Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study

Finding a needle in a haystack: The identification of clinical practice guidelines for psychosocial oncology through an environmental scan of the academic and gray literature

OBJECTIVE

Clinical practice guidelines (CPGs) are evidence-based tools well-suited to translate the latest research evidence into recommendations for routine clinical care. Given the rapid expansion of psychosocial oncology research, they represent a key opportunity for informing the treatment decisions of overburdened clinicians, standardizing service delivery, and improving patient-reported outcomes. Yet, there is little consensus on how clinicians can most effectively access these tools and little to no information on the current availability and scope of CPGs for the range of psychosocial symptoms and concerns experienced by patients with cancer.

METHOD

Our environmental scan consisted of an academic and gray literature designed to identify currently available CPGs addressing a range of cancer-related psychosocial symptoms.

RESULTS

Findings revealed a total of 23 existing psychosocial oncology CPGs that met full eligibility criteria. The gray literature search was found to be more effective at identifying CPGs (n = 22) compared to the academic search (n = 9).

CONCLUSION

Several concerns arose from the systematic search. The limited publication of CPGs in peer-reviewed journals may make clinicians and stakeholders more hesitant to implement CPGs due to uncertainties about the methodological rigor of the development process. Further, many existing CPGs are outdated or failed to be updated according to guideline recommendations, meaning that the recommendations may fall short of their purpose to translate up-to-date research findings.

FUTURE DIRECTIONS

Future research should seek to systematically assess the quality of existing psychosocial oncology CPGs and shed light on the current state of implementation and adherence in clinical practice in order to better inform guideline developers on the current needs of the psychosocial oncology community.

Adjuvant aromatase inhibitor treatment worsens depressive symptoms and sleep quality in postmenopausal women with localized breast cancer: A one-year follow-up study

First-line treatment in postmenopausal women with estrogen- and/or progesterone-positive breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen cognitive function, depressive symptoms, sleep quality and performance in basic activities of daily life as primary and concomitant outcomes in long longitudinal studies in post-menopausal women has been seldom investigated. This study is a cohort trial which aimed to determine if there were differences in cognitive function assessment, depressive symptoms, and sleep quality after 1 year under AROi treatment and to determine the interrelations between these symptoms.

METHODS

A prospective 1-year longitudinal study was performed in a representative sample of tertiary hospital. Women with localized breast cancer newly treated with AROi therapy were evaluated for cognitive functions, depressive symptoms, sleep problems and ability to perform basic activities of the daily life at baseline and after 6 months and 12 months under adjuvant AROi treatment.

RESULTS

Analysis of cognitive functions by the Mini-Mental State Examination (MMSE) scores did not show significantly worsening under AROi treatment after 6 months and 12 months of treatment compared to the baseline. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after 6 and 12 months of treatment with AROi, with women describing more depressive symptoms and more sleep disturbances.

CONCLUSIONS

Our study found impairments in sleep quality and an increase in depressive symptoms, which has important implications for clinicians as they impair quality of life and adherence to treatment.

Anxiety and depression risk in Taiwan women with breast cancer and cervical cancer

Background

Studies comparing mental disorder risks between women with breast cancer and cervical cancer are lacking. This study compared risks of developing anxiety and depression between women with breast cancer (BC cohort) and women with cervical cancer (CC cohort) using insurance claims data of Taiwan.

Methods

From the 2000 to 2016 data, we identified a BC cohort and BC controls (N = 96,862) and a CC cohort and CC controls (N = 26,703), matched by propensity scores. Incident mental disorders and the Cox method estimated the related cancer cohort to control cohort hazard ratios (HRs), and 95% confidence intervals (CIs) were estimated by the end of 2016.

Results

Compared to the CC cohort, the BC cohort had slightly higher incident anxiety (15.9 versus 15.5 per 1,000 person-years) and depression (6.92 vs. 6.28 per 1,000 person-years). These mental disorders were higher in respective cancer cohorts than controls. The BC cohort to BC control adjusted HRs of anxiety and depression were 1.29 (95% CI = 1.25-1.33) and 1.78 (95% CI = 1.69-1.87), respectively. The corresponding adjusted HRs for the CC cohort were 1.12 (95% CI = 1.06-1.18) and 1.29 (95% CI = 1.18-1.41). The combined incidence rates of both disorders were 1.4-fold greater in the BC cohort than in BC controls (22.8 vs. 15.8 per 1,000 person-years), and 1.2-fold greater in the CC cohort than in the CC controls (21.7 vs. 18.3 per 1,000 person-years).

