Long-term depression incidence and associated mortality among African American and White prostate cancer survivors

Social Support, Depression and Anxiety in Cancer Patient-Relative Dyads in Early Survivorship: An Actor-Partner Interdependence Modeling Approach

OBJECTIVE

Cancer places a psychological burden on both patients and their relatives. Perceived social support influences the extent of psychological distress. Our aim was to investigate associations between positive support, detrimental interactions, depression and anxiety in patient-relative dyads in the initial period after diagnosis.

METHODS

Patients with a solid tumor and their relatives participated in this prospective, multicenter observational study. Participants answered validated measures including the Illness-specific Social Support Scale (SSUK-8), the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale (GAD-7). We analyzed cross-sectional data from the initial time following diagnosis with paired t-tests and actor-partner interdependence models.

RESULTS

A total of 347 dyads of patients (mean age 59.9 years) and their relatives (mean age 56.7 years) participated. Compared to their relatives, patients reported significantly higher levels of depression (patients: M = 6.31, SD = 4.94; relatives: M = 5.44, SD = 4.77) and lower levels of anxiety (patients: M = 4.40, SD = 4.10; relatives: M = 4.98, SD = 4.47) as well as more positive support (patients: M = 14.31, SD = 2.07; relatives: M = 12.46, SD = 3.29) and a lower frequency of detrimental interactions (patients: M = 3.21, SD = 2.97; relatives: M = 3.66, SD = 2.93). Intrapersonal effects: Positive support was associated with lower distress only for relatives, whereas detrimental interactions were associated with higher distress for both patients and relatives (all p < 0.05). Interpersonal effects: More positive support and fewer detrimental interactions experienced by relatives were associated with lower patient distress (all p < 0.05).

CONCLUSIONS

Better support for relatives may not only reduce their own distress, but also patients' distress. Relatives experience similar levels of distress and poorer social support than patients.

Mortality Risks Associated with Depression in Men with Prostate Cancer

BACKGROUND

Men diagnosed with prostate cancer (PC) have an increased risk of depression; however, it is unclear to what extent depression affects long-term survival. A better understanding of such effects is needed to improve long-term care and outcomes for men with PC.

OBJECTIVE

To determine the associations between major depression and mortality in a national cohort of men with PC.

DESIGN, SETTING, AND PARTICIPANTS

A national cohort study was conducted of all 180 189 men diagnosed with PC in Sweden during 1998-2017. Subsequent diagnoses of major depression were ascertained from nationwide outpatient and inpatient records through 2018.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Deaths were identified from nationwide records through 2018. Cox regression was used to compute hazard ratios (HRs) for all-cause mortality associated with major depression, adjusting for sociodemographic factors and comorbidities. Subanalyses assessed differences by PC treatment during 2005-2017. PC-specific mortality was examined using competing risks models.

RESULTS AND LIMITATIONS

In 1.3 million person-years of follow-up, 16 134 (9%) men with PC were diagnosed with major depression and 65 643 (36%) men died. After adjusting for sociodemographic factors and comorbidities, major depression was associated with significantly higher all-cause mortality in men with high-risk PC (HR, 1.50; 95% confidence interval [CI], 1.44-1.55) or low- or intermediate-risk PC (1.64; 1.56-1.71). These risks were elevated regardless of PC treatment or age at PC diagnosis, except for youngest men (<55 yr) in whom the risks were nonsignificant. Major depression was also associated with increased PC-specific mortality in men with either high-risk PC (HR, 1.35; 95% CI, 1.28-1.43) or low- or intermediate-risk PC (1.42; 1.27-1.59). This study was limited to Sweden and will need replication in other countries when feasible.

CONCLUSIONS

In this national cohort of men with PC, major depression was associated with ∼50% higher all-cause mortality. Men with PC need timely detection and treatment of depression to support their long-term outcomes and survival.

PATIENT SUMMARY

In this report, we examined the effects of depression on survival in men with prostate cancer. We found that among all men with prostate cancer, those who developed depression had a 50% higher risk of dying than those without depression. Men with prostate cancer need close monitoring for the detection and treatment of depression to improve their long-term health outcomes.

