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
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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.
KeywordsCancer Depression Depressive symptoms Mortality
We would like to thank all patients and their doctors for their participation in the study. Special thanks go to Dr. M. van Bommel, who was willing to function as an independent advisor and to answer questions of patients. In addition, we want to thank the following hospitals for their cooperation: Amphia Hospital, Breda; Bernhoven Hospital, Veghel and Oss; Catharina Hospital, Eindhoven; Elkerliek Hospital, Helmond; Jeroen Bosch Hospital, ‘s-Hertogenbosch; Maxima Medical Centre, Eindhoven and Veldhoven; Saint Anna Hospital, Geldrop; St. Elisabeth Hospital, Tilburg; Twee Steden Hospital, Tilburg and Waalwijk; and VieCury Hospital, Venlo and Venray.
The present research was supported by a VENI grant (#451-10-041) from the Netherlands Organization for Scientific Research (The Hague, The Netherlands) awarded to Floortje Mols and a Cancer Research Award from the Dutch Cancer Society (#UVT-2009-4349) to Lonneke V. van de Poll-Franse. Data collection of this study was funded by the Comprehensive Cancer Centre South, Eindhoven, The Netherlands and an Investment Subsidy (#480-08-009) of the Netherlands Organization for Scientific Research (The Hague, The Netherlands).
Conflict of interest
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