Conclusion

Women with breast cancer or cervical cancer are at an elevated likelihood of developing anxiety and depression disorders. These incident disorders are slightly higher in those with breast cancer.

Association between schizophrenia and prostate cancer risk: Results from a pool of cohort studies and Mendelian randomization analysis

BACKGROUND

Observational studies analyzing the risk of prostate cancer in schizophrenia patients have generated mixed results. We performed a meta-analysis and a Mendelian randomization (MR) analysis to evaluate the relationship and causality between schizophrenia and the risk of prostate cancer.

METHODS

A comprehensive and systematic search of cohort studies was conducted, and a random-effects model meta-analysis was performed to calculate the standardized incidence ratios (SIRs) for prostate cancer incidence among schizophrenia patients versus the general population. To investigate the correlation between genetically-predicted schizophrenia and prostate cancer risk, we used summary statistics from the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome (PRACTICAL) consortium (61,106 controls and 79,148 cases), and 75 schizophrenia-associated single nucleotide polymorphisms (SNP) from European descent as the instrumental variable.

RESULTS

In the meta-analysis of 13 cohort studies with 218,076 men involved, a decreased risk of prostate cancer was observed among schizophrenia patients [SIR 0.610; 95% confidence interval (CI) 0.500-0.740; p < 0.001] with significant heterogeneity (I² = 83.3%; p < 0.001). However, MR analysis did not sustain the link between genetically-predicted schizophrenia and prostate cancer [odds ratio (OR) 1.033; 95% CI 0.998-1.069; p = 0.065]. The result was robust against extensive sensitivity analyses.

CONCLUSIONS

Our study indicated a decreased risk of prostate cancer in schizophrenia patients through meta-analysis, while MR analysis did not support the connection between schizophrenia and prostate cancer. Due to the interaction of genetic variants between binary exposures, we need to be cautious in interpreting and presenting causal associations. Moreover, further research is needed to investigate underlying factors that might link schizophrenia to the risk of prostate cancer.

Prevalence of mental disorders in patients with cancer compared to matched controls - secondary analysis of two nationally representative surveys

AIM

To compare prevalence rates of mental disorders in patients with cancer and general population controls.

METHOD

In two stratified nationally representative surveys, the 12-month prevalence of mental disorders was assessed in 2141 patients with cancer and 4883 general population controls by the standardized Composite International Diagnostic Interview (CIDI). We determined odds ratios (ORs) to compare the odds for mental disorders (combined and subtypes) in cancer patients with age- and gender-matched controls.

RESULTS

The 12-month prevalences rate for any mental disorder was significantly higher in patients with cancer compared to controls (OR 1.28, 95% CI 1.14-1.45). Prevalence rates were at least two times higher for unipolar mood disorders (major depression: OR 2.07, 95% CI 1.71-2.51; dysthymia: OR 2.93, 95% CI 2.13-4.02) and mental disorders due to a general medical condition (OR 3.31, 95% CI 2.32-4.71). There was no significant elevation for anxiety disorders overall (OR 0.95, 95% CI 0.81-1.11). Mildly elevated prevalence rates emerged for post-traumatic stress disorder (OR 1.57, 95% CI 1.11-2.23) and social phobia (OR 1.57, 95% CI 1.07-2.31), while specific phobia (OR 0.82, 95% CI 0.67-1.00) and agoraphobia (OR 0.49, 95% CI 0.33-0.73) were significantly less frequent in cancer.

CONCLUSIONS

While elevated depression rates reinforce the need for its systematic diagnosis and treatment, lower prevalences were unexpected given previous evidence. Whether realistic illness-related fears and worries contribute to lower occurrence of anxiety disorders with excessive fears in cancer may be of interest to future research.

Survival outcomes in elderly Taiwanese women according to breast cancer subtype and lymph node status: A single-center retrospective study

This study aimed to determine the rates of overall survival and recurrence-free survival among elderly Taiwanese women (>65 years old) according to breast cancer subtype and lymph node status. We identified 554 eligible patients who were >65 years old and had been treated based on international recommendations at our center between June 2005 and June 2015. Patients with the luminal A subtype had the highest rates of overall survival (90.6%) and recurrence-free survival (97.0%), while the lowest overall survival rate was observed in those with the triple-negative subtype (81.3%) and the lowest recurrence-free survival rate was observed in those with the luminal B subtype (84.0%). Multivariate Cox proportional hazard analysis, using the luminal A subtype as the reference, revealed significant differences in recurrence-free survival among luminal B patients according to lymph node status. Among elderly Taiwanese women with breast cancer, the breast cancer subtype might help predict survival outcomes. The luminal B subtype was associated with poor recurrence-free survival, and lymph node status was useful for predicting recurrence-free survival in this subset of patients.