The mechanism of cancer-depression comorbidity

Cancer and depression are closely interrelated, particularly in patients with advanced cancer, who often present with comorbid anxiety and depression for various reasons. Recently, there has been a growing interest in the study of depression in cancer patients, with the aim of assessing the possible triggers, predictors, adverse events, and possible treatment options for depression in several common cancers. The objective of this narrative review is to synthesize the extant literature on the relationship between the occurrence and progression of depression in several common patient categories. The authors conducted a comprehensive review of 75 articles published in PubMed over the past five years. This review was further evaluated in the present paper. Ultimately, it was determined that depression is a prevalent and detrimental phenomenon among cancer patients, particularly those with advanced disease. Consequently, there is a pressing need to prioritize research and interventions aimed at improving the quality of life and psychosocial well-being of cancer patients, including those with advanced disease. The relationship between cancer and depression has been evolving dynamically in recent times. The current research findings indicate a strong association between cancer and depression. However, the direction of causality remains unclear. Focusing on depression in cancer patients may, therefore, be beneficial for these patients.

Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer

Emotional distress (ED), commonly characterized by symptoms of depression and/or anxiety, is prevalent in patients with cancer. Preclinical studies suggest that ED can impair antitumor immune responses, but few clinical studies have explored its relationship with response to immune checkpoint inhibitors (ICIs). Here we report results from cohort 1 of the prospective observational STRESS-LUNG study, which investigated the association between ED and clinical efficacy of first-line treatment of ICIs in patients with advanced non-small-cell lung cancer. ED was assessed by Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. The study included 227 patients with 111 (48.9%) exhibiting ED who presented depression (Patient Health Questionnaire-9 score ≥5) and/or anxiety (Generalized Anxiety Disorder 7-item score ≥5) symptoms at baseline. On the primary endpoint analysis, patients with baseline ED exhibited a significantly shorter median progression-free survival compared with those without ED (7.9 months versus 15.5 months, hazard ratio 1.73, 95% confidence interval 1.23 to 2.43, P = 0.002). On the secondary endpoint analysis, ED was associated with lower objective response rate (46.8% versus 62.1%, odds ratio 0.54, P = 0.022), reduced 2-year overall survival rate of 46.5% versus 64.9% (hazard ratio for death 1.82, 95% confidence interval 1.12 to 2.97, P = 0.016) and detriments in quality of life. The exploratory analysis indicated that the ED group showed elevated blood cortisol levels, which was associated with adverse survival outcomes. This study suggests that there is an association between ED and worse clinical outcomes in patients with advanced non-small-cell lung cancer treated with ICIs, highlighting the potential significance of addressing ED in cancer management. ClinicalTrials.gov registration: NCT05477979 .

Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

CONTEXT

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.

OBJECTIVES

Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.

METHODS

Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.

RESULTS

Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.

CONCLUSION

Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: Findings from the NHANES

BACKGROUND

Inflammation and nutrition and depression are interrelated, and both are related to changes in mortality rates. We investigated the association of nutritional and inflammation index or depressive symptoms with the risk of all-cause mortality or cause-specific mortality among cancer survivors.

METHODS

A prospective cohort of a nationally representative sample of cancer survivors, aged 40 years or older (n = 2331; weighted population, 15 248 255; 67.6 ± 11.0 years; 50.6 % males), were recruited from the US National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Advanced lung cancer inflammation index (ALI) reflected inflammation and nutritional status and Patient Health Questionnaire 9 (PHQ-9) demonstrated depressive symptoms. The independent and joint associations of ALI and PHQ-9 score with mortality outcomes were examined among cancer survivors and Cox regression analysis based on weights was used to calculate the relative risk.

RESULTS

We identified 605 all-cause deaths (cancer, 204; non-cancer, 401) over a median of 6.2 years of follow-up (15,385 person-years; interquartile range, 3.3-9.8 years). High ALI was observed to be consistently associated with lower risks of all-cause (hazard ratio [HR], 0.516; 95 % CI, 0.400-0.667) and non-cancer (HR, 0.414; 95 % CI, 0.291-0.588) mortality compared with low ALI in a series of adjusted models. Meanwhile, lower PHQ-9 score (0-4) was associated with lower risks of all-cause (HR, 0.686; 95 % CI, 0.521-0.903) and non-cancer (HR, 0.686; 95 % CI, 0.474-0.992) mortality compared with higher PHQ-9 score (≥10). Furthermore, joint analyses showed that high ALI was associated with a decreased risk of death among cancer survivors who were not depressive. Specifically, survivors with high ALI but not depressive symptoms had the lowest overall (HR, 0.404; 95 % CI, 0.228-0.715) risks.

