Depression and Insomnia in Cancer: Prevalence, Risk Factors, and Effects on Cancer Outcomes
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Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. Behavioral comorbidities often arise during treatment and persist long term to complicate survival and reduce quality of life. This review focuses on depression and insomnia with an emphasis on understanding the role of cancer-specific factors and their contribution to the prevalence of these behavioral comorbidities in cancer patients following cancer diagnosis and treatment. The clinical significance of depression and insomnia for cancer patients is further stressed by epidemiological observations that link depression and insomnia to cancer morbidity and mortality risk.
KeywordsDepression Insomnia Cancer Sleep disturbance Inflammation Fatigue Anxiety Depressive symptoms Major depression Psychiatry
Supported by R01-AG034588, R01-AG026364, R01 CA160245-01, R01-CA119159, R01 HL095799, R01 DA032922-01, P30-AG028748 to MRI, and UCLA CTSI UL1TR000124, and the Cousins Center for Psychoneuroimmunology.
Compliance with Ethics Guidelines
Conflict of Interest
Michael R. Irwin declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
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- 1.Office of Cancer Survivorship 2009.Google Scholar
- 9.• Walker J, Holm Hansen C, Martin P, Sawhney A, Thekkumpurath P, Beale C, et al. Prevalence of depression in adults with cancer: a systematic review. Ann Oncol. 2013;24(4):895–900. This systematic review of studies that have evaluated the prevalence of depression in cancer uses strict inclusion criteria to provide a precise estimate in clinically meaningful subgroups of cancer patients.PubMedCrossRefGoogle Scholar
- 10.•• Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. This systematic meta-analysis provides one of the most comprehensive quantitative summaries on the prevalence of depression as well as anxiety and adjustment disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. Given that some combination of mood disorders occurs in 30–40% of cancer patients across various clinical settings, it is concluded that clinicians should remain vigilant for mood complications, not just depression.PubMedCrossRefGoogle Scholar
- 23.•• Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797–810. This meta-analysis integrated the results of 105 samples derived from 76 prospective studie to show that depression diagnosis and higher levels of depressive symptoms predicted elevated mortality and that this was true in studies that assessed depression before cancer diagnosis as well as in studies that assessed depression following cancer diagnosis.PubMedCrossRefGoogle Scholar
- 26.Pirl WF, Greer JA, Traeger L, Jackson V, Lennes IT, Gallagher ER, et al. Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care. J Clin Oncol. 2012;30:1310–1315.Google Scholar
- 29.•• Irwin MR, Cole SW. Reciprocal regulation of the neural and innate immune systems. Nat Rev Immunol. 2011;11(9):625–32. Given that both depression and many cancers are associated with increases in inflammatory signaling, this review provides a concise overview of the how the central nervous system regulates innate immune responses, and also how the production of proinflammatory cytokines feeds back to regulate behavior.PubMedCrossRefGoogle Scholar
- 42.Palesh OG, Roscoe JA, Mustian KM, Roth T, Savard J, Ancoli-Israel S, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292–8.PubMedCrossRefGoogle Scholar
- 44.• Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011;29(26):3580–6. This longitudinal study is one the largest to assess the prevalence and natural course (incidence, persistence, remission, and relapse) of insomnia comorbid with cancer during an 18-month period. Given that insomnia was found to be a frequent and enduring problem in patients with cancer, it was concluded early intervention strategies, such as cognitive-behavioral therapy, could prevent the problem from becoming more severe and chronic.PubMedCrossRefGoogle Scholar
- 52.Clevenger L, Schrepf A, Degeest K, Bender D, Goodheart M, Ahmed A, et al. Sleep disturbance, distress, and quality of life in ovarian cancer patients during the first year after diagnosis. Cancer. 2012;26(7):1037–44.Google Scholar
- 66.Irwin MR, Olmstead RE, Ganz PA, Haque R. Sleep disturbance, inflammation and depression risk in cancer survivors. Brain Behav Immun. 2013;30:S58–67.Google Scholar
- 71.Liu L, Mills PJ, Rissling M, Fiorentino L, Natarajan L, Dimsdale JE, et al. Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun. 2012;29:706–713.Google Scholar