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Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

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Abstract

Purpose

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.

Methods

Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60–98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.

Results

Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08–1.23) or recovery (OR = 1.26; 95% CI = 1.15–1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90–7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15–0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.

Conclusions

Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.

Implications for Cancer Survivors

Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the participants in the Thinking and Living With Cancer (TLC) study for the sharing of their time and experiences; without their generosity, this study would not have been possible. We are also indebted to Sherri Stahl, Naomi Greenwood, Margery London, and Sue Winarsky, patient advocates from the Georgetown Breast Cancer Advocates, for their insights and suggestions on study design and methods to recruit and retain participants. We thank the TLC staff who contributed by ascertaining, enrolling, and participants.

Funding

This research was supported by the National Cancer Institute of the National Institutes of Health via grants R01CA129769, R35CA197289, and R35CA283926 (J.S.M.). This study was also supported in part by the National Institutes of Health via grant P30CA51008 to the Georgetown Lombardi Comprehensive Cancer Center for support of the Biostatistics and Bioinformatics Resource and the Non-Therapeutic Shared Resource, grants R56AG068086 (J.E.C. and J.S.M.), R01AG068193 (J.S.M. and A.J.S.), R01CA237535 (J.E.C.), K01AG065485 (K.E.R.), P30AG028716 (H.J.C.), K01CA212056 (T.N.B.), K08CA241337 (K.V.D.), R01CA172119 (T.A.A. and J.C.R.), U54CA137788 and P30CA008748 (T.A.A.), K99CA270294 (D.B.T.), R01CA244673 (B.C.M.), P30AG010133 and P30AG072976 (A.J.S.), and R01CA261793 (S.K.P.), T32AG000029 (A.L.A), and grants to the UCLA Cousins Center for Psychoneuroimmunology (J.E.C.).

Author information

Author notes

  1. Jeanne S. Mandelblatt and Judith E. Carroll are co-senior authors.

Authors and Affiliations

  1. Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA

    Zev M. Nakamura

  2. School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA

    Brent J. Small

  3. Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA

    Wanting Zhai, Jaeil Ahn & Xingtao Zhou

  4. Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA

    Wanting Zhai, Jaeil Ahn, Traci N. Bethea, Claudine Isaacs, Xingtao Zhou & Jeanne S. Mandelblatt

  5. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tim A. Ahles & James C. Root

  6. Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA

    Ashley L. Artese & Harvey J. Cohen

  7. Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA

    Elizabeth C. Breen, Michael R. Irwin, Kathleen Van Dyk & Judith E. Carroll

  8. Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA

    Elizabeth C. Breen, Michael R. Irwin, Kate R. Kuhlman & Judith E. Carroll

  9. Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA

    Martine Extermann

  10. John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA

    Deena Graham

  11. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    Heather S.L. Jim & Danielle B. Tometich

  12. Department of Psychological Science, University of California, Irvine, CA, USA

    Kate R. Kuhlman

  13. Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California, Irvine, CA, USA

    Kate R. Kuhlman

  14. Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA

    Brenna C. McDonald & Andrew J. Saykin

  15. City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    Sunita K. Patel

  16. Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA

    Kelly E. Rentscher

  17. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA

    Kathleen Van Dyk

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  1. Zev M. Nakamura
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  2. Brent J. Small
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Contributions

Zev M. Nakamura: conceptualization, investigation, writing, and editing. Brent J. Small: Supervision, methodology, formal analysis, data curation, and writing. Wanting Zhai: formal analysis, data curation, and writing. Ashley L. Artese: investigation, writing, and editing. Tim A. Ahles: conceptualization, investigation, resources, writing, project administration, and funding acquisition. Jaeil Ahn: supervision, methodology, formal analysis, data curation, and writing. Traci N. Bethea: investigation, writing, and editing. Elizabeth C. Breen: investigation, writing, and editing. Harvey J. Cohen: conceptualization, writing, and editing. Martine Extermann: investigation, writing, and editing. Deena Graham: investigation, resources, writing, and editing. Michael Irwin: Investigation, writing, and editing. Claudine Isaacs: investigation, resources, writing, and editing. Heather S. L. Jim: investigation, resources, writing, editing, project administration, and funding acquisition. Kate Kuhlman: investigation, writing, and editing. Brenna C. McDonald: investigation, resources, writing, editing, project administration, and funding acquisition. Sunita K. Patel: Investigation, resources, writing, editing, and project administration. Kelly E. Rentscher: investigation, writing, and editing. James C. Root: investigation, supervision, writing, and editing. Andrew J. Saykin: investigation, resources, writing, editing, project administration, and funding acquisition. Danielle B. Tometich: investigation, writing, and editing. Kathleen Van Dyk: investigation, writing, and editing. Xingtao Zhou: formal analysis, data curation, and writing. Jeanne S. Mandelblatt: conceptualization, investigation, resources, writing, editing, supervision, project administration, and funding acquisition. Judith E. Carroll: conceptualization, investigation, supervision, project administration, writing, and editing.

Corresponding author

Correspondence to Zev M. Nakamura.

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Competing interests

Elizabeth C. Breen has been a consultant for Georgetown University. Martine Extermann has been a consultant for Aileron and Alnylam and has received honoraria from OncLive. Claudine Isaacs has been a consultant for Genentech, AstraZeneca, Gilead Sciences, Novartis, Puma Biotechnology, Seagen, and Pfizer and received royalties from McGraw-Hill Companies and Wolter Kluwer; other disclosures are available at https://coi-asco-org.libproxy.lib.unc.edu/share/KZZ-5URC/Claudine%20Isaacs. Heather S. L. Jim has been a consultant for SBR Bioscience. Andrew J. Saykin has received support from Avid Radiopharmaceuticals, a subsidiary of Eli Lilly (in-kind contribution of a positron emission tomography tracer precursor), Bayer Oncology (scientific advisory board), Eisai (scientific advisory board), Siemens Medical Solutions USA (dementia advisory board), and Springer–Nature Publishing (editorial office support as editor in chief, Brain Imaging and Behavior). All other authors have declared no conflicts of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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N/A. No individual person’s data is presented in any form in this manuscript.

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The study sponsor did not have any role in the design of the study, the collection, analysis, and interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

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Nakamura, Z.M., Small, B.J., Zhai, W. et al. Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01490-2

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