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Depression as a predictor of disease progression and mortality in cancer patients†
Article first published online: 14 SEP 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 22, pages 5349–5361, 15 November 2009
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
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.
- Issue published online: 3 NOV 2009
- Article first published online: 14 SEP 2009
- Manuscript Accepted: 21 APR 2009
- Manuscript Revised: 16 MAR 2009
- Manuscript Received: 7 NOV 2008
- Michael Smith Foundation for Health Research
- New Investigator Team grant, Canadian Institutes for Health Research. Grant Number: #AQC83559
- psychosocial oncology
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.
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.
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.
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.