CONCLUSION

In this cohort study, we observed impact of nutritional and inflammatory status and depressive symptoms on mortality among cancer survivors, with the lowest risks of death from both all causes and non-cancer being noted among the combination of high level ALI with no depression.

Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference

Poor mental health has been found to be more prevalent among those with cancer and is considered a public health crisis since COVID-19. This study assessed the impact of COVID-19 and cancer survivorship on mental health and investigated factors, including online patient-provider communications (OPPC; email/internet/tablet/smartphone), associated with poor mental health prior to and during the early COVID-19. Nationally representative Health Information National Trends Survey data during 2017-2020 (n = 15,871) was used. While the prevalence of poor mental health was high (40-42%), Difference-In-Difference analyses revealed that cancer survivorship and COVID-19 were not associated with poor mental health. However, individuals that used OPPC had 40% higher odds of poor mental health. Low socioeconomic status (low education/income), younger age (18-64 years), and female birth gender were also associated with poor mental health. Findings highlight the persistence of long-standing mental health inequities and identify that OPPC users might be those who need mental health support.

Investigating the Relationship Between Physical Activity Disparities and Health-Related Quality of Life Among Black People With Knee Osteoarthritis

INTRODUCTION

Knee osteoarthritis (OA) is the most common form of arthritis, which is a leading cause of disability. Although no cure exists for knee OA, physical activity has been shown to improve functionality, which can improve an individual's health-related quality of life (HR-QOL). However, racial disparities exist in participating in physical activity, which can result in Black people with knee OA experiencing lower HR-QOL compared with their White counterparts. The purpose of this study was to investigate disparities of physical activity and related determinants, specifically pain and depression, and how these constructs explain why Black people with knee OA experience low HR-QOL.

METHODS

Data were from the Osteoarthritis Initiative, a multicenter longitudinal study that collected data from people with knee OA. The study used a serial mediation model to test whether a change in scores for pain, depression, and physical activity over 96 months mediated the effects between race and HR-QOL.

RESULTS

Analysis of variance models found Black race to be associated with high pain, depression, and lower physical activity and HR-QOL at baseline and month 96. The findings supported the prospective multi-mediation model, which found pain, depression, and physical activity to mediate between race and HR-QOL (β = -0.11, SE = 0.047; 95% CI, -0.203 to -0.016).

CONCLUSION

Disparities in pain, depression, and physical activity could explain why Black people with knee OA experience lower HR-QOL compared with their White counterparts. Future interventions should address sources of pain and depression disparities by improving health care delivery. Additionally, designing race- and culture-appropriate community physical activity programs would help to achieve physical activity equity.

Trends and Factors Associated With the Mortality Rate of Depressive Episodes: An Analysis of the CDC Wide-Ranging Online Data for Epidemiological Research (WONDER) Database

Background Depressive episodes are associated with increased mortality rates across the United States. Recognizing the relationship between depression and physical health, understanding the contributing factors, and addressing disparities are critical in reducing mortality rates and improving the overall well-being of individuals experiencing depressive episodes. Continued research, public health efforts, and collaborative approaches are essential to tackle this complex public health concern effectively. Studying the mortality rate trends of depressive episodes along with other related factors will help enhance the understanding of the condition, which, in turn, will assist in reducing mortality rates in the vulnerable population. Methodology Data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on the Underlying Cause of Death were examined to identify individuals who experienced fatal outcomes related to depressive episodes from 1999 to 2020. The WONDER database refers to the online system used by the CDC to make its various resources accessible to the public and public health experts. CDC WONDER offers access to a broader range of information on public health. Results A total of 13,290 individuals who died from depressive episodes between 1999 and 2020 were identified. Data analysis revealed an overall mortality rate of 0.20 per 100,000 individuals during the specified period. The highest mortality rates were observed in the years 2003 (0.28), 2001 (0.27), and 1999 (0.27). The analysis revealed significant disparities in mortality rates among different demographic groups. Older adults, females, specific racial groups, including Whites and African Americans, and specific geographic areas, including the Midwest, Northeast, South, and West, exhibited higher mortality rates associated with depressive episodes. Conclusions The study identified that older individuals, females, Whites, and African Americans, as well as certain geographic regions, exhibited an increased likelihood of mortality related to depressive episodes. These findings highlight the importance of understanding the complex interplay between mental health and mortality. The findings emphasize the importance of addressing disparities in mental health outcomes among different demographic groups. Identifying vulnerable populations can inform targeted interventions and resources to address the elevated mortality risk.

