consult Clin Psychol. 1994;62(3):550–9. CrossRef
- Cosco TD, Doyle F, Watson R, Ward M, McGee H. Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease. Gen Hosp Psychiatry. 2012;34(2):167–72. CrossRef
- Coyne JC, van Sonderen E. The Hospital Anxiety and Depression Scale (HADS) is dead, but like Elvis, there will still be citings. J Psychosom Res. 2012;73(1):77–8. CrossRef
- Coyne JC, van Sonderen E. No further research needed: abandoning the Hospital and Anxiety Depression Scale (HADS). J Psychosom Res. 2012;72(3):173–4. CrossRef
- Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry
Journal of Cancer Survivorship
Volume 7, Issue 3 , pp 484-492
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Depressive symptoms
- Industry Sectors
- Author Affiliations
- 1. CoRPS, Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
- 2. Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands
- 3. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands