New study highlights the link between depression and breast cancer mortality in women
A new study presented at the European Psychiatric Association Congress 2024 sheds light on the significant impact of depression on the survival rates and quality of life for women diagnosed with breast cancer. This study, conducted by a team of researchers in Russia, conducted a comprehensive analysis of existing research on the prevalence and impact of depression in breast cancer patients.
Breast cancer is the most common cancer among women and a leading cause of death globally and in the EU, it is estimated that 1 in 11 women in the EU-27 will develop breast cancer before the age of 74. [i] The psychological impact of breast cancer is well documented and previous studies have estimated that, globally, 32% of breast cancer sufferers also live with depression. Despite the improvements in screening, diagnostics and treatment of breast cancer, patients are still not properly screened for mental health conditions and often do not receive adequate support. [ii]
Key findings from the study include:
The study found a wide range in the reported prevalence of depression among breast cancer patients, varying from 4.5% to 38% across different studies. The research highlights a significant correlation between depression and mortality, with studies indicating: 50% increased risk of all-cause mortality in patients with depression compared to non-depressed patients with stage I-III breast cancer. 2-2.5-fold increase in breast cancer-specific and all-cause mortality in patients with early-stage (stage I & II) cancer and depression. 2.5 times greater risk of death within 8-15 years for women with non-metastatic breast cancer and mild to moderate depressive symptoms after surgery compared to those with minimal or no depressive symptoms. Overall, the study concludes that both depression and anxiety can negatively impact survival rates and reduce the quality of life for breast cancer patients. Dr Ruslan A. Starostin, oncologist and breast surgeon at Druzhkov Clinic LLC, Kazan, Russia commented on the findings, stating “Cancer, depression and anxiety disorders are closely interrelated. Our task is therefore to identify the presence of mental disorders in patients at the time of initial breast cancer diagnosis in order to begin treatment as early as possible, because the quality of life and overall survival of patients is extremely important.”
Svetlana V. Kuzmina, Professor of Psychiatry in the Department of Psychiatry and Medical Psychology at Kazan State Medical University in Kazan, Russia, commented on the findings, stating “The mental health of breast cancer patients warrants such attention as malignant disease can have a negative impact on mental wellbeing, treatment adherence and quality of life. In the context of our investigation, we also hope to reduce the burden of disease on the daily lives of patients and their environment.”
Ilgiz G. Gataullin, Professor of the Department of Oncology, Radiology and Palliative Medicine of the Kazan State Medical Academy, Russia further added “There are still no universal methods for the screening of this mental health condition. It is likely that psychotherapy and antidepressant treatment may reduce the risk of psychological distress, but further research in this area is needed.”
“These findings underscore the crucial need for routine depression screening for breast cancer patients at the time of diagnosis, integrated approach to treatment that includes the involvement of mental health professions and, most importantly, increased awareness about the impact of breast cancer on mental health and the need for open communication alongside early intervention.” explains Dr Julian Beezhold, the Secretary General of the European Psychiatric Association.
The European Congress of Psychiatry takes place from 6-9 April 2024 in Budapest, Hungary, and represents Europe’s largest congress dedicated to psychiatry, with over 4000 participants: epa-congress.org.
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Notes to Editors
Prevalence of depressive disorders in breast cancer patients (O0062)
Introduction: Breast cancer is the most common type of cancer and the leading cause of death from malignant neoplasms in women in Russia and in most countries in the world (Lima et al. EClinicalMedicine 2021; 38 100985). According to an analysis of the incidence and mortality from 36 cancers in 185 countries (Sung et al. CA Cancer J Clin 2021. 3 209-249) in 2020, 2261419 new cases of breast cancer were identified in the world in both sexes, which is accounted for 11.7% of the total cancer incidence. Mortality from breast cancer in 2020 amounted to 684996 cases. Patients with comorbid depression and anxiety disorders experience more severe symptoms, have longer recovery time, use more healthcare resources and have poorer outcome compare to those with cancer alone (Katon et al. Gen Hosp Psychiatry 2007; 2 147-155).
Objectives: Analytical review of data on the impact of depressive spectrum disorders as comorbid conditions on the survival of breast cancer patients and their quality of life.
Methods: The following databases were searched for publications: PubMed, Embase, CINAHL, PsycINFO, Scopus, Science Citation Index/Social Sciences Citation Index, Cochrane Evidence Based Medicine database. The searches were limited to English language and studies with more than 100 subjects with diagnosed breast cancer where this information was mentioned. The analyzed period is between 1977 and 2018.
