Risk of depressive symptoms before and after the first hospitalisation for cancer: Evidence from a 16-year cohort study in the Czech Republic

Research progress on the psychological burden and intervention measures in cancer patients

In the past 40 years, the gradually increasing incidence and mortality rates of malignant tumors have severely impacted the quality of life of patients, bringing significant physical and psychological burdens and becoming an increasingly serious social issue. With the development of medical standards, new methods for cancer detection and treatment have been continuously proposed. Although it has been proven that cancer is related to increased psychological burden and suicidal behaviors in patients, current research on the psychological burden caused by cancer is insufficient. Clinicians often overlook the psychological health issues of patients while treating their physical diseases. Considering the high incidence of cancer, this review will outline the psychological burdens of cancer patients worldwide in recent years and its high-risk factors. Moreover, this review will summarize the common methods for evaluating psychological burdens, present current predictive models and treatment methods for the psychological burden of cancer patients, aiming to provide a research basis and future direction for the timely and accurate assessment of the psychological burden in cancer patients.

Factors associated with depressive symptoms among cancer patients: a nationwide cross-sectional study

OBJECTIVE

Research on factors contributing to depressive symptoms in cancer patients at a national level, encompassing a comprehensive set of variables was limited. This study aimed to address this gap by identifying the factors associated with depressive symptoms among cancer patients through a nationwide cross-sectional analysis.

METHODS

Various factors, including demographic, socioeconomic, behavioral patterns, general and self-rated health status, chronic conditions, dietary habits, and cancer-related factors, were examined. Data was from the National Health and Nutrition Examination Survey. Univariate and multivariate logistic regression analyses were performed to identify associated factors. The receiver-operating characteristic (ROC) curve was used to evaluate the performance of the logistic model.

RESULTS

The findings showed that five sociodemographic factors, two behavioral styles, self-rated health status, comorbid arthritis, two dietary factors and two cancer-related factors were strongly associated with depressive symptoms. Compared with those aged 20-39 years, cancer individuals aged 40-59 years (OR = 0.48, P < 0.05) and those 60 years or older (OR = 0.18, P < 0.05) had lower odds of depression. Positive factors included being never married (OR = 1.98, P < 0.05), widowed, divorced or separated (OR = 1.75, P < 0.05), unemployment (OR = 1.87, P < 0.05), current smoking (OR = 1.84, P < 0.05), inadequate sleep (OR = 1.96, P < 0.05), comorbid arthritis (OR = 1.79, P < 0.05), and poor self-rated health status (OR = 3.53, P < 0.05). No significant association was identified between the Healthy Eating Index 2015 and the Dietary Inflammatory Index with depression (P > 0.05). Shorter cancer diagnosis duration was associated with reduced odds of depression (P < 0.05). The logistic model had an area under the curve of 0.870 (95% CI: 0.846-0.894, P < 0.05).

CONCLUSIONS

Cancer patients should receive enhanced family and social support while cultivating a healthy lifestyle and diet. Incorporating plenty of fruits, greens, and beans is highly recommended, along with establishing a comprehensive health management framework.

Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study

Objective

This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort.

Methods

A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality.

Results

The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11-4.44) and women (HR = 3.69; 95% CI = 1.69-8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46-3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10-6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76-4.90) only in the male population.

Conclusion

C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.

Mental health, functional impairment, and barriers to mental health access among cancer patients in Vietnam

OBJECTIVE

This study evaluated the prevalence and severity of depression and anxiety symptomatology, barriers to mental health access, and correlates of functional impairment among cancer inpatients.

METHODS

This cross-sectional study recruited adult cancer patients (N = 300) in June and July 2022 at the largest oncological hospital in Vietnam. Multivariable linear regression analyses examined the association between demographics, clinical characteristics, and patients' functional impairment.

RESULTS

Approximately 46.3% and 27.0% showed some depression and anxiety symptomatology, while 8.0% and 3.0% experienced major depressive and anxiety symptoms, respectively. Patients reported the most impairment in mobility and capacity for life activities. More functional impairment was identified in patients with gastrointestinal cancers, those receiving radiation therapy alone, and those scoring higher on depression and anxiety than in those with cancers originating in the head, neck, or lung or those receiving chemotherapy alone. Reports of better overall health status were negatively associated with functional impairment. Patients reported extensive perceived barriers to seeking psychiatric care, including not knowing where to get mental health support (86.7%), wanting to manage mental health independently (73.7%), and thinking mental health will resolve on its own (73.7%), and denying mental health concerns (61.0%).

CONCLUSION

High frequency and severity of depression and anxiety symptomatology underscore the importance of integrating mental health services into existing oncological treatment protocols. Increasing mental health literacy and provision of psychoeducation is critical to addressing barriers to mental health service access. Integration of functional impairment evaluations into hospital admission and discharge planning is also needed.

Is depression the missing link between inflammatory mediators and cancer?

