To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same.
Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study.
Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18–1.36; HR 1.14, 95% CI 1.08–1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments.
The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.
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The data that support the findings of this study are available from National Health Insurance Service in Korea but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data can be however available from the National Health Insurance Service in Korea upon reasonable request and with permission of the National Health Insurance Service in Korea.
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This work was supported by the Korean Breast Cancer Society and the Study of Multi-disciplinary Teamwork for breast cancer survivorship (SMARTSHIP).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (the institutional review board of Chosun University Hospital; IRB N. CHOSUN 2016-11-001) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Patient-informed consent is not required as this study used existing data of the National Health Insurance Service in Korea which are not individually identifiable.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Eun-Jung Shim and Jong Won Lee contributed equally to this work.
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Shim, E., Lee, J.W., Cho, J. et al. Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea. Breast Cancer Res Treat 179, 491–498 (2020). https://doi.org/10.1007/s10549-019-05479-3
- Antidepressive agents
- Breast cancer