Charles S. Carver

Antoni, M. H., Jacobs, J. M., Bouchard, L. C., Lechner, S. C., Jutagir, D. J., Gudenkauf, L. M., Blomberg, B. B., Glück, S., Carver, C. S. (2017). Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up. General Hospital Psychiatry, 44, 16-21.

Background: Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up.

Methods: From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10 weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up.

Results: A total of 95women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M = 13.56 years; SE = 0.26) than those in the mild/moderate depressed group (M = 11.45 years; SE=0.40), Log-rank ?2(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n= 191). Depression category did not predict disease-free survival in the overall or invasive sample.

Conclusions: Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.

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