Predictors of depression in breast cancer patients treated with radiation: Role of prior chemotherapy and nuclear factor kappa B
Article first published online: 19 MAR 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 11, pages 1951–1959, 1 June 2013
How to Cite
Torres, M. A., Pace, T. W., Liu, T., Felger, J. C., Mister, D., Doho, G. H., Kohn, J. N., Barsevick, A. M., Long, Q. and Miller, A. H. (2013), Predictors of depression in breast cancer patients treated with radiation: Role of prior chemotherapy and nuclear factor kappa B. Cancer, 119: 1951–1959. doi: 10.1002/cncr.28003
- Issue published online: 20 MAY 2013
- Article first published online: 19 MAR 2013
- Manuscript Accepted: 22 JAN 2013
- Manuscript Revised: 11 JAN 2013
- Manuscript Received: 13 NOV 2012
- breast cancer;
- nuclear factor kappa B
Depression is common during and after breast cancer treatment. However, the role of specific therapeutic modalities and related biologic mechanisms remains unclear. Radiation is an essential component of breast-conserving therapy and may contribute to depression in patients with breast cancer through the activation of inflammatory pathways.
Depressive symptoms and inflammatory mediators, including nuclear factor kappa B (NF-κB), were assessed at baseline (before radiation), during radiation, and 6 weeks after radiation in 64 women who had stage 0 through IIIA breast cancer.
No significant increases in depressive symptoms occurred during or after radiation, although a number of patients exhibited moderate-to-severe depression throughout the study. Multivariate analyses of baseline factors predictive of depression revealed that educational status, perceived stress, prior chemotherapy, and peripheral blood NF-κB DNA binding all were independent predictors of persistent depressive symptoms after radiation (all P < .05). Of these factors, only prior chemotherapy was associated with inflammatory mediators, including NF-κB DNA binding, soluble tumor necrosis factor-alpha receptor 2, and interleukin-6, which, in univariate analyses predicted depressive symptoms after radiation (all P < .05). Chemotherapy-treated patients also exhibited an over-representation of gene transcripts regulated by NF-κB.
Radiation was not associated with increased depressive symptoms in the current study, but of disease and treatment-related factors, prior chemotherapy predicted significant depression after radiation. Longitudinal studies are warranted to investigate the relationship among prior chemotherapy, inflammation, and persistent depression after breast cancer treatment. Cancer 2013;119:1951–1959. © 2013 American Cancer Society.