Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis

Abstract

Purpose: Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival.

Methods: In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival.

Results: Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association.

Conclusion: Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.

Fig 1.

CONSORT diagram.

Fig 2.

Kaplan-Meier survival curve for increasing (solid gold line) versus decreasing (dashed blue line) Center for Epidemiologic Studies–Depression Scale (CES-D) symptoms during the initial intervention year in a randomized trial of supportive-expressive group therapy. Breast cancer was the cause of death for 94.4% of the patients.