Depression Can Shorten Lives

Kidney cancer patient depression linked to shorter survival

(RxWiki News) Being diagnosed with any advanced cancer is not happy news. So becoming depressed might be a natural response, but it's not a life-prolonging one.

How long someone with advanced kidney cancer lives can be influenced both by depression and its effect on biology. 

Stated more simply, depression can shorten an advanced kidney cancer patient's life.

"Never hesitate to ask for help."

Researchers at The University of Texas MD Anderson Cancer Center uncovered the role of depressive symptoms in people newly diagnosed with metastatic (has spread) kidney cancer.

“Our findings, and those of others, suggest that mental health and social well-being can affect biological processes, which influence cancer-related outcomes,” said Lorenzo Cohen, PhD, professor in MD Anderson’s Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program.

dailyRx spoke to Shelli R. Kesler, PhD assistant professor of psychiatry at Stanford University School of Medicine and Director of the Neuropsychology and Neurorehab Lab. She said similar studies had shown an association between depression and breast cancer survival. 

Dr. Cohen and his team examined 217 MD Anderson patients newly diagnosed with metastatic renal cell carcinoma between April, 2000 and November, 2005.

Participants completed various surveys which measured symptoms of depression, overall quality of life, social support, coping skills, religion and spirituality.

They also provided blood samples at the beginning of the study and five saliva samples a day for three days.

The saliva samples measured the patterns of cortisol, the stress hormone. Cortisol levels are ideally highest in the morning and decrease throughout the day. Elevated cortisol is linked with depression.

About a quarter (23 percent) of patients reported clinical depression symptoms. These individuals, along with those whose cortisol levels remained unchanged throughout the day, didn't live as long as the individuals who were not depressed.

The researchers wanted to find out if this event was associated with genes that regulate inflammation. The team conducted a whole-gene profile of tissue samples from 15 of the most depressed patients, and 15 of the least depressed individuals.

Anil Sood, MD, professor in MD Anderson’s Department of Gynecologic Oncology and a co-author on the study. “Our goal was to determine if these pathways were expressed at greater levels in patients with depressive symptoms and we found data indicating they were.”

What's happening, the scientists believe, is that the inflammatory response and the cortisol levels in depressed patients are disrupted, which in turn impacts lifespan.

Dr. Cohen said,“Our findings indicate that we’re now able to understand some of the possible biological pathways that explain the association between depression and survival.”

Mental health screenings should be given even to folks with advanced disease, so the team can help "manage distress," according to Dr. Cohen.

Dr. Kesler, who was not involved in this study, told dailyRx, "This study by MD Anderson helps further this area of research by providing more evidence that inflammatory pathways are an important potential target for intervening in these symptoms."

The authors noted the limitations of the study which include not totally understanding the nature, cause and history of patient stress. The study didn't take into account other factors affecting depressive symptoms.

More study is needed in the form of clinical trials to learn if behavioral therapy or medications could effectively treat depression and thereby extend life.

This study was published August 1 in PLoS ONE.

The research was supported by the Dana Foundation, the Mary and David Wolff Family Foundation, the National Institutes of Health and the MD Anderson Cancer Center Support Grant.

No conflicts of interest were reported. 

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Review Date: 
August 7, 2012