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Depression as a predictor of disease progression and mortality in cancer patients†

A Meta-Analysis

  1. Jillian R. Satin MA‡,*,
  2. Wolfgang Linden PhD,
  3. Melanie J. Phillips BSc

Article first published online: 14 SEP 2009

DOI: 10.1002/cncr.24561

Issue

Cancer

Cancer

Volume 115, Issue 22, pages 5349–5361, 15 November 2009

Additional Information

How to Cite

Satin, J. R., Linden, W. and Phillips, M. J. (2009), Depression as a predictor of disease progression and mortality in cancer patients. Cancer, 115: 5349–5361. doi: 10.1002/cncr.24561

Author Information

  1. Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada

  1. ‡

    Fax: (604) 822-6923

*Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4 Canada

  1. †

    We thank Paul Ruescher and Alena Talbot Ellis for their help with data collection. We extend our appreciation to Drs Gregory Miller, Liisa Galea, Carolyn Gotay, and Andrea Vodermaier for reviewing earlier drafts of this manuscript.

  2. ‡

    Fax: (604) 822-6923

Publication History

  1. Issue published online: 3 NOV 2009
  2. Article first published online: 14 SEP 2009
  3. Manuscript Accepted: 21 APR 2009
  4. Manuscript Revised: 16 MAR 2009
  5. Manuscript Received: 7 NOV 2008

Funded by

  • Michael Smith Foundation for Health Research
  • New Investigator Team grant, Canadian Institutes for Health Research. Grant Number: #AQC83559

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Keywords:

  • cancer;
  • depression;
  • mortality;
  • recurrence;
  • meta-analysis;
  • psychosocial oncology

Abstract

BACKGROUND:

Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta-analysis assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients.

METHODS:

Using the MEDLINE, PsycINFO, CINAHL, and EMBASE online databases, the authors identified prospective studies that examined the association between depressive symptoms or major/minor depression and risk of disease progression or mortality in cancer patients. Two raters independently extracted effect sizes using a random effects model.

RESULTS:

Based on 3 available studies, depressive symptoms were not shown to significantly predict cancer progression (risk ratio [RR] unadjusted = 1.23; 95% confidence interval [CI], 0.85-1.77; P = .28). Based on data from 25 independent studies, mortality rates were up to 25% higher in patients experiencing depressive symptoms (RR unadjusted = 1.25; 95% CI, 1.12-1.40; P < .001), and up to 39% higher in patients diagnosed with major or minor depression (RR unadjusted = 1.39; 95% CI, 1.10-1.89; P = .03). In support of a causal interpretation of results, there was no evidence that adjusting for known clinical prognostic factors diminished the effect of depression on mortality in cancer patients.

CONCLUSIONS:

This meta-analysis presented reasonable evidence that depression predicts mortality, but not progression, in cancer patients. The associated risk was statistically significant but relatively small. The effect of depression remains after adjustment for clinical prognosticators, suggesting that depression may play a causal role. Recommendations were made for future research to more clearly examine the effect of depression on cancer outcomes. Cancer 2009. © 2009 American Cancer Society.

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