Prevalence of Depression and Cancer - A systematic review

Objective: While comorbidity of different forms of cancer and clinical depression is reported for many single studies, representative and global overviews are scarce. Methods: A systematic review was carried out (mainly based on Medline, Embase, Cochrane, PsychLit, and Psyndex) to identify studies in adult cancer patients from 2007 to 2019. Studies with noncancer populations and cancer survivors were excluded. Assessment methods of depression were chart-based diagnoses, interview-based and self-report questionnaires. Quality and plausibility were checked using the adapted Downs & Black checklist. Results: For all 210 included studies the prevalence rate of clinical depression varied from 7.9 % to 32.4 %, with a mean of 21.2 % depression for different (mixed) cancer entities. The different methods of assessment have led to under- (especially charts-based diagnoses) as well as overreporting for some forms of cancer. In general, the different assessment forms show an acceptable variation in prevalence. Conclusions: The risk for a cancer patient to suffer a clinical depression during the first year after diagnoses is 15 % to 20 %, meaning every fifth or sixth patients. Different cancer entities, stage of cancer and treatments as well as different cultural and medical backgrounds show only slight variation in prevalence rates.

The influence of high-efficiency particulate air filtration on mortality among multiple myeloma patients receiving autologous stem cell transplantation

Autologous stem cell transplantation (ASCT) continues to be the standard treatment for transplant-eligible multiple myeloma (MM) patients. A portion of MM patients received ASCT in an isolation room with high-efficiency particulate air (HEPA) filtration. The effectiveness of the HEPA filtration on reducing treatment-related mortality (TRM) is controversial. We enrolled patients with newly diagnosed MM in Taiwan between 2000 and 2017. The primary endpoint of the study was TRM, which was defined as death within 100 days after ASCT. A total of 961 MM patients received ASCT. Of them, 480 patients (49.9%) received ASCT in an isolation room with HEPA filtration (HEPA group). The median overall survival from ASCT was 7.52 years for the HEPA group and 5.88 years for the remaining patients (non-HEPA group) (p = 0.370). The 100-day mortality rate was 1.5% and 1.0% for the HEPA and non-HEPA groups, respectively. In the multivariate analysis, the 100-day mortality had no difference between the HEPA and non-HEPA groups (adjusted hazard ratio 1.65, 95% CI 0.52-5.23). The median cost for ASCT inpatient care was $13,777.6 and $6527.6 for the HEPA and non-HEPA groups, respectively (p < 0.001). Although half of MM patients in Taiwan received ASCT in HEPA room, it didn't affect 100-day mortality.

Psychiatric problems of anxiety and depression disorder are associated with medical service utilization and survival among patients with cervical cancer

OBJECTIVE

There are few nationwide studies regarding the long-term analysis of cervical cancer patients in Taiwan. Thus, this study aimed to evaluate medical service utilization, and survival among cervical cancer patients initially diagnosed with or without anxiety and/or depressive disorders.

MATERIALS AND METHODS

This was a retrospective longitudinal study using data from the National Health Insurance Research Database from 1996 to 2010. The study subjects were cervical cancer patients identified by ICD-9-CM codes 180.X, while subjects with anxiety and/or depressive disorders were identified using the following codes: 300.0X-300.9X (minus 300.4X) for anxiety disorder, and 296.2X, 296.3X, 300.4, and 311.X for depressive disorder. The cervical patients with anxiety or/and depression disorder were classified as anxiety/depression (AD) group or the non-disorder (ND) group. Propensity score matching (PSM) was used to adjust for differences between the AD and ND groups. T-tests were used to evaluate differences in medical utilization and the Kaplan-Meier method was used to evaluate survival conditions between the two groups. Statistical analyses were performed using SPSS Statistics 20.0.

RESULTS

A total of 3664 patients were identified, with 862 (23.5%) having anxiety, 149 (4.1%) with depression, and 349 (9.5%) having both anxiety and depression. In total, 1360 cervical cancer patients had anxiety/depression disorders. After PSM, the AD group had significantly more outpatient department (OPD) visits than the ND group (p < 0.001) but the survival status was better in the AD group than the ND group (p < 0.001).