A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy

CONTEXT

Many cancer survivors experience a lingering symptom burden after chemotherapy.

OBJECTIVES

In this sequential multiple assignment randomized trial, we tested optimal sequencing of two evidence-based interventions for symptom management.

METHODS

Survivors of solid tumors (N = 451) were interviewed at baseline and stratified as high or low need for symptom management based on comorbidity and depressive symptoms. High need survivors were randomized initially to the 12-week Symptom Management and Survivorship Handbook (SMSH, N = 282) or 12-week SMSH with eight weeks of Telephone Interpersonal Counseling (TIPC, N = 93) added during weeks one to eight. After four weeks of the SMSH alone, non-responders on depression were re-randomized to continue with SMSH alone (N = 30) or add TIPC (N = 31). Severity of depression and summed severity index of 17 other symptoms over weeks one to13 were compared between randomized groups and among three dynamic treatment regimes (DTRs): 1) SMSH for 12 weeks; 2) SMSH for 12 weeks with eight weeks of TIPC from week one; 3) SMSH for four weeks followed by SMSH+TIPC for eight weeks if no response to the SMSH alone on depression at week four.

RESULTS

There were no main effects for randomized arms or DTRs, but there was a significant interaction of trial arm with baseline depression favoring SMSH alone during weeks one to four in the first randomization and SMSH+TIPC in the second randomization.

CONCLUSION

The SMSH may represent a simple effective option for symptom management, adding TIPC only when there is no response to SMSH alone for people with elevated depression and multiple co-morbidities.

Role, race, and place: Prostate cancer disparities in Patients' and Partners' health outcomes and psychosocial factors

PURPOSE

This study aimed to examine the effects of participant role (patient vs. partner), race (white vs. non-white), and place (less vs. more neighborhood deprivation) on health outcomes (quality of life [QOL] and symptoms) and stress-coping-related psychosocial factors (appraisals of illness and coping resources).

METHODS

This descriptive study included 273 patients and their partners (dyads) who transitioned from PCa treatment to self-management. We used established, psychometrically sound measures to assess health outcomes and psychosocial factors and conducted multilevel modeling analyses.

RESULTS

Compared to partners, patients reported worse physical QOL; less frequent anxiety; less pain and fatigue; less bothersome hormonal problems; more bothersome urinary and sexual problems; greater self-efficacy; and more instrumental support. Compared to their white counterparts, non-white dyads reported better overall, emotional, and functional QOL; less depression; more positive appraisals, and greater self-efficacy. Compared to dyads in low ADI neighborhoods, dyads in high ADI (more deprived) neighborhoods reported worse social QOL; more bothersome urinary, sexual, and hormonal symptoms; and less interpersonal support. White patients reported the highest emotional support among all groups, while white partners reported the lowest emotional support.

CONCLUSION

Our findings underscore the need to consider social determinants of health at multiple levels when investigating PCa disparities. Considering neighborhood-level socioeconomic factors, in addition to race and role, improves our understanding of the PCa disparities in QOL, symptoms, and psychosocial factors among patients and partners. Targeted multilevel supportive care interventions should tailor to the needs of racially diverse PCa patients and partners residing in deprived neighborhoods are needed.

Antidepressant use pattern and disparities among cancer patients in the United States

Many cancer patients also suffer from depression, however, pharmacotherapy of depression and related disparities in US cancer survivors have not been examined in a nationally representative sample. In the present study, 2,590 adult cancer survivors participating in the National Health and Nutrition Examination Survey 2011-2020 were included and antidepressant use pattern was investigated. To examine disparities by social-demographic characteristics and access to healthcare, multivariate logistic regression analysis was conducted in 422 cancer patients who were using antidepressants and 230 cancer patients who were not using antidepressants but were diagnosed with depression. Results suggested that 21% of adult cancer survivors were using antidepressants and selective serotonin reuptake inhibitors were the most common type of antidepressants used. Antidepressant users were more likely to be female, non-Hispanic white, those who were married or living with partner. In addition, those without a routine place to go for healthcare were less likely to use antidepressants. Disparities were not found by age, family income levels, education, or health insurance coverage. The findings highlight disparities in antidepressant use in cancer patients in the US. Policy makers need to better allocate healthcare resources and facilitate availabilities of affordable care to every patient in need.