Changes in mood can influence breast cancer survival

Last Updated: 2010-12-15 16:20:22 -0400 (Reuters Health)

By Lynne Peeples

NEW YORK (Reuters Health) - Women with advanced breast cancer whose mood improved over the course of a year appeared to survive longer, researchers report.

They found that women whose scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) improved outlived those whose scores worsened by more than two years.

Depression can burden the body in a number of ways that are linked with cancer progression -- from decreasing immune function to increasing inflammation, according to lead researcher Dr. Janine Giese-Davis, of the University of Calgary in Alberta, Canada.

"When these physiological changes become chronic, we believe that they may deplete the resources of the body, making it more difficult for patients to recover," she said in an e-mail to Reuters Health.

The new study was a secondary analysis of 100 women with metastatic breast cancer enrolled in a randomized trial comparing weekly supportive-expressive group therapy plus education with education alone. Unfortunately, the weekly therapy didn't improve survival.

As part of the trial, the women completed the CES-D questionnaire at four, eight and 12 months. (While CES-D is not a diagnostic criterion, a score of 16 or higher does indicate clinically significant depression, the authors say; in this study, the women's average baseline score was 11.)

Among women whose CES-D scores improved over the year - no matter which group they'd been assigned to -- the median overall survival was 53.6 months, vs 25.1 months for women whose scores worsened.

Improvement in mood had longer-term benefits, too: it raised the chances of survival beyond 14 years by as much as 68%, the researchers reported online December 13th in the Journal of Clinical Oncology.

They didn't find a relationship between depression severity at the outset of the study and later survival, however, and neither group therapy nor antidepressant use appeared to affect how long women lived.

"Our results did not specify one particular treatment," said Dr. Giese-Davis. "The only thing that mattered was the decrease over time in depression symptoms."

"The magnitude of this effect, the roughly doubling of survival time, is comparable to that observed in studies of depression and mortality from heart disease," she and her colleagues wrote in their report.

While it is too early to be sure whether depression can truly shorten survival, Dr. Giese-Davis said, the finding does point to the importance of doctors, patients and families being aware that chronic depression in illness might take a toll.

"We do not advocate simply 'thinking positive,'" noted Dr. Giese-Davis. "It is normal for patients to feel sad, angry and fearful."

Rather, she said talking openly about those feelings could be helpful. Overcoming depression, she added, will improve patients' quality of life, their social relationships, their healthy behaviors, and their ability to follow through on their doctors' recommendations.


J Clin Oncol 2010.

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