CONCLUSIONS

Cervical cancer patients with anxiety/depression disorders visited the OPD more frequently than those without anxiety/depression disorders but had better survival status. Gynecologists should also consider cancer patients' mental status during follow-up, referring patients to psychiatric professionals for appropriate psychiatric care if appropriate.

The Double-Edged Sword of Reflective Pondering: The Role of State and Trait Reflective Pondering in Predicting Depressive Symptoms Among Women With Breast Cancer

BACKGROUND AND PURPOSE

Prior research has debated whether reflective pondering is a more constructive form of rumination than brooding, which is generally considered maladaptive. This study sought to investigate whether reflective pondering predicts depressive symptoms and whether reflective pondering is adaptive under certain conditions. We predicted that the effectiveness of reflective pondering could depend on concurrent coping strategies and the trait-state distinction.

METHOD

Women with breast cancer (N = 309; M age = 47.5) were assessed at four waves over 2 years. A time-lagged design was applied, with rumination (i.e., brooding and reflective pondering) and coping (i.e., engagement and disengagement) measured from T1 to T3, predicting depressive symptoms assessed from T2 to T4. These variables were measured by the Ruminative Response Scale, the Brief COPE, and the Hospital Anxiety and Depression Scale.

RESULTS

Using hierarchical linear modeling, brooding, but not reflective pondering, predicted elevated depressive symptoms at both between- and within-person levels. The relationship between reflective pondering and depression was moderated by the coping strategies. Individual differences in reflective pondering predicted worse depressive symptoms, but higher use of engagement coping mitigated the detrimental effect. Within individuals, the co-occurrence of reflective pondering and disengagement coping predicted a subsequent decrease in depressive symptoms.

CONCLUSIONS

The emerging role of reflective pondering in the face of breast cancer-related stress appears to be a double-edged sword. Its impact on depression may depend on concurrent coping strategies and whether reflective pondering is assessed at state and trait levels.

Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom

BACKGROUND

Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health-related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer.

METHODS AND FINDINGS

We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health-related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health-related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29-1.36; p < 0.001), depression (1.35; 1.32-1.38; p < 0.001), sexual dysfunction (1.27; 1.17-1.38; p < 0.001), and sleep disorder (1.68; 1.63-1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97-1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25-1.31; p < 0.001), pain (1.22; 1.20-1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83-1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97-1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact.

CONCLUSIONS

In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5-10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.

Mental health among nonelderly adult cancer survivors: A national estimate

BACKGROUND

This study assessed mental health (MH) outcomes across age groups in a nationally representative US sample of adult cancer survivors.

METHODS

The 2015 to 2017 National Survey on Drug Use and Health was used to identify respondents aged 18 to 64 years. The authors compared MH outcomes between respondents with a cancer history and respondents without a cancer history in adjusted analyses controlling for demographics and socioeconomic status. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. All analyses were stratified by age group (18-34, 35-49, or 50-64 years).

RESULTS

In a comparison of 2656 survivors and 112,952 individuals without cancer, within each age group, survivors had an elevated prevalence of MH problems in 5 of the 7 outcome measures. Among young adults (aged 18-34 years), survivors were more likely than noncancer counterparts to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P values <.05). These differences persisted in adjusted analyses (P values <.01). Similar survivor-comparison differences were observed among older groups but with a smaller magnitude. Among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all outcomes (P values <.05).

CONCLUSIONS

This population-based study shows an elevated prevalence of MH problems among adult cancer survivors in comparison with the general population. This finding highlights the importance of developing strategies to ensure the early detection of mental illness and to improve access to MH treatment for cancer survivors.

Psychological distress, social support, self-management ability and utilization of social resources for female patients with cancer in Oncology Outpatient Settings in Taiwan

Oncology outpatient care centers generally subjugate patients' psychosocial needs to their physical care requirements. Consequently, the patients' self-management (SM) ability and utilization of social resources are essential in regulating their psychological distress (anxiety and depression). The study aims were (1) to examine the prevalence and severity of psychological distress in female cancer patients in outpatient settings in Taiwan and (2) to identify the major factors of psychological distress. Female cancer patients were recruited from oncology outpatient settings in Taiwan. Patients completed the questionnaires of anxiety, depression, social support, and utilization of social resources, and SM ability. In total, 116 patients were included. A total of 17.2% and 21.6% of the patients were at risk of anxiety and depression, respectively. Patients' mean anxiety and depression scores were 4.2 (SD = 4.1) and 4.1 (SD = 4.0), respectively. The patients' physical function, attendance of social support groups, degree of social support, and SM ability had a significant effect on their anxiety and depression. Patients' anxiety was intensified by the presence of comorbidity. Health professionals in oncology outpatient care centers should assess the patients' physical function, comorbidity, SM ability, and social support/engagement in order to reduce their psychological distress and devise appropriate follow-up interventions.