Results: The reported prevalence of depression in breast cancer patients, according to researches, varies 4,5 to 38%. In patients with I-III stage breast cancer depression increased hazards of all-cause mortality by 50% compared to non-depressed patients. Stage-specific analyses demonstrated a 2–2.5 fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease (Vodermaier et al. Breast Cancer Res Treat 2014; 2 373-384.). Women with non-metastatic breast cancer who report mild to moderate depressive symptoms in the weeks after surgery have approximately 2.5 times greater risk of death 8–15 years later than women who report little or no depressive symptoms post-surgery (Antoni et al. Gen Hosp Psychiatry 2017; 44 16-21). Depression in advanced cancer not only reduces quality of life but is also an independent predictor of poorer survival (Lloyd-Williams et al. J Affect Disord 2009; 113 127-132.).
Conclusions: Depression and anxiety both have adverse effects on recurrence and all-cause mortality in patients with breast cancer. Untreated depression leads to significant increase in incidence and mortality. Depression can debut at any stage of cancer, including the stage of diagnosis. It proves the necessity for affective disorders screening in patients with cancer on the stage of diagnosis. Patients with diagnosed affective disorders should be observed not only by oncologist, but also by a psychotherapist in order to receive the necessary treatment to improve the quality of life and reduce the risk of mortality.
Disclosure of interest: None declared.
About the European Psychiatric Association
With active individual members in as many as 88 countries and 44 National Psychiatric Association Members who represent more than 78,000 European psychiatrists, the European Psychiatric Association is the main association representing psychiatry in Europe. The EPA’s activities address the interests of psychiatrists in academia, research and practice throughout all stages of career development. The EPA deals with psychiatry and its related disciplines and focuses on the improvement of care for the mentally ill as well as on the development of professional excellence. More information: https://www.europsy.net/
References
[i] Europa Donna – Breast Cancer Facts. Link: https://www.europadonna.org/breast-cancer/#:~:text=Breast%20cancer%20is%20the%20most%20common%20cancer%20in%20women%20in,before%20the%20age%20of%2074*. Last Accessed: 28.04.24
[ii] Javan Biparva A, Raoofi S, Rafiei S, Masoumi M, Doustmehraban M, Bagheribayati F, Vaziri Shahrebabak ES, Noorani Mejareh Z, Khani S, Abdollahi B, Abedi Bafrajard Z, Sotoude Beidokhti S, Shojaei SF, Rastegar M, Pashazadeh Kan F, Nosrati Sanjabad E, Ghashghaee A. Global depression in breast cancer patients: Systematic review and meta-analysis. PLoS One. 2023 Jul 26;18(7):e0287372. doi: 10.1371/journal.pone.0287372. PMID: 37494393; PMCID: PMC10370744.
END
Breast cancer is the most common cancer among women and a leading cause of death globally and in the EU, it is estimated that 1 in 11 women in the EU-27 will develop breast cancer before the age of 74. [i] The psychological impact of breast cancer is well documented and previous studies have estimated that, globally, 32% of breast cancer sufferers also live with depression. Despite the improvements in screening, diagnostics and treatment of breast cancer, patients are still not properly screened for mental health conditions and often do not receive adequate support. [ii]
Key findings from the study include:
The study found a wide range in the reported prevalence of depression among breast cancer patients, varying from 4.5% to 38% across different studies. The research highlights a significant correlation between depression and mortality, with studies indicating: 50% increased risk of all-cause mortality in patients with depression compared to non-depressed patients with stage I-III breast cancer. 2-2.5-fold increase in breast cancer-specific and all-cause mortality in patients with early-stage (stage I & II) cancer and depression. 2.5 times greater risk of death within 8-15 years for women with non-metastatic breast cancer and mild to moderate depressive symptoms after surgery compared to those with minimal or no depressive symptoms. Overall, the study concludes that both depression and anxiety can negatively impact survival rates and reduce the quality of life for breast cancer patients. Dr Ruslan A. Starostin, oncologist and breast surgeon at Druzhkov Clinic LLC, Kazan, Russia commented on the findings, stating “Cancer, depression and anxiety disorders are closely interrelated. Our task is therefore to identify the presence of mental disorders in patients at the time of initial breast cancer diagnosis in order to begin treatment as early as possible, because the quality of life and overall survival of patients is extremely important.”
Svetlana V. Kuzmina, Professor of Psychiatry in the Department of Psychiatry and Medical Psychology at Kazan State Medical University in Kazan, Russia, commented on the findings, stating “The mental health of breast cancer patients warrants such attention as malignant disease can have a negative impact on mental wellbeing, treatment adherence and quality of life. In the context of our investigation, we also hope to reduce the burden of disease on the daily lives of patients and their environment.”
Ilgiz G. Gataullin, Professor of the Department of Oncology, Radiology and Palliative Medicine of the Kazan State Medical Academy, Russia further added “There are still no universal methods for the screening of this mental health condition. It is likely that psychotherapy and antidepressant treatment may reduce the risk of psychological distress, but further research in this area is needed.”
