Patients diagnosed with early-stage lung cancer who are also diagnosed with depression have an increased risk of mortality, according to a prospective, observational study published in the Journal of Clinical Oncology.
Donald R. Sullivan, MA, of the division of pulmonary and critical care medicine at the Oregon Health & Science University, and colleagues analyzed 1,790 patients from five geographic areas of the United States who were enrolled in the Cancer Care Outcomes Research and Surveillance Consortium. Patients were evaluated for depression within 3 months of a lung cancer diagnosis and again 12 months later.
Thirty-eight percent (681) of patients had depression symptoms at diagnosis. Compared to patients with no history of depression, patients with early-stage disease who had depression symptoms at baseline had an increased risk of mortality (hazard ratio [HR], 1.61; P < .001). There was no increased mortality risk seen in depressed study participants diagnosed with late-stage disease (HR, 1.05; P = .47). A prior psychiatric history was not associated with increased mortality (P = .25).
The median estimated survival was 797 days and 604 days in the no depression and depression groups, respectively—about 6.5 months longer among patient without depression.
According to prior studies, patients with lung cancer are particularly vulnerable to symptoms of depression. As many as 44% of patients experience some form of depression, according to estimates.
“Importantly, remission of depression symptoms at follow-up was associated with comparable mortality as never having had depression symptoms,” wrote the study authors.
At the 12-month follow-up, 62% (254) of patients continued to experience depression while an additional 14% (105) were newly diagnosed with depression symptoms.
At the 12-month follow-up, the researchers found an increased risk of mortality in patients who both continued to have depression (adjusted HR, 1.42; P = .001) and those newly diagnosed with depression (adjusted HR, 1.50; P = .006) compared with those who were never depressed. Depression symptoms at follow-up increased mortality of both those with early-stage and late-stage disease (P < .001 and P = .025, respectively). The difference in median survival between those with and without depression symptoms at follow-up was 130 days.
“These results provide further evidence that depression symptoms are associated with increased mortality and that longitudinal changes are significant,” the study authors concluded. “Research is needed to explore depression treatment delivery and determine whether treatment can actually improve survival.”
Fifty-seven percent of the participants were older than 65 years of age, 72% were white, 45% were female, and 29% were current tobacco users. Forty-seven percent of patients were diagnosed with stage I or stage II lung cancer.