Developing a preventive psycho-oncology for a global context. The International Psycho-Oncology Society 2018 Sutherland Award Lecture

OBJECTIVE

Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer-related psychosocial distress (CRPD). Here, a prevention-oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD.

METHODS

The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention-oriented activities in psycho-oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self-limiting and preferably self-managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence.

RESULTS

It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision-making is also required.

CONCLUSIONS

There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self-manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor-patient communication around treatment decisions is warranted.

Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review

Background

We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer.

Methods

Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias.

Results

Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status.

Conclusions

There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.

Timing and risk of mood disorders requiring psychotropics in long-term survivors of adult cancers: A nationwide cohort study

BACKGROUND

The increasing number of long-term cancer survivors over the past few decades poses the challenge of mental health care needs. However, little is known about risks of mood disorders in long-term cancer survivors.

METHODS

Long-term survivors (≥5 years) of adult cancers (LSAC) (n = 190,748) newly diagnosed between January 1, 2000 and December 31, 2007 were matched with one control. The primary outcome was diagnosis of mood disorders requiring psychotropics. Cumulative incidences and sub-hazard ratios (SHR) were calculated and multivariate analyses were conducted after accounting for mortality.

RESULTS

The mood disorder risk was significantly higher in the LSAC cohort than in the control cohort (adjusted SHR = 1.16, 95% confidence interval [CI] = 1.13-1.18, P < 0.001). Patients with certain cancer types were at increased risk, particularly in the first 2 years after diagnosis. However, patients with head and neck cancers or esophageal cancers had a higher risk after the 5-year follow-up period. Multivariate analysis indicated that being female, aged 40-59 years, with more than two primary cancers, receiving two or more treatment modalities, having CCI scores higher than 3, a higher urbanization level, and lower monthly income were independently associated with an increased risk of mood disorders.

LIMITATIONS

Some potential confounders such as lifestyle factors were not available in the study.

CONCLUSION

These findings call for increased mental health awareness not only in the early years after the cancer diagnosis, but also during long-term follow-up for certain cancer subtypes.

What characteristics are associated with earlier onset of first depressive episodes: A 16-year follow-up of a national population-based cohort

This study examined characteristics associated with earlier onset of first depressive episodes. A nationally representative Canadian sample was randomly selected and followed from 1994 to 2011. At baseline complete data on depression history (Yes/No) and related diseases was available for 12,227 study subjects. Proportional hazard models were used. Meta-analyses were also applied to sync results across studies. Being younger, a woman, a Caucasian, a regular smoker, and having a chronic disease were significantly associated with the expedited trajectory for the onset of the first depressive episode. People were at the greater risk of having earlier onset of first depressive episodes at the 2-year follow-up (p < 0.001), with the risk declining after four years (p < 0.001). Women and men had different sets of characteristics associated with earlier onset of first depressive episodes. In meta-analyses, those having a chronic disease (HR_pooled = 1.31) and being a woman (HR_pooled = 1.43) were more likely to have earlier onset of first depressive episodes. This study provides solid evidence on the timing effect of these characteristics on first depressive episodes. Approaches focused on these identified risk characteristics should be prioritized to reduce the risk and postpone the onset of major depressive episode.

Risk of mood disorders in patients with colorectal cancer

BACKGROUND

To assess the risk of mood disorders among patients with colorectal cancer (CRC), a population-based cohort study was performed using the Taiwanese National Health Insurance Research Database.

METHODS

The study cohort included 27242 patients diagnosed with CRC between January 1, 2000 and December 31, 2010. Four insurants from the general population without CRC were frequency matched to each case by age, sex, and index year/month to create the control group. Cox's proportional hazard regression model with hazard ratios (HRs) and 95% confidence intervals (CIs) was conducted to estimate the impact of CRC on the risk of mood disorders.

RESULTS

Patients with CRC exhibited a significantly higher risk of developing mood disorders (adjusted HR=3.05, 95% CI=2.89-3.20) compared with the control group. This phenomenon was also observed for each type of mood disorder (depression, bipolar disease and anxiety), as well as across different subgroups by patient characteristics. However, a follow-up time longer than 1 year was more likely to have significantly increased risks, and we unexpectedly found that some treatments in CRC patients tended to have a decreased risk of anxiety compared to their counterparts.

