From the Stanford University School of Medicine, Stanford, CA; University of Calgary; Tom Baker Cancer Centre, Calgary; Cross Cancer Institute; and University of Alberta, Edmonton, Alberta, Canada.

Corresponding author: Janine Giese-Davis, PhD, Alberta Health Services Cancer Care–Holy Cross Site, Department of Psychosocial Resources, 2202 2nd St SW, Calgary, Alberta, Canada, T2S 3C1; e-mail: jgieseda@ucalgary.ca.

Presented at the 159th Annual Meeting of the American Psychiatric Association, May 20-25, 2006, Toronto, Ontario, Canada; Department of Oncology Grand Rounds, April 18, 2007, Calgary, Alberta, Canada; and Department of Psychiatry Grand Rounds, April 11, 2007, Tucson, AZ.

Abstract

Purpose Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival.

Methods In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies–Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival.

Results Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association.

Conclusion Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.

Footnotes

Supported by National Institute of Mental Health Grant No. 5R01MH047226, with additional funding from the National Cancer Institute (RO1CA118567 and PO1AG018784), the National Institute on Aging (PO1AG018784), the American Cancer Society (Grant No. PF-4185), The John D. and Catherine T. MacArthur Foundation, and the Fetzer Institute.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
Clinical trial information can be found for the following: NCT00226928.

Received February 3, 2010.
Accepted September 28, 2010.

Articles citing this article

Mind Matters in Cancer Survival JAMA Feb 2, 2011:502

Cancer , 2008

BACKGROUND. The question of whether stress poses a risk for cancer progression
has been difficult to answer. A randomized clinical trial tested the hypothesis
that cancer patients coping with their recent diagnosis but receiving a psychologic
intervention would have improved survival compared with patients who
were only assessed.
METHODS. A total of 227 patients who were surgically treated for regional breast
cancer participated. Before beginning adjuvant cancer therapies, patients were
assessed with psychologic and behavioral measures and had a health evaluation,
and a 60-mL blood sample was drawn. Patients were randomized to Psychologic
Intervention plus assessment or Assessment only study arms. The intervention
was psychologist led; conducted in small groups; and included strategies to
reduce stress, improve mood, alter health behaviors, and maintain adherence to
cancer treatment and care. Earlier articles demonstrated that, compared with the
Assessment arm, the Intervention arm improved across all of the latter secondary
outcomes. Immunity was also enhanced.
RESULTS. After a median of 11 years of follow-up, disease recurrence was
reported to occur in 62 of 212 (29%) women and death was reported for 54 of
227 (24%) women. Using Cox proportional hazards analysis, multivariate comparison
of survival was conducted. As predicted, patients in the Intervention arm
were found to have a reduced risk of breast cancer recurrence (hazards ratio
[HR] of 0.55; P 5.034) and death from breast cancer (HR of 0.44; P 5.016) compared
with patients in the Assessment only arm. Follow-up analyses also demonstrated
that Intervention patients had a reduced risk of death from all causes (HR
of 0.51; P 5.028).
CONCLUSIONS. Psychologic interventions as delivered and studied here can
improve survival. Cancer 2008;113:3450–8. 2008 American Cancer Society.
KEYWORDS: breast, cancer, recurrence, survival, psychologic, intervention, biobehavioral.

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