Patients with cancer are at greater risk of developing depression in comparison to the general population and this is associated with serious adverse effects, such as poorer quality of life, worse prognosis and higher mortality. Although the relationship between depression and cancer is now well established, a common underlying pathophysiological mechanism between the two conditions is yet to be elucidated. Existing theories of depression, based on monoamine neurotransmitter system dysfunction, are insufficient as explanations of the disorder. Recent advances have implicated neuroinflammatory mechanisms in the etiology of depression and it has been demonstrated that inflammation at a peripheral level may be mirrored centrally in astrocytes and microglia serving to promote chronic levels of inflammation in the brain. Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely. Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowledged as being the hallmark of depression. It also results in neurotoxic effects on brain regions thought to be involved in the evolution of major depression. Proinflammatory mediators also play a crucial role in impairing regulatory glucocorticoid mediated feedback of the hypothalamic-pituitary-adrenal axis, which is activated by stress and considered to be involved in both depression and cancer. The third route is via the glutamatergic pathway, whereby glutamate excitotoxicity may lead to depression associated with cancer. A better understanding of the mechanisms underlying these dysregulated and other newly emerging pathways may provide a rationale for therapeutic targeting, serving to improve the care of cancer patients.

Factors associated with and risk factors for depression in cancer patients - A systematic literature review

Objective

The prevalence of depression in oncological patients is 3, 4-fold compared to the general population. However, the specific risk factors for these prevalence rates are not fully understood.

Methods

A systematic literature review was conducted in nine electronic databases between 2005 and 2020. The quality of the eligible studies was appraised by two persons using the adapted 11-items Downs and Black checklist.

Results

Among 2010 potentially relevant articles, 40 studies were eligible, with 27 studies of high quality and 13 studies of moderate quality. A total of 156 factors associated with depression were identified which were clustered into somatic, psychological, social and sociodemographic factors. Pre-existing depression and personality factors were the most consistent associated factors with depression in cancer patients, while for most somatic and treatment-related factors only modest associations were found.

Conclusions

Grouped as bio-psycho-social associated factors, somatic factors showed a modest influence, whereas social relationship (support) and previous depression are unequivocally significantly associated with depression.

Investigation of anxiety and depressive disorders and psychiatric medication use before and after cancer diagnosis

OBJECTIVE

Data regarding the prevalence of depression and anxiety among cancer patients, especially before cancer diagnosis, remains scarce. This study investigated the prevalence of these conditions and associated drug use among cancer patients pre- and post-diagnosis.

METHODS

This population-based cohort study using data from Taiwan's National Health Insurance Research Database recruited patients with a registered cancer diagnosis and matched control between January 1, 2000, and December 31, 2011. We compared the prevalence of anxiety and depressive disorders between cancer patients and non-cancer participants during a 2-year period both pre- and post-diagnosis by Pearson's chi-square test. Psychiatric medication use was also examined for the associated mental condition.

RESULTS

We examined participants diagnosed with liver (N = 17,154), colorectal (N = 30,391), breast (N = 40,036), gynecological (N = 23,218), and lung (N = 15,671) cancer. Before the cancer diagnosis, the prevalence of depression was higher in non-cancer participants than in gynecological cancer patients (p = 0.018) but anxiety is higher in liver, colorectal, and lung cancer patients when compared to non-cancer participants (p < 0.05). After the cancer diagnosis, the prevalence of anxiety and depression became significantly higher in all enrolled cancer patients than non-cancer participants (p < 0.05). Similar results were observed in psychiatric medication use trends.

CONCLUSIONS

This study proposed that patients with liver, colorectal, and lung cancer had an increased risk of developing anxiety, which might be a sentinel diagnosis. The participants had a significantly higher level of anxiety and depressive disorder post-diagnosis, which highlights the importance of the care for both mental and physical conditions in cancer management.

Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model

PURPOSE

Depression and anxiety are now considered as common adverse reactions to cancer. Prior research has shown that social support and functional coping strategies alleviate depressive and anxious symptoms of cancer patients but the exact relationship between social support and coping strategies in amelioration of the symptoms is yet to be elaborated.

METHODS

The current study examined the relationship between social support, coping strategies and depressive-anxious symptomatology and explored the possible role of coping strategies in mediating the relationship between social support, depression and anxiety in Iranian breast cancer patients (N = 221). Anxiety and depressive symptoms were measured using the Depression-Anxiety-Stress (DASS-21) scale, social support was measured using the Medical Outcome Survey, Social Support Scale (MOSS-SSS), and coping strategies were measured using the brief COPE.

RESULTS

All of the social support subscales were negatively correlated with depression and anxiety. Most of the coping strategies were negatively correlated with depressive-anxious symptoms. When controlling for covariates, mediation analysis revealed that active coping, positive reframing and acceptance partially mediated the association of social support of different types with depression. Positive reframing also partially mediated the relationship of the total social support and positive social interactions with anxiety.

CONCLUSIONS

High levels of social support may relieve depressive and anxious symptoms of breast cancer patients through functional coping. The management of breast cancer patients should also focus on providing patients with social support and educating them on the practice of functional coping strategies.