CONCLUSION

The findings of this population-based cohort study suggest that patients with CRC are at a higher risk of mood disorders, especially when follow-up time is longer than 1 year, but various treatments may inversely affect this association.

Depression in breast cancer patients who have undergone mastectomy: A national cohort study

Objective

The objective of this study was to compare the incidence of post-operative depression in breast cancer patients who have undergone mastectomy with the incidence of post-operative depression in non-breast cancer participants (controls).

Methods

Using data from the Korean Health Insurance Review and Assessment Service (HIRA), we selected 2,130 patients with breast cancer who have undergone mastectomy for this national cohort study and matched these patients 1:4 with 8,520 control participants according to age, sex, income, region, and pre-operative depression. The incidence of post-operative depression was measured from mastectomy year to post-op year 10. The Mann-Whitney U test was used for data analysis, and the false-discovery rate was applied to determine statistical significance (P < 0.05).

Results

The incidence of depression was higher in the breast cancer with mastectomy group than in the control group up to 3 years after mastectomy). However, there was no difference in the incidence of depression between the breast cancer with mastectomy group and the control group after post-op 4 years. The incidence of depression was higher in the breast cancer with mastectomy group than in the control group up to 2 years after mastectomy, and there was no difference in the incidence of depression between the two groups after post-op 3 years in middle-aged and older adults (≥ 40 years old). In young adults (≤ 39 years old), the incidence of depression was significantly higher in the breast cancer with mastectomy group than in the control group in mastectomy year.

Conclusion

Patients undergoing mastectomy for breast cancer experience depression more frequently than healthy people. However, patients overcome their depressive mood symptoms during the postoperative period. Young adults overcome their symptoms more quickly than middle-aged and older adults.

Association between antipsychotic drug use and cataracts in patients with bipolar disorder: A population-based, nested case-control study

BACKGROUND

No previous study has focused on the association between use of antipsychotic drugs and the development of cataracts in patients with bipolar disorder (BD); hence, we aimed to examine this association in the present study.

METHODS

We conducted a retrospective nested case-control study using data from the National Health Insurance Database of Taiwan between 2000 and 2011. A total of 3292 BD patients, 1684 with cataracts and 1608 controls matched for age, sex, and index date, were included. Antipsychotic drug exposure was categorized by type of drug and duration of use. A conditional logistic regression analysis was used to analyze the association.

RESULTS

Among BD patients, we found significantly reduced odds ratio (OR) of cataract development among past (adjusted OR (AOR), 0.74; 95% confidence interval (CI), 0.62-0.89; p=0.001) and continuous users (AOR, 0.71; 95% CI, 0.59-0.85; p<0.001) of atypical antipsychotics. No association was found between the odds of cataract development and typical antipsychotics. Besides, concomitant use of antidepressants (AOR, 1.23; 95% CI, 1.06-1.43; p=0.007) and mood stabilizers (AOR, 1.23; 95% CI, 1.06-1.42; p=0.007) were associated with increased odds of cataract development.

LIMITATIONS

Some important contributors to cataract development such as family history of cataract, smoking and alcohol exposure could not be measured from the claims data and this may confound the results.

CONCLUSIONS

Reduced odds of cataract were found in patients with BD taking atypical antipsychotics. However, given that BD patients often have risk factors for developing cataract, regular ocular evaluations are recommended for those treated with antipsychotics drugs.

Psychological prognosis after newly diagnosed chronic conditions: socio-demographic and clinical correlates

BACKGROUND

This study was aimed toward discerning depressive symptom trajectories associated with different chronic conditions and toward finding modifiable factors associated with those trajectories.

METHODS

Data were drawn from the 1996-2007 Taiwan Longitudinal Study on Aging. Nine chronic conditions were selected, and mood trajectories were measured with the Center of Epidemiological Studies-Depression scale.

RESULTS

Among the nine chronic conditions we examined, four patterns of depressive symptom trajectories were identified: (1) elevated depressive symptoms and worsened over time after diagnosed with heart disease (n = 681), arthritis (n = 850), or hypertension (n = 1,207); (2) elevated depressive symptoms without worsening over time after diagnosed with stroke (n = 160), lung diseases (n = 432), gastric conditions (n = 691), or liver diseases (n = 234); (3) no elevated depressive symptoms after diagnosis but an increase in depressive symptoms over time for participants with diabetes (n = 499); and (4) no significant patterns after diagnosed with cancer (n = 57). Cumulative psychological burden over time was significant for participants with hypertension, diabetes, heart diseases, or arthritis. However, these effects disappeared after controlling for comorbidities and physical limitations. Moreover, psychiatric condition was found to play an important role in baseline depressive symptoms among participants diagnosed with lung diseases, arthritis, or liver diseases.

