Depression Negatively Affects Treatment, Survival of Patients With Breast Cancer

In this video, Bin Huang, DrPH, discusses his team's study, which used data from the Kentucky Cancer Registry to assess the influence of depression on breast cancer treatment and survival, what he found surprising about his team's study results, whether the results of his study are generalizable to the United States population at-large, and more.

Additional Resource:

• Lei F, Vanderpool RC, McLouth LE, et al. Influence of depression on breast cancer treatment and survival: A Kentucky population-based study. Cancer. 2023;10.1002/cncr.34676. doi:10.1002/cncr.34676

For more major depression disorder content, visit the resource center.

Bin Huang, DrPH is an associate professor of Biostatistics at the University of Kentucky (Lexington, Kentucky). 

TRANSCRIPTION:

Consultant360: Why were you interested in developing this study?

Bin Huang, DrPH: We were always interested in depression, especially how depression impacts patients from the Appalachian region. That's, how we started this study. And then we picked breast cancer because we had more and more patients with breast cancer who were surviving, who also likely experience depressive conditions.

C360: How does this study fill a current gap in our knowledge?

Dr Huang: Thanks for asking this question. The impact of depression on receiving guideline recommended treatment of survival has been examined before. Most of those studies were based on either clinic- or hospital-based data. This is the first population-based study to examine the effect of depression, both before and after cancer diagnosis on receiving guideline recommended treatment and survival in patients with cancer. We also looked at patients from Appalachian Kentucky as well as the underserved population with extremely high cancer burden.

So the study results showed that pre-cancer depression could potentially lead to lower chance of receiving guideline-recommended treatment and having depression is associated with reduced survival. More importantly, this study results suggested that if depression is well-managed, patients with depression were comparable with patients without depression in terms of survival. This highlights the importance of depression management among breast cancer patient.

C360: Can you tell us a little more about this patient population?

Dr Huang: Yes. This patient population consists of all female patients with breast cancer who resided in Kentucky at the time of cancer diagnosis. And also all those cases were linked with health claims data. So it's health claims data linked with Kentucky Cancer registry data.

C360: Considering the study’s patient population, are these results generalizable to a broader population?

Dr Huang: Potentially. But it's, as you know, the Kentucky population is relatively rural in the population, so that the results could vary in the other populations. And also more importantly, while the focus of the Kentucky population is Appalachian Kentucky, which is an underserved population, and the results of the study could have an implication for other underserved populations as well.

C360: What gaps in our knowledge still remain and what kinds of studies are needed still to fill those gaps?

Dr Huang: Yes, and there are several, some of those are limitations of the study, which you certainly would want to do more and to find out. For example, this is one study focused on patients with breast cancer in Kentucky, certainly more studies are needed to examine different types of cancer or other populations. Just as the question you ask, if this can be implied to other populations, certainly we need to do more that, and also especially for minority and underserved populations, we should do more of research on those populations as well. And in our study, we did not examine the severity of the depression condition. The study was specifically treatment related to depression management. So we need an in-depth study in this area needed to provide a better understanding of depression management among cancer patients.

C360: What findings stood out from the results of your study?

Dr Huang: It's really interesting, when we just started, initially in the study, we defined depression into three periods. Before depression, before cancer diagnosis only, and the depression after cancer diagnosis only, what we call the persistent depression. The depression diagnosis was found before and after cancer diagnosis. Initially, we saw the depression found both before and after cancer diagnosis, probably had the highest impact in survival and also the recipient of the guideline recommended treatment. But that's not the case. Very surprisingly, we found that, what we call the persistent depression patient, actually they did not have worse survival compared to those patients without depression.

And so we think more, we realized that because under diagnosis, under management among depression among cancer patients is very common. So a patient who has consistent depression in our study is actually an indicator of the patient who likely will have their depression managed. That's why we did not find a significant difference in survival between those with persistent depression and those without depression.

C360: And what would you say is the overall take home message from your study?

Dr Huang: I think the main takeaway message from the study is that depression had an adverse impact on breast cancer survival and accessibility to mental health service. The management of depression in cancer care is critical in improving survival of patients with cancer.

C360: What specialists are impacted by this study beyond mental health care providers?

Dr Huang: I think this question is a little bit beyond this scope of this study, but however, I think depression is a health condition that requires long-term management and a collaborative approach among oncologists, mental health providers, and the primary care providers who may provide a comprehensive and effective care in management of depression, which may ultimately affect patients' long-term survival.