Bouchard, L. C., Antoni, M. H., Blomberg, B. B., Stagl, J. M., Gudenkauf, L. M., Jutagir, D. R., Diaz, A, Lechner, S., Glück, S., Derhagopian, R. P., & Carver, C. S. (2016). Post-surgical depressive symptoms and pro-inflammatory cytokine elevations in women undergoing primary treatment for breast cancer. Psychosomatic Medicine, 78, 26-37.

Objective: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and cancer patients. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early stage BCa before beginning adjuvant treatment. Method: Women with stage 0-III BCa were recruited approximately 4-8 weeks post-surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression and blood samples were collected to quantify circulating levels of IL-1?, IL-6, and TNF-? by ELISA. ANCOVAs were used to test for group differences (elevated vs. low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results: Thirty-six of 89 (40%) patients showed elevated levels of depressive symptoms, and in adjusted models had marginally higher levels of IL-1? (M=14.49, 95% CI [6.11, 32.65] vs. M=4.68, 95% CI [1.96, 9.86]) and significantly higher levels of TNF-? (M=17.07, 95% CI [8.27, 34.32] vs. M=6.94, 95% CI [3.58, 12.80]) than women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1? (?=0.06, p=0.006, R2=0.25) and TNF-? (?=0.06, p=0.003, R2=0.27). Conclusions: Post-surgery and pre-adjuvant treatment for early stage BCa, depressive symptoms covary with elevated levels of multiple pro-inflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.

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