CONCLUSIONS

Findings from this study provide information in addressing psychological burden at different times for different conditions. In addition, minimizing the incidence of comorbidities, physical limitations, or psychiatric conditions may have the prospective effect of avoiding the trend of increased depressive symptoms, especially when adults diagnosed with hypertension, diabetes, heart diseases, arthritis, lung diseases, arthritis, or liver diseases.

Mood State of Women with Breast Cancer and that of Their Spouses

OBJECTIVES

This work sought to determine mood levels of women subjected to treatments for breast cancer and of their spouses.

METHODS

Descriptive cross-sectional study with non-probabilistic sampling. The profile of mood states (POMS) instrument, Spanish version, was applied to a sample of 103 couples from five Colombian cities.

RESULTS

The mood level in women reported a mean of 61.4 ± 5.7 and 60.7 ± 4.9 in their spouses, without being statistically significant. Upon analyzing the score of the mood subscales, statistically significant differences were only noted in tension (higher score in spouses) and fatigue (higher score in women).

CONCLUSIONS

The emotional area was moderately affected in the study couples, which could be consequential of late effects of the treatments for breast cancer. Nursing must develop care actions that promote the emotional wellbeing of women with breast cancer and include participation from the spouses.

Association between depressive disorders and risk of breast cancer recurrence after curative surgery

The aim of the study was to investigate the association between depressive disorders and risk of tumor recurrence in patients with breast cancer after curative surgery.A nationwide cohort study between January 2001 and December 2007 was conducted. Data were taken from the Taiwan National Health Insurance Research Database. Among 30,659 newly diagnosed breast cancer patients, we identified 1147 breast cancer patients with depressive disorders and 2294 matched breast cancer patients without depressive disorders, both of whom received curative breast surgery between January 2003 and December 2007.The risk of first tumor recurrence was compared between patients who developed depressive disorders after breast surgery (depressive disorder cohort, n = 1147) and matched patients who did not develop depressive disorders (matched nondepressive disorder cohort, n = 2294). Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality.The depressive disorder cohort had a higher rate of recurrence when compared with the matched nondepressive disorder cohort (17.1% vs 12.5%; P < .001). The Kaplan-Meier analysis revealed a predisposition of patients with depressive disorders to suffer from recurrence (log-rank test, P < .001). After multivariate adjustment, the HR for subsequent recurrence among the depressive disorder cohort was 1.373 (95% confidence interval 1.098-1.716, P = 0.005). Moreover, the depressive disorder cohort had higher risk of overall mortality even though not significant after adjusted (adjusted HR 1.271, 95% confidence interval 0.930-1.737, P = 0.132).Depressive disorder was associated with a higher risk of breast cancer recurrence among patients after curative breast surgery.

Use of atypical antipsychotics and risks of cataract development in patients with schizophrenia: A population-based, nested case-control study

OBJECTIVE

Previous research has suggested a link between typical antipsychotic use and the development of cataracts, but the association between atypical antipsychotics and cataracts remains unclear in schizophrenia (SZ).

METHODS

A retrospective nested case-control study was conducted using data from the National Health Insurance Database of Taiwan between the year of 2000 and 2011. A total of 2144 SZ patients with cataracts and 2222 controls matched for age, sex, and index date were included. Antipsychotic exposure was categorized by type and duration, and the association between antipsychotic exposure and cataract development was assessed using a conditional logistic regression analysis.

RESULTS

We found that the severity of physical comorbidities, concurrent antidepressant use, and comorbidity with glaucoma or other retinal disorders were associated with an increased risk for cataract development. Alternatively, we did not find significant associations between continuous use of clozapine, risperidone, paliperidone, ziprasidone, olanzapine, quetiapine, amisulpride, zotepine or aripiprazole and risk of cataract development in SZ patients.

CONCLUSIONS

We did not detect any association between atypical antipsychotic use and risk of cataract development in SZ patients. Future studies with longitudinal ocular evaluations in patients using atypical antipsychotics are warranted to confirm our findings.

A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients

BACKGROUND

Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics.

METHODS

PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted.