“These findings underscore the crucial need for routine depression screening for breast cancer patients at the time of diagnosis, integrated approach to treatment that includes the involvement of mental health professions and, most importantly, increased awareness about the impact of breast cancer on mental health and the need for open communication alongside early intervention.” explains Dr Julian Beezhold, the Secretary General of the European Psychiatric Association.
The European Congress of Psychiatry takes place from 6-9 April 2024 in Budapest, Hungary, and represents Europe’s largest congress dedicated to psychiatry, with over 4000 participants: epa-congress.org.
+++
Notes to Editors
Prevalence of depressive disorders in breast cancer patients (O0062)
Introduction: Breast cancer is the most common type of cancer and the leading cause of death from malignant neoplasms in women in Russia and in most countries in the world (Lima et al. EClinicalMedicine 2021; 38 100985). According to an analysis of the incidence and mortality from 36 cancers in 185 countries (Sung et al. CA Cancer J Clin 2021. 3 209-249) in 2020, 2261419 new cases of breast cancer were identified in the world in both sexes, which is accounted for 11.7% of the total cancer incidence. Mortality from breast cancer in 2020 amounted to 684996 cases. Patients with comorbid depression and anxiety disorders experience more severe symptoms, have longer recovery time, use more healthcare resources and have poorer outcome compare to those with cancer alone (Katon et al. Gen Hosp Psychiatry 2007; 2 147-155).
Objectives: Analytical review of data on the impact of depressive spectrum disorders as comorbid conditions on the survival of breast cancer patients and their quality of life.
Methods: The following databases were searched for publications: PubMed, Embase, CINAHL, PsycINFO, Scopus, Science Citation Index/Social Sciences Citation Index, Cochrane Evidence Based Medicine database. The searches were limited to English language and studies with more than 100 subjects with diagnosed breast cancer where this information was mentioned. The analyzed period is between 1977 and 2018.
Results: The reported prevalence of depression in breast cancer patients, according to researches, varies 4,5 to 38%. In patients with I-III stage breast cancer depression increased hazards of all-cause mortality by 50% compared to non-depressed patients. Stage-specific analyses demonstrated a 2–2.5 fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease (Vodermaier et al. Breast Cancer Res Treat 2014; 2 373-384.). Women with non-metastatic breast cancer who report mild to moderate depressive symptoms in the weeks after surgery have approximately 2.5 times greater risk of death 8–15 years later than women who report little or no depressive symptoms post-surgery (Antoni et al. Gen Hosp Psychiatry 2017; 44 16-21). Depression in advanced cancer not only reduces quality of life but is also an independent predictor of poorer survival (Lloyd-Williams et al. J Affect Disord 2009; 113 127-132.).
Conclusions: Depression and anxiety both have adverse effects on recurrence and all-cause mortality in patients with breast cancer. Untreated depression leads to significant increase in incidence and mortality. Depression can debut at any stage of cancer, including the stage of diagnosis. It proves the necessity for affective disorders screening in patients with cancer on the stage of diagnosis. Patients with diagnosed affective disorders should be observed not only by oncologist, but also by a psychotherapist in order to receive the necessary treatment to improve the quality of life and reduce the risk of mortality.
Disclosure of interest: None declared.
About the European Psychiatric Association
With active individual members in as many as 88 countries and 44 National Psychiatric Association Members who represent more than 78,000 European psychiatrists, the European Psychiatric Association is the main association representing psychiatry in Europe. The EPA’s activities address the interests of psychiatrists in academia, research and practice throughout all stages of career development. The EPA deals with psychiatry and its related disciplines and focuses on the improvement of care for the mentally ill as well as on the development of professional excellence. More information: https://www.europsy.net/
References
[i] Europa Donna – Breast Cancer Facts. Link: https://www.europadonna.org/breast-cancer/#:~:text=Breast%20cancer%20is%20the%20most%20common%20cancer%20in%20women%20in,before%20the%20age%20of%2074*. Last Accessed: 28.04.24
[ii] Javan Biparva A, Raoofi S, Rafiei S, Masoumi M, Doustmehraban M, Bagheribayati F, Vaziri Shahrebabak ES, Noorani Mejareh Z, Khani S, Abdollahi B, Abedi Bafrajard Z, Sotoude Beidokhti S, Shojaei SF, Rastegar M, Pashazadeh Kan F, Nosrati Sanjabad E, Ghashghaee A. Global depression in breast cancer patients: Systematic review and meta-analysis. PLoS One. 2023 Jul 26;18(7):e0287372. doi: 10.1371/journal.pone.0287372. PMID: 37494393; PMCID: PMC10370744.
END