RESULTS

Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI = 4.3-12.5), more common in female (22.6%; 95% CI = 16.0-31.0) or breast cancer patients (22.6%; 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens.

CONCLUSIONS

There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.

Risk of depressive disorders in women undergoing hysterectomy: A population-based follow-up study

OBJECTIVE

The objective of this study was to assess the risk of depressive disorders in women who underwent hysterectomy in Taiwan.

METHODS

A retrospective study was conducted in a matched cohort of cases using the National Health Insurance Research Database of Taiwan. Database records from 1689 women who underwent hysterectomy between 2001 and 2005 were included in this study. A control group matched for age and physical comorbidity was selected from the same database (n = 6752). For all cases, medical records were tracked until the end of 2009 to identify whether a depressive disorder was diagnosed during the follow-up period. The hazard ratio (HR) for depression during the observation period was analyzed using multivariable Cox proportional-hazards models, adjusted for age, physical comorbidities, and other socioeconomic factors.

RESULTS

The HR for depression was 1.78 times higher for the group that underwent hysterectomy than for the control group (adjusted HR = 1.78; 95% CI = 1.46-2.18, p < 0.001). In addition, HR for major depressive disorder in women who underwent hysterectomy was significantly higher (1.84 times) than for the control group (adjusted HR = 1.84; 95% CI = 1.23-2.74, p < 0.01).

CONCLUSIONS

Our study revealed that, in Taiwan, women who underwent hysterectomy had an increased risk of developing depression. Longitudinal studies to follow-up the psychological outcomes in Taiwanese women who underwent hysterectomy will be necessary to confirm our findings.

Adjuvant treatments of breast cancer increase the risk of depressive disorders: A population-based study

BACKGROUND

Previous studies have posited conflicting results regarding depressive disorders among breast cancer survivors who received adjuvant therapies including chemotherapy, radiotherapy, selective estrogen receptor modulator (e.g. tamoxifen), third-generation aromatase inhibitors (AIs; e.g. anastrozole, letrozole or exemestane), and monoclonal antibody (e.g. trastuzumab). We therefore performed a population-based study with a defined breast cancer cohort to investigate the risk of depressive disorders in breast cancer patients who received adjuvant therapies.

METHODS

We conducted a retrospective study of a breast cancer cohort of 36,586 participants who were selected from the National Health Insurance Research Database(NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidences of newly onset depressive disorders. Kaplan-Meier and Cox regression analyses were used to identify the risk factors associated with depressive disorders in breast cancer patients who underwent adjuvant therapies

RESULTS

Of the total 36,586 patients, 1342 (3.7%) were ascertained with depressive disorders. The Cox multivariate proportional hazards analysis showed that age of 40-59 (adjusted hazard ratio (aHR) 1.327, 95% CI 1.123-1.567, p=0.001), chemotherapy (aHR 1.555, 95% CI 1.387-1.743, p<0.001), radiotherapy (aHR 1.385 95% CI 1.220-1.571, p<0.001), tamoxifen (aHR 1.458, 95% CI 1.110-1.914, p=0.007), AIs (aHR 1.360, 95% CI 1.193-1.550, p<0.001), and trastuzumab (aHR 1.458, 95% CI 1.110-1.914, p=0.007) were independent risk factors for developing depressive disorders.

LIMITATIONS

The dosage effect of adjuvant treatments, cancer staging, genetic or environmental confounders associated with the risk of depressive disorders were not comprehensively evaluated.

CONCLUSION

Developing depressive disorders are at higher risk in breast cancer survivors aged 40-59 who received adjuvant treatments including chemotherapy, radiotherapy, tamoxifen, AIs or trastuzumab. Psychological evaluation and support are necessarily needed in breast cancer survivors who received adjuvant therapies.

First manic episode in a patient with breast cancer

Mental disorders occur in as much as 50% of patients with cancer, impairing the oncologic prognosis and quality of life. The diagnostic investigation and treatment planning of this comorbidity impose a clinical challenge once complications related to the neoplasm, such as brain metastasis and paraneoplastic syndromes, must be excluded. In addition, psychotropic medications may interfere with oncologic treatment. We report the case of a 39-year-old female patient who presented with a first episode of psychotic mania after having been recently diagnosed with breast cancer. Also, we present a literature review of this comorbidity and point out a possible pathophysiological link between the two diseases.

Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

BACKGROUND

Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.

METHODS

We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.

FINDINGS

Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses.

INTERPRETATION

Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.

FUNDING

None.